Azilsartan Explained

Verifiedfields:changed
Watchedfields:changed
Verifiedrevid:456077928
Tradename:Edarbi, Azilva
Dailymedid:Azilsartan
Routes Of Administration:By mouth
Atc Prefix:C09
Atc Suffix:CA09
Legal Ca:Rx-only
Legal Ca Comment:[1]
Legal Uk:POM
Legal Us:Rx-only
Legal Eu:Rx-only
Legal Status:Rx-only
Bioavailability:60%
Metabolism:CYP2C9
Elimination Half-Life:11 hrs
Excretion:55% feces, 42% urine
Index2 Label:as medoxomil
Cas Number:147403-03-0
Cas Number2:863031-21-4
Pubchem:135415867
Pubchem2:135409642
Iuphar Ligand:6901
Drugbank2:DB08822
Chemspiderid:8001032
Chemspiderid2:9413866
Unii:F9NUX55P23
Unii2:LL0G25K7I2
Kegg:D08864
Kegg2:D08067
Chebi:68850
Chebi2:68845
Chembl:57242
Chembl2:2028661
Synonyms:TAK-536, TAK-491
Iupac Name:2-Ethoxy-1--1H-benzimidazole-7-carboxylic acid
C:25
H:20
N:4
O:5
Smiles:CCOC1=NC2=CC=CC(=C2N1CC3=CC=C(C=C3)C4=CC=CC=C4C5=NOC(=O)N5)C(=O)O
Stdinchi:InChI=1S/C25H20N4O5/c1-2-33-24-26-20-9-5-8-19(23(30)31)21(20)29(24)14-15-10-12-16(13-11-15)17-6-3-4-7-18(17)22-27-25(32)34-28-22/h3-13H,2,14H2,1H3,(H,30,31)(H,27,28,32)
Stdinchikey:KGSXMPPBFPAXLY-UHFFFAOYSA-N
Stdinchi2:1S/C30H24N4O8 /c1-3-38-28-31-23-10-6-9-22(27(35)39-16-24-17(2)40-30(37)41-24)25(23)34(28)15-18-11-13-19(14-12-18)20-7-4-5-8-21(20)26-32-29(36)42-33-26/h4-14H,3,15-16H2,1-2H3,(H,32,33,36)
Stdinchikey2:QJFSABGVXDWMIW-UHFFFAOYSA-N

Azilsartan, sold under the brand name Edarbi among others, is used for the treatment of hypertension.[2] [3] [4] It is used as the prodrug azilsartan medoxomil, is an angiotensin II receptor antagonist,[5] and was developed by Takeda.

The most common adverse reaction in adults is diarrhea.

It is available as a generic medication.[6] It is also sold as a combination drug with chlortalidone under the brand name Edarbyclor.[7]

Medical uses

Azilsartan is used for the treatment of hypertension in adults. One of the benefits of the medication is that Azilsartan does not need dose adjustments for patients with renal or hepatic dysfunction.

Contraindications

Azilsartan must not be used with aliskiren, a renin inhibitor, in patients with diabetes as this increases the risk of serious adverse effects. Like other antihypertensive drugs acting on the renin–angiotensin system, it is contraindicated during the second and third trimesters of pregnancy.[8] It should not be used during pregnancy.[9]

Interactions

No relevant drug interactions have been found in studies. Based on experiences with other drugs acting on the renin–angiotensin system, it is theorized that azilsartan could increase the toxicity of lithium and of other drugs increasing potassium levels, such as potassium sparing diuretics.

Pharmacology

Mechanism of action

See main article: Angiotensin II receptor antagonist. Azilsartan medoxomil lowers blood pressure by blocking the action of angiotensin II at the AT1 receptor, a hormone that contracts blood vessels and reduces water excretion through the kidneys.

Pharmacokinetics

Azilsartan medoxomil is quickly absorbed from the gut, independently of food intake. Maximal blood plasma concentrations are reached after one to three hours. The liver enzyme CYP2C9 is involved in the formation of the two main metabolites, which are pharmacologically inactive; they are the O-deethylation and decarboxylation products of azilsartan. Elimination half life is about 11 hours. 55% are excreted via the feces, and 42% via the urine, of which 15% are present as azilsartan and the rest in form of the metabolites.[10]

Chemistry

The drug formulation contains the potassium salt of azilsartan medoxomil (codenamed TAK-491), an ester of azilsartan's carboxyl group with the alcohol (5-methyl-2-oxo-1,3-dioxol-4-yl)methanol. This ester is more lipophilic than azilsartan itself.

History

In February 2011, the U.S. Food and Drug Administration (FDA) approved azilsartan medoxomil for the treatment of high blood pressure in adults.[11] [12] In July 2011, azilsartan medoxomil was approved in the European Union for the treatment of essential hypertension. In March 2012, Health Canada approved the drug for mild to moderate essential hypertension.[13]

In December 2014, Valeant Canada acquired the marketing rights to Edarbi and Edarbyclor from Takeda Pharmaceutical.[14]

Notes and References

  1. Web site: Product monograph brand safety updates . Health Canada . February 2024 . 24 March 2024.
  2. Web site: Edarbi- azilsartan kamedoxomil tablet . DailyMed . 26 July 2019 . 9 March 2020.
  3. Book: Hardin MD, Jacobs TF . Azilsartan . July 2021 . StatPearls [Internet] . Treasure Island (FL) . StatPearls Publishing . 30860708 .
  4. Pradhan A, Tiwari A, Sethi R . Azilsartan: Current Evidence and Perspectives in Management of Hypertension . International Journal of Hypertension . 2019 . 1824621 . 2019 . 31885897 . 6925743 . 10.1155/2019/1824621 . free .
  5. Web site: Edarbi EPAR . European Medicines Agency (EMA) . 18 May 2018 . 9 March 2020.
  6. Web site: 2022 First Generic Drug Approvals . U.S. Food and Drug Administration (FDA) . 3 March 2023 . https://web.archive.org/web/20230630003602/https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/2022-first-generic-drug-approvals . 30 June 2023 . live . 30 June 2023.
  7. Web site: Drug Approval Package:Edarbyclor (azilsartan medoxomil and chlorthalidone) NDA #202331 . U.S. Food and Drug Administration (FDA) . 16 August 2012 . 11 March 2020.
  8. Book: Austria-Codex. Edarbi-Tabletten. Haberfeld H . Österreichischer Apothekerverlag. Vienna. 2015. de.
  9. Web site: Azilsartan medoxomil (Edarbi) Use During Pregnancy . Drugs.com . 28 February 2020 . 9 March 2020.
  10. Book: Arzneistoff-Profile. Dinnendahl V, Fricke U . Govi Pharmazeutischer Verlag. Eschborn, Germany. 2012. 26. 2. 978-3-7741-9846-3. de.
  11. Web site: Drug Approval Package: Edarbi (azilsartan medoxomil) NDA 200796 . U.S. Food and Drug Administration (FDA) . 4 April 2011 . 9 March 2020.
  12. FDA approves Edarbi to treat high blood pressure . U.S. Food and Drug Administration . 25 February 2011 . 1 March 2011 . https://web.archive.org/web/20170118091135/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm244722.htm . 18 January 2017 . dead .
  13. Web site: Summary Basis of Decision - Edarbi - Health Canada . . 26 June 2012 . Government of Canada . 6 March 2021.
  14. Valeant Canada acquires rights to Edarbi and Edarbyclor for the Canadian market . Valeant Canada . Cision . 17 December 2014 . 9 March 2020.