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The First Russian Fixed Combination of Indapamide Retard and Candesartan: Results of Two Pharmacokinetic and Bioequivalence Studies

https://doi.org/10.18087/cardio.2025.12.n3093

Abstract

Aim    To study the pharmacokinetics and prove the bioequivalence of Hyposart I (indapamide 1.5 mg + candesartan 16 mg) modified-release film-coated tablets (OOO AKRIKHIN, Russia) compared to the concomitant drugs Arifon® retard (indapamide) prolonged-release film-coated tablets, 1.5 mg (Servier Laboratories, France) + Atacand® (candesartan) tablets, 16 mg (AstraZeneca AB, Sweden).
Material and methods    Two two-period crossover-design bioequivalence studies were conducted. In Study 1, healthy volunteers (n=72) took the drugs once either fasted or after a meal, and in Study 2 (n=24), they took them multiple times in a fasting condition. The dosing interval was 7 days. Analyte concentrations in samples were measured by a validated analytical method of high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS). Pharmacokinetic parameters were determined for both drugs in Study 1 and for indapamide only in Study 2.
Results     The 90% confidence intervals for the ratios of all Ln-transformed pharmacokinetic parameters (Cmax and AUC0-t of candesartan and indapamide in Study 1; Cmax, ss, AUC(0-τ) ss and Cτ, ss of indapamide in Study 2) were in the range of 80-125%.
Conclusion    The study has proved the bioequivalence of Hyposart I (AO AKRIKHIN) to the reference concomitant drugs Atacand® (AstraZeneca AB, Sweden) and Arifon® retard (Servier Laboratories, France).

 

About the Authors

Zh. D. Kobalava
Patrice Lumumba Peoples’ Friendship University of Russia
Russian Federation

Corresponding Member of the Russian Academy of Sciences, MD, PhD, Professor, Head of the Department of Internal Diseases with a course of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Medical Institute, People`s Friendship University of Russia named after Patrice Lumumba (RUDN University).

Moscow, Russia



A. Yu. Moiseeva
Patrice Lumumba Peoples’ Friendship University of Russia
Russian Federation
PhD, Assistant of the Department of Internal Diseases with a course of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Medical Institute, People`s Friendship University of Russia named after Patrice Lumumba (RUDN University).Moscow, Russia 


S. M. Noskov
Yaroslavl State Medical University
Russian Federation

Professor, Doctor of Medical Sciences, Head of the Department of Hospital Therapy Yaroslavl State Medical University.

Yaroslavl,  Russia



I. E. Shohin
OOO Center of Pharmaceutical Analytics
Russian Federation
Doctor of Pharmaceutical Sciences, General Director, Limited Liability Company "Center of Pharmaceutical Analytics" (LLC "CPHA")Moscow, Russia


K. S. Manko
AO AKRIKHIN, Moscow Region
Russian Federation
MD, PhD, Medical Director, AKRIKHIN JSCOld Kupavna, Russia


E. V. Timoshina
AO AKRIKHIN, Moscow Region
Russian Federation
MD, Senior Medical Advisor, AKRIKHIN JSCOld Kupavna, Russia


References

1. World Health Organization. Global report on hypertension 2025: high stakes: turning evidence into action. [Internet] Available at: https://www.who.int/publications/i/item/9789240115569

2. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Journal of Hypertension. 2023;41(12):1874–2071. DOI: 10.1097/HJH.0000000000003480

3. Boytsov S.A., Balanova Yu.A., Shal’nova S.A., Deev A.D., Artamonova G.V., Gatagonova T.M. et al. Arterial hypertension among persons aged 25-64: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4–14. DOI: 10.15829/1728-8800-2014-4-4-14

4. Franklin SS, Lopez VA, Wong ND, Mitchell GF, Larson MG, Vasan RS et al. Single Versus Combined Blood Pressure Components and Risk for Cardiovascular Disease: The Framingham Heart Study. Circulation. 2009;119(2):243–50. DOI: 10.1161/CIRCULATIONAHA.108.797936

5. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal. 2024;45(38):3912–4018. DOI: 10.1093/eurheartj/ehae178

6. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I. et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):230– 329. DOI: 10.15829/1560-4071-2024-6117

7. Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressurelowering treatment in hypertension: 9. Discontinuations for adverse events attributed to different classes of antihypertensive drugs meta-analyses of randomized trials. Journal of Hypertension. 2016;34(10):1921–32. DOI: 10.1097/HJH.0000000000001052

