Canrenone Explained

Canrenone, sold under the brand names Contaren, Luvion, Phanurane, and Spiroletan, is a steroidal antimineralocorticoid[1] [2] of the spirolactone group related to spironolactone which is used as a diuretic in Europe, including in Italy and Belgium.[3] [4] [5] [6] It is also an important active metabolite of spironolactone, and partially accounts for its therapeutic effects.

Medical uses

Canrenone has been found to be effective in the treatment of hirsutism in women.[7]

Heart failure

Two studies of canrenone in people with heart failure have shown a mortality benefit compared to placebo. In the evaluation which studied people with chronic heart failure (CHF), people that were treated with canrenone displayed a lower number of deaths compared to the placebo group, indicating a death and morbidity benefit of the medication.

One study compared 166 treated with canrenone to 336 given conventional therapy lasting 10 years. Differences in systolic and diastolic blood pressure was observed between both patient groups where, patients treated with canrenone, showed a lower blood pressure compared to conventional therapy. Uric acid was lower in the group treated with canrenone; however, no differences were seen in potassium, sodium, and brain natriuretic peptide (BNP) levels. Left ventricular mass was also lower in the group treated with canrenone and a greater progression of NYHA class was observed in the control group compared to patients treated with canrenone.[8]

Another study concluded that treatment with canrenone in patients with chronic heart failure improves diastolic function and further decreased BNP levels.[9]

Pharmacology

Pharmacodynamics

Canrenone is reportedly more potent as an antimineralocorticoid relative to spironolactone, but is considerably less potent and effective as an antiandrogen.[10] [11] Similarly to spironolactone, canrenone inhibits steroidogenic enzymes such as 11β-hydroxylase, cholesterol side-chain cleavage enzyme, 17α-hydroxylase, 17,20-lyase, and 21-hydroxylase, but once again, is comparatively less potent in doing so.[12]

Pharmacokinetics

The elimination half-life of canrenone is about 16.5 hours.

As a metabolite

Canrenone is an active metabolite of spironolactone, canrenoic acid, and potassium canrenoate, and is considered to be partially responsible for their effects.[13] It has been found to have approximately 10 to 25% of the potassium-sparing diuretic effect of spironolactone,[14] whereas another metabolite, 7α-thiomethylspironolactone (7α-TMS), accounts for around 80% of the potassium-sparing effect of the drug.[15] [16] [17]

History

Canrenone was described and characterized in 1959. It was introduced for medical use, in the form of potassium canrenoate (the potassium salt of canrenoic acid), by 1968.[18]

Society and culture

Generic names

Canrenone is the and of the drug.

Brand names

Canrenone has been marketed under the brand names Contaren, Luvion, Phanurane, and Spiroletan, among others.

Availability

Canrenone appears to remain available only in Italy, although potassium canrenoate remains marketed in various other countries as well.[19] [20]

See also

Notes and References

  1. Losert W, Casals-Stenzel J, Buse M . Progestogens with antimineralocorticoid activity . Arzneimittel-Forschung . 35 . 2 . 459–471 . 1985 . 4039568 .
  2. Fernandez MD, Carter GD, Palmer TN . The interaction of canrenone with oestrogen and progesterone receptors in human uterine cytosol . British Journal of Clinical Pharmacology . 15 . 1 . 95–101 . January 1983 . 6849751 . 1427833 . 10.1111/j.1365-2125.1983.tb01470.x .
  3. Book: Elks J . The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. 14 November 2014. Springer. 978-1-4757-2085-3. 210–.
  4. Book: Hill R, Makin H, Kirk D, Murphy G . Dictionary of Steroids . 23 May 1991 . CRC Press . 978-0-412-27060-4 . 656–.
  5. Romanelli RG, Gentilini P . Cross reactivity due to positive canrenone interference . Gut . 53 . 5 . 772–773 . May 2004 . 15082604 . 1774040 .
  6. Book: Index Nominum 2000: International Drug Directory. January 2000. Taylor & Francis. 978-3-88763-075-1. 167–.
  7. Sobbrio GA, Granata A, Panacea A, Trimarchi F . Effectiveness of short term canrenone treatment in idiopathic hirsutism . Minerva Endocrinologica . 14 . 2 . 105–108 . 1989 . 2761494 .
  8. Derosa G, Maffioli P, Scelsi L, Bestetti A, Vanasia M, Cicero AF, Spinardi L, Bentivenga C, Esposti DD, Caprio M, Borghi C, Pitt B, Cosentino E . 6 . Canrenone on cardiovascular mortality in congestive heart failure: CanrenOne eFFects on cardiovascular mortality in patiEnts with congEstIve hearT failure: The COFFEE-IT study . Pharmacological Research . 141 . 46–52 . March 2019 . 30502530 . 10.1016/j.phrs.2018.11.037 . 54564252 .
  9. de Simone G, Chinali M, Mureddu GF, Cacciatore G, Lucci D, Latini R, Masson S, Vanasia M, Maggioni AP, Boccanelli A . 6 . Effect of canrenone on left ventricular mechanics in patients with mild systolic heart failure and metabolic syndrome: the AREA-in-CHF study . English . Nutrition, Metabolism, and Cardiovascular Diseases . 21 . 10 . 783–791 . October 2011 . 21939839 . 10.1016/j.numecd.2010.02.012 .
  10. Book: Coelingh Benni H, Vemer H . Chronic Hyperandrogenic Anovulation . 15 December 1990 . CRC Press . 978-1-85070-322-8 . 152–.
  11. Book: Seldin DW, Giebisch GH . Diuretic Agents: Clinical Physiology and Pharmacology . 23 September 1997 . Academic Press . 978-0-08-053046-8 . 630–.
  12. Colby HD . Chemical suppression of steroidogenesis . Environmental Health Perspectives . 38 . 119–127 . April 1981 . 6786868 . 1568425 . 10.1289/ehp.8138119 .
  13. Book: Clark MA, Harvey RA, Finkel R, Rey JA, Whalen K . Pharmacology . 15 December 2011 . Lippincott Williams & Wilkins . 978-1-4511-1314-3 . 286–.
  14. Book: Angeli P, Gatta A . Medical Treatment of Ascites in Cirrhosis . Ginés P, Arroyo V, Rodés J, Schrier RW . Ascites and Renal Dysfunction in Liver Disease: Pathogenesis, Diagnosis, and Treatment. https://books.google.com/books?id=Z3PARx4oYDgC&pg=PR6. 15 April 2008. John Wiley & Sons. 978-1-4051-4370-7. 229.
  15. Maron BA, Leopold JA . Mineralocorticoid receptor antagonists and endothelial function . Current Opinion in Investigational Drugs . 9 . 9 . 963–969 . September 2008 . 18729003 . 2967484 .
  16. Book: International Agency for Research on Cancer. World Health Organization. Some Thyrotropic Agents. 2001. World Health Organization. 978-92-832-1279-9. 325–.
  17. Agusti G, Bourgeois S, Cartiser N, Fessi H, Le Borgne M, Lomberget T . A safe and practical method for the preparation of 7α-thioether and thioester derivatives of spironolactone . Steroids . 78 . 1 . 102–107 . January 2013 . 23063964 . 10.1016/j.steroids.2012.09.005 . 8992318 .
  18. Book: William Andrew Publishing. Pharmaceutical Manufacturing Encyclopedia, 3rd Edition. 22 October 2013. Elsevier. 978-0-8155-1856-3. 804–.
  19. Web site: List of Aldosterone receptor antagonists . Drugs.com .
  20. Web site: Potassium Uses, Side Effects & Interactions . Drugs.com .

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