Comparative Pharmacology
Head-to-head clinical analysis: AVALIDE versus CANDESARTAN CILEXETIL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: AVALIDE versus CANDESARTAN CILEXETIL.
AVALIDE vs CANDESARTAN CILEXETIL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Avalide is a combination of an angiotensin II receptor blocker (irbesartan) and a thiazide diuretic (hydrochlorothiazide). Irbesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively antagonizing the AT1 receptor. Hydrochlorothiazide increases sodium and water excretion by inhibiting the Na+/Cl- symporter in the distal convoluted tubule.
Candesartan cilexetil is a prodrug that is hydrolyzed to candesartan, an angiotensin II receptor blocker (ARB) that selectively and competitively binds to the angiotensin II type 1 (AT1) receptor, blocking the vasoconstrictor and aldosterone-secreting effects of angiotensin II. This results in decreased peripheral resistance and blood pressure.
AVALIDE (irbesartan/hydrochlorothiazide) is available as tablets containing 150/12.5 mg, 300/12.5 mg, or 300/25 mg. The typical starting dose is 150/12.5 mg once daily, titrated to 300/12.5 mg once daily as needed. Maximum dose is 300/25 mg once daily.
Oral, 8 mg once daily initially, titrate to 16-32 mg once daily as tolerated; maximum 32 mg/day.
None Documented
None Documented
Clinical Note
moderateCandesartan cilexetil + Torasemide
"The risk or severity of hypotension can be increased when Candesartan cilexetil is combined with Torasemide."
Clinical Note
moderateCandesartan cilexetil + Etacrynic acid
"The risk or severity of hypotension can be increased when Candesartan cilexetil is combined with Etacrynic acid."
Clinical Note
moderateCandesartan cilexetil + Furosemide
"The risk or severity of hypotension can be increased when Candesartan cilexetil is combined with Furosemide."
Clinical Note
moderateIrbesartan: 11-15 h (terminal), HCTZ: 6-15 h (terminal). Clinical context: Steady state reached in 3-5 days; allows once-daily dosing.
The terminal elimination half-life is approximately 9 hours. In clinical practice, this supports once-daily dosing, with steady state achieved within 3–4 days.
Renal: HCTZ ~70% unchanged; Irbesartan ~20% unchanged, remainder as metabolites via biliary (60%) and renal (20%). Combined: Renal ~50%, biliary/fecal ~50%.
Candesartan is eliminated primarily via the kidneys (approximately 60% of recovered dose) and the feces (approximately 40%) following biliary excretion. Less than 1% is excreted unchanged in urine.
Category C
Category D/X
ARB and Thiazide Diuretic Combination
ARB
Candesartan cilexetil + Bumetanide
"The risk or severity of hypotension can be increased when Candesartan cilexetil is combined with Bumetanide."