8. Ostroumova O.D., Kochetkov A.I., Pavleeva E.E., Guseva T.F. Modern ideas about the choice of fixed combinations of antihypertensive drugs: focus on effectiveness and prognosis. Medical Business. 2018;2:39–48. DOI: 10.24411/2071-5315-2018-12001

9. Banic A, Benkovic V, Knezevic A. Effectiveness of Hypertension Therapy by Using Fixed Combinations and Monocomponent Drugs – A Prospective Study from Croatia. Journal of Pharmacy and Pharmacology. 2018;6(4):333–9. DOI: 10.17265/2328-2150/2018.03.004

10. Karpov Yu.A., Ruda M.M., Adyrhaev Z.A., Astashkin E.I., Baybulatova E.A., Beketova T.V. et al. Rational pharmacotherapy of heart and vascular diseases. - M.: Litterra; 2024. - 720p. ISBN 978-5-4235-0397-0

11. Matsuzaki M, Ogihara T, Umemoto S, Rakugi H, Matsuoka H, Shimada K et al. Prevention of cardiovascular events with calcium channel blocker-based combination therapies in patients with hypertension: a randomized controlled trial. Journal of Hypertension. 2011;29(8):1649–59. DOI: 10.1097/HJH.0b013e328348345d

12. MacDonald TM, Williams B, Webb DJ, Morant S, Caulfield M, Cruickshank JK et al. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial. Journal of the American Heart Association. 2017;6(11):e006986. DOI: 10.1161/JAHA.117.006986

13. Egan BM, Bandyopadhyay D, Shaftman SR, Wagner CS, Zhao Y, Yu-Isenberg KS. Initial Monotherapy and Combination Therapy and Hypertension Control the First Year. Hypertension. 2012;59(6):1124–31. DOI: 10.1161/HYPERTENSIONAHA.112.194167

14. Corrao G, Parodi A, Zambon A, Heiman F, Filippi A, Cricelli C et al. Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice. Journal of Hypertension. 2010;28(7):1584–90. DOI: 10.1097/ HJH.0b013e328339f9fa

15. Garjón J, Saiz LC, Azparren A, Elizondo JJ, Gaminde I, Ariz MJ et al. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database of Systematic Reviews. 2017;1(1):CD010316. DOI: 10.1002/14651858.CD010316.pub2

16. Borisevich I.V., Zhuravleva M.V., Movsesyants A.A., Nedogoda S.V., Prokofiev A.B., Romanov B.K. et al. Guidelines for the examination of medicines. V. 1. - M.: Grif and K; 2014. - 328p. ISBN 978-5-8125-1858-5

17. Decision No. 85 of the Council of the Eurasian Economic Commission dated November 3, 2016, «On Approval of the Rules for Conducting Bioequivalence Studies of Medicinal Products within the Eurasian Economic Union». Av. at: https://www.alta.ru/tamdoc/16sr0085/?ysclid=mj3x10ymdj116236915.

18. Meredith PA. Angiotensin II Receptor Antagonists Alone and Combined with Hydrochlorothiazide: Potential Benefits Beyond the Antihypertensive Effect. American Journal of Cardiovascular Drugs. 2005;5(3):171–83. DOI: 10.2165/00129784-200505030-00004

19. Zhang Z, Yang H, Guo H. Comparative efficacy and safety of six angiotensin II receptor blockers in hypertensive patients: a network meta-analysis. International Journal of Clinical Pharmacy. 2024;46(5):1034–43. DOI: 10.1007/s11096-024-01755-5

20. Waeber B, Rotaru C, Feihl F. Position of indapamide, a diuretic with vasorelaxant activities, in antihypertensive therapy. Expert Opinion on Pharmacotherapy. 2012;13(10):1515–26. DOI: 10.1517/14656566.2012.698611

21. Ogihara T, Fujimoto A, Nakao K, Saruta T. ARB candesartan and CCB amlodipine in hypertensive patients: the CASE-J trial. Expert Review of Cardiovascular Therapy. 2008;6(9):1195–201. DOI: 10.1586/14779072.6.9.1195

22. Escobar C, Barrios V, Calderón A, Barrios S, Echarri R, Navarro‐Cid J et al. Electrocardiographic Left Ventricular Hypertrophy Regression Induced by an Angiotensin Receptor Blocker‐Based Regimen in Hypertensive Patients With the Metabolic Syndrome: Data From the SARA Study. The Journal of Clinical Hypertension. 2008;10(3):208–14. DOI: 10.1111/j.1751-7176.2008.07596.x

23. Gosse P, Sheridan DJ, Zannad F, Dubourg O, Guéret P, Karpov Y et al. Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE study. Journal of Hypertension. 2000;18(10):1465–75. DOI: 10.1097/00004872-200018100-00015

