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Candesartan

pharmaceutical raw materials
Candesartan structure

Candesartan 

structure
  • CAS No:

    139481-59-7

  • Formula:

    C24H20N6O3

  • Chemical Name:

    Candesartan

  • Synonyms:

    1H-Benzimidazole-7-carboxylic acid,2-ethoxy-1-[[2′-(2H-tetrazol-5-yl)[1,1′-biphenyl]-4-yl]methyl]-;1H-Benzimidazole-7-carboxylic acid,2-ethoxy-1-[[2′-(1H-tetrazol-5-yl)[1,1′-biphenyl]-4-yl]methyl]-;2-Ethoxy-1-[[2′-(2H-tetrazol-5-yl)[1,1′-biphenyl]-4-yl]methyl]-1H-benzimidazole-7-carboxylic acid;CV 11974;Candesartan;Candesartan M1;2-Ethoxy-1-[[2′-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]-1H-benzimidazole-7-carboxylic acid;2-Ethoxy-1-[[2′-(1H-tetrazol-5-yl)-1,1′-biphenyl-4-yl]methyl]-7-benzimidazolecarboxylic acid;2-Ethoxy-1-[[2′-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]benzimidazole-7-carboxylic acid;3-[[2′-(1H-Tetrazol-5-yl)biphenyl-4-yl]methyl]-2-ethoxy-3H-benzimidazole-4-carboxylic acid;1-((2′-(1H-Tetrazol-5-yl)-[1,1′-biphenyl]-4-yl)methyl)-2-ethoxy-1H-benzo[d]imidazole-7-carboxylic acid;2-Ethoxy-1-([4-[2-(1H-1,2,3,4-tetrazol-5-yl)phenyl]phenyl]methyl)-1H-1,3-benzodiazole-7-carboxylic acid;875515-04-1

  • Categories:

    Pharmaceutical Intermediates  >  Cardiovascular Agents

Description

Crystalline SolidChEBI: A benzimidazolecarboxylic acid that is 1H-benzimidazole-7-carboxylic acid substituted by an ethoxy group at position 2 and a ({2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl}methyl) group at position 1. It is a angiotensin eceptor antagonist used for the treatment of hypertension.Candesartan, (+)-1-[[(cyclohexyloxy)carbonyl]-oxy]ethyl 2- ethoxy-1-[[2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl]methyl]-1H-benzimidazole-7-carboxylate(Atacand), like losartan, possesses the acidic


Solid


Candesartan is a benzimidazolecarboxylic acid that is 1H-benzimidazole-7-carboxylic acid substituted by an ethoxy group at position 2 and a ({2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl}methyl) group at position 1. It is a angiotensin receptor antagonist used for the treatment of hypertension. It has a role as an antihypertensive agent, an angiotensin receptor antagonist, an environmental contaminant and a xenobiotic. It is a benzimidazolecarboxylic acid and a biphenylyltetrazole. It is a conjugate acid of a candesartan(2-).|Candesartan is an angiotensin-receptor blocker (ARB) that may be used alone or with other agents to treat hypertension. It is available as a prodrug in the form of [candesartan cilexetil].|Candesartan is an Angiotensin 2 Receptor Blocker. The mechanism of action of candesartan is as an Angiotensin 2 Receptor Antagonist.|Candesartan is an angiotensin II receptor blocker used widely in the therapy of hypertension and heart failure. Candesartan is associated with a low rate of transient serum aminotransferase elevations and has been linked to rare instances of acute liver injury.|Candesartan is a synthetic, benzimidazole-derived angiotensin II receptor antagonist prodrug with antihypertensive activity. Candesartan selectively competes with angiotensin II for the binding of the angiotensin II receptor subtype 1 (AT1) in vascular smooth muscle, blocking angiotensin II-mediated vasoconstriction and inducing vasodilatation. In addition, antagonism of AT1 in the adrenal gland inhibits angiotensin II-stimulated aldosterone synthesis and secretion by the adrenal cortex; sodium and water excretion increase, followed by a reduction in plasma volume and blood pressure.