24. Papademetriou V, Farsang C, Elmfeldt D, Hofman A, Lithell H, Olofsson B et al. Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE). Journal of the American College of Cardiology. 2004;44(6):1175–80. DOI: 10.1016/j.jacc.2004.06.034

25. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358(9287):1033–41. DOI: 10.1016/S0140-6736(01)06178-5

26. Chalmers J, Mourad J-J, Brzozowska-Villatte R, De Champvallins M, Mancia G. Benefit of treatment based on indapamide mostly combined with perindopril on mortality and cardiovascular outcomes: a pooled analysis of four trials. Journal of Hypertension. 2023;41(3):508–15. DOI: 10.1097/HJH.0000000000003368

27. Philipp T, Martinez F, Geiger H, Moulin B, Mourad G, Schmieder R et al. Candesartan improves blood pressure control and reduces proteinuria in renal transplant recipients: results from SECRET. Nephrology Dialysis Transplantation. 2010;25(3):967–76. DOI: 10.1093/ndt/gfp581

28. Marre M, Puig JG, Kokot F, Fernandez M, Jermendy G, Opie L et al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: The NESTOR* study. Journal of Hypertension. 2004;22(8):1613–22. DOI: 10.1097/01.hjh.0000133733.32125.09

29. Sjølie AK, Klein R, Porta M, Orchard T, Fuller J, Parving HH et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. The Lancet. 2008;372(9647):1385–93. DOI: 10.1016/S0140-6736(08)61411-7

30. London G, Schmieder R, Calvo C, Asmar R. Indapamide SR Versus Candesartan and Amlodipine in Hypertension: The X-CELLENT Study. American Journal of Hypertension. 2006;19(1):113–21. DOI: 10.1016/j.amjhyper.2005.06.027

31. Musini VM, Nazer M, Bassett K, Wright JM. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database of Systematic Reviews. 2014;5:1–185. DOI: 10.1002/14651858.CD003824.pub2

32. Chazova I.E., Mychka V.B. Diuretics in patients with metabolic disturbances. Cardiovascular Therapy and Prevention. 2007;6(2):28–33.

33. Patel A. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. The Lancet. 2007;370(9590):829–40. DOI: 10.1016/S0140-6736(07)61303-8

34. Codreanu M, Iacob D, Onofrei MI, Vlase A-M, Muntean DM, Vlase L. Food-effect study on the pharmacokinetics of indapamide prolongedrelease tablets. Acta Marisiensis - Seria Medica. 2024;70(4):238–45. DOI: 10.2478/amma-2024-0032

35. Schiavi P, Jochemsen R, Guez D. Pharmacokinetics of sustained and immediate release formulations of indapamide after single and repeated oral administration in healthy volunteers. Fundamental & Clinical Pharmacology. 2000;14(2):139–46. DOI: 10.1111/j.1472-8206.2000.tb00402.x

36. Gleiter CH, Morike KE. Clinical Pharmacokinetics of Candesartan. Cli nical Pharmacokinetics. 2002;41(1):7–17. DOI: 10.2165/00003088-200241010-00002

37. Cernes R, Mashavi M, Zimlichman R. Differential clinical profile of candesartan compared to other angiotensin receptor blockers. Vascular Health and Risk Management. 2011;7:749–59. DOI: 10.2147/VHRM.S22591

38. Han M, He Y, Liang J, Yao F, Lu P, Yan H et al. Pharmacokinetics and bioequivalence study of candesartan cilexetil tablet in Chinese volunteers under fasting condition: an open-label, randomized-sequence, 2-period crossover study. Translational and Clinical Pharmacology. 2024;32(2):107–14. DOI: 10.12793/tcp.2024.32.e10

39. van Lier JJ, van Heiningen PN, Sunzel M. Absorption, metabolism and excretion of 14C-candesartan and 14C-candesartan cilexetil in healthy volunteers. Journal of Human Hypertension. 1997;11(Suppl 2):S27-28. PMID: 9331001

40. State Register of Medicines. Instructions for use of the medicinal product for medical use Arifon® retard (Indapamide). Av. at: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=f471bdd1-bfb14547-a8fb-c7984d225936.


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For citations:


Kobalava Zh.D., Moiseeva A.Yu., Noskov S.M., Shohin I.E., Manko K.S., Timoshina E.V. The First Russian Fixed Combination of Indapamide Retard and Candesartan: Results of Two Pharmacokinetic and Bioequivalence Studies. Kardiologiia. 2025;65(12):39-50. (In Russ.) https://doi.org/10.18087/cardio.2025.12.n3093

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