Candesartan Basic Attributes

440.45

440.45

1806241-263-5

S8Q36MD2XX

759858

DTXSID0022725

C65284

Colorless crystals from ethyl acetate + methanol

C - Cardiovascular system

29419000

Characteristics

119

4.1

Solid

1.41±0.1 g/cm3(Predicted)

183-185 °C

754.8±70.0 °C(Predicted)

410.3±35.7 °C

1.719

soluble in ethyl acetate, methanol, water (<1 mg/ml at 25°C), DMSO (88 mg/ml at 25°C), and ethanol (1 mg/ml at 25°C).

-20°C Freezer

1.8X10-18 mm Hg at 25 deg C (est)

Henry's Law constant = 8.7X10-19 atm-cu m/mol at 25 °C (est)

pKa1 = 2.45 (carboxylic acid); pKa2 = 6.70 (N-heterocyclic) (est)

Colorless crystals from ethanol + water, mp 163 °C (decomposes). Also reported as white to off-white powder, sparingly soluble in methanol. Practically insoluble in water. /Candesartan 1-[[(Cyclohexyloxy)carbonyl]oxy]ethyl ester/|White to off-white powder, mw - 610.67. Practically insoluble in water and sparingly soluble in methanol. ... a racemic mixture containing one chiral center at the cyclohexyloxycarbonyloxy ethyl ester group. Following oral administration ... undergoes hydrolysis at the ester link to form the active drug, candesartan, which is achiral. /Cilexetil/|White, or practically white, crystalline powder, mw - 297.72 .. Slightly soluble in water, but freely soluble in hydroxide solution /Cilexetil hydrochlorothiazide/|Hydroxyl radical reaction rate constant = 4.96X10-11 cu cm/molec-sec at 25 °C (est)

Safety Information

NONH for all modes of transport

20/21/22-36/37/38

26-36-60-36/37-9

DD6671000

Xn

Stable under recommended storage conditions.

P201, P202, P261, P271, P281, P304+P312, P304+P340, P308+P313, P312, P405, P501

H332

SRP: Expired or waste pharmaceuticals shall carefully take into consideration applicable DEA, EPA, and FDA regulations. It is not appropriate to dispose by flushing the pharmaceutical down the toilet or discarding to trash. If possible return the pharmaceutical to the manufacturer for proper disposal being careful to properly label and securely package the material. Alternatively, the waste pharmaceutical shall be labeled, securely packaged and transported by a state licensed medical waste contractor to dispose by burial in a licensed hazardous or toxic waste landfill or incinerator.|SRP: At the time of review, regulatory criteria for small quantity disposal are subject to significant revision, however, household quantities of waste pharmaceuticals may be managed as follows: Mix with wet cat litter or coffee grounds, double bag in plastic, discard in trash.|Waste treatment methods. Product: Offer surplus and non-recyclable solutions to a licensed disposal company. Contact a licensed professional waste disposal service to dispose of this material. Dissolve or mix the material with a combustible solvent and burn in a chemical incinerator equipped with an afterburner and scrubber. Contaminated packaging: Dispose of as unused product.

Incompatible materials: Oxidizing agents, strong acids and strong bases.

The Approved Drug Products with Therapeutic Equivalence Evaluations identifies currently marketed prescription drug products, including candesartan cilexetil, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act. /Candesartan cilexetil/

|Warning|H332 (25%): Harmful if inhaled [Warning Acute toxicity, inhalation]|P201, P202, P261, P271, P273, P281, P304+P312, P304+P340, P308+P313, P312, P391, P405, and P501|Aggregated GHS information provided by 4 companies from 4 notifications to the ECHA C&L Inventory. Each notification may be associated with multiple companies.|H361: Suspected of damaging fertility or the unborn child [Warning Reproductive toxicity]|P201, P202, P273, P281, P308+P313, P391, P405, and P501

Eye/face protection: Safety glasses with side-shields conforming to EN166 Use equipment for eye protection tested and approved under appropriate government standards such as NIOSH (US) or EN 166(EU).|Skin protection: Handle with gloves.|Body Protection: Impervious clothing, The type of protective equipment must be selected according to the concentration and amount of the dangerous substance at the specific workplace.|Respiratory protection: Where risk assessment shows air-purifying respirators are appropriate use a full-face particle respirator type N100 (US) or type P3 (EN 143) respirator cartridges as a backup to engineering controls. If the respirator is the sole means of protection, use a full-face supplied air respirator. Use respirators and components tested and approved under appropriate government standards such as NIOSH (US) or CEN (EU).

Suitable extinguishing media: Use water spray, alcohol-resistant foam, dry chemical or carbon dioxide.|Advice for firefighters: Wear self contained breathing apparatus for fire fighting if necessary.

Accidental Release Measures. Personal precautions, protective equipment and emergency procedures: Use personal protective equipment. Avoid dust formation. Avoid breathing vapours, mist or gas. Ensure adequate ventilation. Evacuate personnel to safe areas. Avoid breathing dust. Environmental precautions: Prevent further leakage or spillage if safe to do so. Do not let product enter drains. Discharge into the environment must be avoided. Methods and materials for containment and cleaning up: Pick up and arrange disposal without creating dust. Sweep up and shovel. Keep in suitable, closed containers for disposal.

Precautions for safe handling: Avoid contact with skin and eyes. Avoid formation of dust and aerosols. Provide appropriate exhaust ventilation at places where dust is formed.|Appropriate engineering controls: Handle in accordance with good industrial hygiene and safety practice. Wash hands before breaks and at the end of workday.|Gloves must be inspected prior to use. Use proper glove removal technique (without touching glove's outer surface) to avoid skin contact with this product. Dispose of contaminated gloves after use in accordance with applicable laws and good laboratory practices. Wash and dry hands.|SRP: Local exhaust ventilation should be applied wherever there is an incidence of point source emissions or dispersion of regulated contaminants in the work area. Ventilation control of the contaminant as close to its point of generation is both the most economical and safest method to minimize personnel exposure to airborne contaminants. Ensure that the local ventilation moves the contaminant away from the worker.

Toxicity

IDENTIFICATION AND USE: Candesartan is a white to off white powder that is formulated into oral tablets. Candesartan is an angiotensin II type 1 (AT1) receptor antagonist. It is used alone or in combination with other classes of antihypertensive agents in the management of hypertension in adults and children from 1 to less than 17 years of age. It is also used for the treatment of heart failure in adults with left ventricular systolic dysfunction to reduce cardiovascular death and heart failure hospitalizations. HUMAN EXPOSURE AND TOXICITY: The most likely manifestations of candesartan overdose include hypotension, dizziness, and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation. While candesartan can be used in hypertensive children, it is not approved for use in children less one 1 year of age as drugs that act directly on the renin-angiotensin system (RAS) can have effects on the development of immature kidneys. The use of candesartan is also contraindicated during pregnancy. While use during the first trimester does not suggest a risk of major anomalies, use during the second and third trimester may cause teratogenicity and severe fetal and neonatal toxicity. Fetal toxic effects may include anuria, oligohydramnios, fetal hypocalvaria, intrauterine growth restriction, premature birth and patent ductus arteriosus. Stillbirth or neonatal death may occur. Anuria-associated oligohydramnios may produce fetal limb contractures, craniofacial deformation, and pulmonary hypoplasia. Severe anuria and hypotension, resistant to both pressor agents and volume expansion, may occur in the newborn following in utero exposure to candesartan. ANIMAL STUDIES: There was no evidence of carcinogenicity when candesartan was orally administered to mice. Also, the fertility of male and female rats was unaffected by administration of candesartan. No maternal toxicity or adverse effects on fetal development were observed when candesartan was administered to pregnant mice at oral doses up to 1000 mg/kg. However, doses as low as 10 mg/kg/day administered to rats were associated with reduced survival and an increased incidence of hydronephrosis in the offspring. Candesartan given to pregnant rabbits at an oral dose of 3 mg/kg/day caused maternal toxicity (decreased body weight and death) but had no adverse effects on fetal survival, fetal weight, or external, visceral, or skeletal development. Candesartan and its O-deethyl metabolite tested positive for genotoxicity in the in vitro Chinese hamster lung (CHL) chromosomal aberration assay. Neither compound tested positive in the Ames microbial mutagenesis assay or the in vitro mouse lymphoma cell assay. Candesartan (but not its O-deethyl metabolite) was also evaluated in vivo in the mouse micronucleus test and in vitro in the Chinese hamster ovary (CHO) gene mutation assay, in both cases with negative results. Candesartan cilexetil was evaluated in the Ames test, the in vitro mouse lymphoma cell and rat hepatocyte unscheduled DNA synthesis assays and the in vivo mouse micronucleus test, in each case with negative results.

Candesartan has been associated with a low rate of serum aminotransferase elevations (

Do not co-administer aliskiren with Atacand in patients with diabetes. Avoid use of aliskiren with Atacand in patients with renal impairment (GFR <60 mL/min).|Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors, and with some angiotensin II receptor antagonists. An increase in serum lithium concentration has been reported during concomitant administration of lithium with Atacand. Monitor serum lithium levels.|Patients on diuretics, and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with Atacand. The possibility of symptomatic hypotension with the use of Atacand can be minimized by discontinuing the diuretic prior to initiation of treatment and/or lowering the initial dose of Atacand. /From table/|Atacand decreases the production of aldosterone. Potassium-sparing diuretics or potassium supplements should be given only for documented hypokalemia and with frequent monitoring of serum potassium. Potassium-containing salt substitute should also be used with caution. /From table/|For more Interactions (Complete) data for CANDESARTAN (8 total), please visit the HSDB record page.

LDDog (male) oral > 2,000 mg/kg|LD50 Rat oral > 2,000 mg/kg|LD50 Mouse oral > 2,000 mg/kg|LD50 Rat (male) iv 1,350 mg/kg|For more Non-Human Toxicity Values (Complete) data for CANDESARTAN (11 total), please visit the HSDB record page.

Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.|Sensitivity reactions, including various anaphylactoid reactions and/or angioedema, have been reported with use of angiotensin II receptor antagonists, including candesartan. Candesartan is not recommended in patients with a history of angioedema associated with or unrelated to ACE or angiotensin II receptor antagonist therapy.|Children < 1 year of age must not receive Atacand for hypertension. Drugs that act directly on the renin-angiotensin system (RAS) can have effects on the development of immature kidneys.|Despite data suggesting that angiotensin-receptor blockers (ARBs) are associated with increased risk to the fetus, there has been an increasing exposure of ARBs in pregnancy. We report a case report regarding a woman, who accidentally was treated with Candesartan during the first 22 weeks of pregnancy. At 22 weeks of gestation the fetal kidneys were oedematous with very little amniotic fluid. The prognosis for the fetus was considered poor. Five weeks after discontinuation of Candesartan normal quantities of amnionic fluid and a visible fetal bladder was registered. After delivery at week 31, creatinine clearance, diuresis and urine examination of the neonate were within normal limits. Ultrasound examinations of the kidneys showed bilaterally marked calices, small cysts and parenchymal increased echogenety at 1 week with complete sonographic normalization at 6 weeks. However, experimental studies raise the question of potential long-term adverse effects, including renal dysfunction and arterial hypertension in adulthood.|For more Populations at Special Risk (Complete) data for CANDESARTAN (7 total), please visit the HSDB record page.

While data specific to candesartan were not located(SRC, 2007), the literature suggests that some pharmaceutically active compounds originating from human and veterinary therapy are not eliminated completely in municipal sewage treatment plants and are therefore discharged into receiving waters(1). Wastewater treatment processes often were not designed to remove them from the effluent(2). Selected organic waste compounds may be degrading to new and more persistent compounds that may be released instead of or in addition to the parent compound(2).

EXPERIMENTAL: It is not known whether candesartan is excreted in human milk, but candesartan has been shown to be present in rat milk.

Drug Information

Treatment of hypercholesterolaemia, Treatment of hypertension|Treatment of hypertension|Essential hypertension|Cutaneous T-cell lymphoma (including ICD-10 codes C84.0 (mycosis fungoides) and C84.1 (Sezary's Disease)

Candesartan is an angiotensin II receptor blocker used widely in the therapy of hypertension and heart failure. Candesartan is associated with a low rate of transient serum aminotransferase elevations and has been linked to rare instances of acute liver injury.

Angiotensin II Receptor Antagonists

Candesartan has known transformation products that include Valsartan acid.

Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents|Atacand is indicated for the treatment of hypertension in adults and children 1 to < 17 years of age. It may be used alone or in combination with other antihypertensive agents. /Included in US product labeling/|Atacand is indicated for the treatment of heart failure (NYHA class II-IV) in adults with left ventricular systolic dysfunction (ejection fraction = 40%) to reduce cardiovascular death and to reduce heart failure hospitalizations. Atacand also has an added effect on these outcomes when used with an ACE inhibitor. /Included in US product labeling/|Both angiotensin II receptor antagonists and ACE inhibitors have been shown to slow the rate of progression of renal disease in hypertensive patients with diabetes mellitus and microalbuminuria or overt nephropathy, and use of a drug from either class is recommended in such patients. /NOT included in US product label/|For more Therapeutic Uses (Complete) data for CANDESARTAN (7 total), please visit the HSDB record page.

/BOXED WARNING/ WARNING: FETAL TOXICITY. When pregnancy is detected, discontinue Atacand as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.|Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death. When pregnancy is detected, discontinue Atacand as soon as possible. These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy. Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.|Neonates with a history of in utero exposure to Atacand: If oliguria or hypotension occurs, direct attention toward support of blood pressure and renal perfusion. Exchange transfusions or dialysis may be required as a means of reversing hypotension and/or substituting for disordered renal function.|FDA Pregnancy Risk Category: D /POSITIVE EVIDENCE OF RISK. Studies in humans, or investigational or post-marketing data, have demonstrated fetal risk. Nevertheless, potential benefits from the use of the drug may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective./|For more Drug Warnings (Complete) data for CANDESARTAN (19 total), please visit the HSDB record page.

Drugs used in the treatment of acute or chronic vascular HYPERTENSION regardless of pharmacological mechanism. Among the antihypertensive agents are DIURETICS; (especially DIURETICS, THIAZIDE); ADRENERGIC BETA-ANTAGONISTS; ADRENERGIC ALPHA-ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CALCIUM CHANNEL BLOCKERS; GANGLIONIC BLOCKERS; and VASODILATOR AGENTS. (See all compounds classified as Antihypertensive Agents.)|Agents that antagonize ANGIOTENSIN II TYPE 1 RECEPTOR. Included are ANGIOTENSIN II analogs such as SARALASIN and biphenylimidazoles such as LOSARTAN. Some are used as ANTIHYPERTENSIVE AGENTS. (See all compounds classified as Angiotensin II Type 1 Receptor Blockers.)

The volume of distribution of candesartan is 0.13 L/kg. Candesartan is highly bound to plasma proteins (>99%) and does not penetrate red blood cells. The protein binding is constant at candesartan plasma concentrations well above the range achieved with recommended doses. In rats, it has been demonstrated that candesartan crosses the blood-brain barrier poorly, if at all. It has also been demonstrated in rats that candesartan passes across the placental barrier and is distributed in the fetus.|Following administration of candesartan cilexetil, the absolute bioavailability of candesartan was estimated to be 15%. After tablet ingestion, the peak serum concentration (Cmax) is reached after 3 to 4 hours. Food with a high fat content does not affect the bioavailability of candesartan after candesartan cilexetil administration.|Total plasma clearance of candesartan is 0.37 mL/min/kg, with a renal clearance of 0.19 mL/min/kg. When candesartan is administered orally, about 26% of the dose is excreted unchanged in urine. Following an oral dose of (14)C-labeled candesartan cilexetil, approximately 33% of radioactivity is recovered in urine and approximately 67% in feces. Following an intravenous dose of (14)C-labeled candesartan, approximately 59% of radioactivity is recovered in urine and approximately 36% in feces. Biliary excretion contributes to the elimination of candesartan.|It is not known whether candesartan is excreted in human milk, but candesartan has been shown to be present in rat milk.

Candesartan cilexetil is rapidly and completely bioactivated by ester hydrolysis during absorption from the gastrointestinal tract to candesartan, a selective AT1 subtype angiotensin II receptor antagonist. Candesartan is mainly excreted unchanged in urine and feces (via bile). It undergoes minor hepatic metabolism by O-deethylation to an inactive metabolite.|Candesartan has known human metabolites that include (2S,3S,4S,5R)-6-[2-Ethoxy-3-[[4-[2-(2H-tetrazol-5-yl)phenyl]phenyl]methyl]benzimidazole-4-carbonyl]oxy-3,4,5-trihydroxyoxane-2-carboxylic acid and 3-[[4-[2-[2-[(3R,4S,5S,6S)-6-carboxy-3,4,5-trihydroxyoxan-2-yl]tetrazol-5-yl]phenyl]phenyl]methyl]-2-ethoxy-1H-benzimidazol-3-ium-4-carboxylic acid.

The elimination half-life of candesartan is approximately 9 hours.

Although these agents /angiotensin II receptor antagonists/ are similar to ACE inhibitors in that they decrease the effects of angiotensin II, rather than decreasing the formation of angiotensin II, drugs antagonize angiotensin II at the type I angiotensin receptor. This allows the drugs to inhibit the vasoconstrictive and aldosterone promoting effects of angiotensin II without interfering with bradykinin degradation, significantly reducing the adverse effects of cough and angioedema seen with ACE inhibitor therapy. ... /Angiotensin II receptor antagonists/|Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). Angiotensin II is the principal pressor agent of the renin-angiotensin system, with effects that include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation, and renal reabsorption of sodium. Candesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. Its action is, therefore, independent of the pathways for angiotensin II synthesis. There is also an AT2 receptor found in many tissues, but AT2 is not known to be associated with cardiovascular homeostasis. Candesartan has much greater affinity (>10,000-fold) for the ATI receptor than for the AT2 receptor. Blockade of the renin-angiotensin system with ACE inhibitors, which inhibit the biosynthesis of angiotensin II from angiotensin I, is widely used in the treatment of hypertension. ACE inhibitors also inhibit the degradation of bradykinin, a reaction also catalyzed by ACE. Because candesartan does not inhibit ACE (kininase II), it does not affect the response to bradykinin. Whether this difference has clinical relevance is not yet known. Candesartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation. Blockade of the angiotensin II receptor inhibits the negative regulatory feedback of angiotensin II on renin secretion, but the resulting increased plasma renin activity and angiotensin II circulating levels do not overcome the effect of candesartan on blood pressure.

/SRP:/ Immediate first aid: Ensure that adequate decontamination has been carried out. If patient is not breathing, start artificial respiration, preferably with a demand valve resuscitator, bag-valve-mask device, or pocket mask, as trained. Perform CPR if necessary. Immediately flush contaminated eyes with gently flowing water. Do not induce vomiting. If vomiting occurs, lean patient forward or place on the left side (head-down position, if possible) to maintain an open airway and prevent aspiration. Keep patient quiet and maintain normal body temperature. Obtain medical attention. /Poisons A and B/|/SRP:/ Basic treatment: Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if needed. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary ... . Monitor for shock and treat if necessary ... . Anticipate seizures and treat if necessary ... . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during transport ... . Do not use emetics. For ingestion, rinse mouth and administer 5 mL/kg up to 200 mL of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool ... . Cover skin burns with dry sterile dressings after decontamination ... . /Poisons A and B/|/SRP:/ Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag valve mask device may be beneficial. Consider drug therapy for pulmonary edema ... . Consider administering a beta agonist such as albuterol for severe bronchospasm ... . Monitor cardiac rhythm and treat arrhythmias as necessary ... . Start IV administration of D5W TKO /SRP: "To keep open", minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer's (LR) if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload ... . Treat seizures with diazepam or lorazepam ... . Use proparacaine hydrochloride to assist eye irrigation ... . /Poisons A and B/|Treatment and supportive measures. Monitor blood pressure and heart rate for 6 hours after ingestion. If symptomatic or significant hypotension develops, observe for at least 24 hours. 1. If hypotension occurs, treat it with supine positioning and IV fluids. Vasopressors are rarely necessary. 2. Treat angioedema with usual measures (eg, diphenhydramine, corticosteroids) and discontinue the ACE inhibitors. Switching to an AR blocker may not be appropriate as angioedema has also been reported with these agents. 3. Treat hyperkalemia if it occurs. /Angiotensin blockers and ACE inhibitors/|For more Antidote and Emergency Treatment (Complete) data for CANDESARTAN (6 total), please visit the HSDB record page.

/SIGNS AND SYMPTOMS/ The most likely manifestation of overdosage with Atacand would be hypotension, dizziness, and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation. If symptomatic hypotension should occur, supportive treatment should be instituted.|/CASE REPORTS/ ... A patient with generalized pustular psoriasis induced by candesartan cilexetil (AT1 receptor antagonist), who was previously diagnosed as flexural psoriasis /is described/.|/CASE REPORTS/ Despite data suggesting that angiotensin-receptor blockers (ARBs) are associated with increased risk to the fetus, there has been an increasing exposure of ARBs in pregnancy. We report a case report regarding a woman, who accidentally was treated with Candesartan during the first 22 weeks of pregnancy. At 22 weeks of gestation the fetal kidneys were oedematous with very little amniotic fluid. The prognosis for the fetus was considered poor. Five weeks after discontinuation of Candesartan normal quantities of amnionic fluid and a visible fetal bladder was registered. After delivery at week 31, creatinine clearance, diuresis and urine examination of the neonate were within normal limits. Ultrasound examinations of the kidneys showed bilaterally marked calices, small cysts and parenchymal increased echogenety at 1 week with complete sonographic normalization at 6 weeks. However, experimental studies raise the question of potential long-term adverse effects, including renal dysfunction and arterial hypertension in adulthood.|/CASE REPORTS/ A 41 year old woman was treated with candesartan throughout a 32 week gestation. Because of anhydramnios, she was delivered of a 1120 gram (0.4th percentile) male infant in poor condition. The infant had defective ossification of the roof of the calvarium, joint contractures, mild hypospadias, rocker bottom feet, a large abdominal left kidney and absent right kidney. He developed intractable hypotension, unresponsive to hydration, and remained anuric until he died.|For more Human Toxicity Excerpts (Complete) data for CANDESARTAN (14 total), please visit the HSDB record page.

2-ethoxy-1-((2'-(1H-tetrazol-5-yl)(1,1'-biphenyl)-4-yl)methyl)-1H-benzimidazole-7-carboxylic acid

Candesartan Use and Manufacturing

Methods of Manufacturing

To the product obtained in Step A) (350 g) dissolved in methanol (1.17 L) was added sodium hydroxide solution (93 g in 1.17 L water). The reaction mass was heated to reflux at 78-80°C and maintained for 1 hour. After completion of reaction, methanol was completely removed under vacuum at 40-45°C and to the residue was added ethyl acetate (2. 8 L) and water (3.50 L) at room temperature. Stirred the mixture for about 1 hour at 25- 30°C and allowed to settle for 15 minutes. Separated the layers and pH of the aqueous layer was adjusted to 4-5 with acetic acid (about 450 g) at 10-15°C. The precipitated product was filtered and washed twice with water (2 x 0.7 L) and suck dried. The wet cake was air dried at room temperature for 2 hours and then at 50-55°C to afford the title compound. Yield: 323 g (95percent)To 80.0 grams (0.176 moles) of methyl 2-ethoxy-1-[[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]-methyl] benzimidazole-7-carboxylate, were added 265 ml ofmethanol, 535 ml of water, and 21.1 grams of sodium hydroxide, below 10°C, andthe mixture was heated to 70°C and maintained until the reaction completed. Themethanol was distilled off completely under reduced pressure, and the residuewas cooled to 10°C. The pH of the residue was adjusted to 2 with aqueoushydrochloric acid solution. The precipitated compound was filtered, washed withwater and dried at 60-70°C to get 70.0 grams (90percent) of 2-ethoxy-1-[[2'-(1 H-tetrazol-5-yl)biphenyl-4-yl]-methyl]benzimidazole-7-carboxylicacid.An aqueous sodium hydroxide solution (73 kg/826L) was added to the wet MET (369.6 kg) obtained in Reference Example 9, and the mixture was stirred at 68 to 72 °C for 1 to 2 hours. The reaction solution was cooled, and washed twice with methylene chloride (486 kg) and once with toluene (366 L). Methanol (1437 L) was added to the aqueous layer, the pH was adjusted to 7.0 +/-0.5 with concentrated hydrochloric acid (about 35 L). Activated charcoal (11kg) was added, followed by stirring for about 30 minutes. The activated charcoal was filtered off, and concentrated hydrochloric acid (about 20L) was added until the solution became cloudy, followed by stirring at 25 +/-5°C for about 1 hour. Water (487 L) was added, and the pH was adjusted to 3.5 +/-0.3 with concentrated hydrochloric (about 85 L). After stirring at 24 to 30°C for about 30 minutes, water (687 L) was added, and the mixture was cooled to 10°C or lower, and stirred for about 1 hour. The crystals were separated, washed with water (412 L) and then acetone (427 L), ground, and dried to give 2-ethoxy-1-[[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl]benzimidazole-7-carboxylic acid (200kg, 82.0percent). mp.183-185°C 1NMR (200MHz, DMSO-d6) δ: 1.38(3H, t), 4.58(2H, q), 5.63(2H, s), 6.97(4H.q), 7.17(1H, t), 7.47-7.68(6H, m) IR (KBr) cm-1:1710, 1550, 1480, 1430, 1280, 1240, 1040, 760A solution of ethyl 2-ethoxy-1-[{2'-[1-(triphenylmethyl)-1H-tetrazol-5-yl]-1, 1'-biphenyl-4-yl}methyl]-benzimidazole-7-carboxylate (0.28g) and 1M LiOH (1.2 ml) in ethanol (3.5 ml) was stirred at 80°C for three hours. The reaction mixture was concentrated and washed with toluene (5x2ml). The aqueous layer was adjusted to pH 2-3 with 1 M HCl to give a white solid (0.15g, 85percent yield) corresponding to 2-ethoxy-1-{[2'-(1H-tetrazol-5-yl)-1, 1'-biphenyl-4-yl]methyl}-benzimidazole-7-carboxylic acid. Example 14.WORKING EXAMPLE 5 Zn(Ac)22H2O (0.03 mmol, 0.0066 g) was dissolved in the methanol(5 mL), and then DMF solution (1 mL) of tppbc (0.03 mmol, 0.0132 g) was added into the above mixture to give a clear solution.The reaction mixture crystallized at room temperature forabout a month by slow evaporation to give the desired colorlessblock crystals. Yield: 68% (based on Zn). Elemental analysis (%)calcd for C30H32ZnN8O5: C, 55.43; H, 4.96; N, 17.34. Found: C, 55.55; H, 4.98; N, 17.28. IR(KBr/pellet, cm1): 3501(w), 2937(w), 2167(w), 1649 (s), 1548(s), 1425(m), 1378(s), 1244(m), 1110(w), 907(w), 762(s), 666(w).A mixture of ZnSO47H2O (0.0183 g, 0.05 mmol), tppbc(0.0220 g, 0.05 mmol), methanol (8 mL), water (4 mL) and 4, 40-bipyridyl (0.0078 g, 0.05 mmol) was sealed in a 25 mL Teflon-linedstainless steel container, which was heated at 135 C for 3 days andthen gradually cooled to room temperature at a rate of 5 C h1, colorless block crystals of 1 were obtained with a yield of 45%(based on Zn). Element analysis was measured after heated complex1 at 110 C for an hour and a half. Elemental analysis (%) Calcdfor C54H34Zn2N14O6: C, 58.65; H, 3.10; N, 17.73. Found: C, 58.67; H, 3.05; N, 17.61. IR(KBr/pellet, cm1): 3412(w), 3456(w), 2961(w), 1550(s), 1447(s), 1392(s), 1328(m), 1284(m), 1094(w), 856(m), 746(s), 663(w).A mixture of CdI2 (0.0183 g, 0.05 mmol), tppbc (0.0220 g, 0.05 mmol), methanol (8 mL), water (4 mL) and pyridine (1 mL)was sealed in a 25 mL Teflon-lined stainless steel container whichwas heated at 150 C for 3 days and then gradually cooled to roomtemperature at a rate of 5 C h1, colorless block crystals of 3 wereobtained with a yield of 56% (based on Cd). Elemental analysis (%)calcd for C27H21CdN7O4: C, 52.31; H, 3.41; N, 15.82. Found: C, 52.27; H, 3.43; N, 15.79. IR(KBr/pellet, cm1): 3513(w), 3159(w), 2952(w), 1697(s), 1602(w), 1559(s), 1449(m), 1409(s), 1357(w), 1141(m), 763(m), 692(w).

Uses

antihypertensive, angiotensin II inhibitor

Trade Name: Amias, Kenzen /From table/|Table: Candesartan Cilexetil Preparations [Table#7228]|Table: Candesartan Cilexetil Combination Preparations [Table#7229]

Human Drugs -> EU pediatric investigation plans|Pharmaceuticals|Pharmaceuticals -> Sartans

Computed Properties

Molecular Weight:440.5
XLogP3:4.1
Hydrogen Bond Donor Count:2
Hydrogen Bond Acceptor Count:7
Rotatable Bond Count:7
Exact Mass:440.15968852
Monoisotopic Mass:440.15968852
Topological Polar Surface Area:119
Heavy Atom Count:33
Complexity:660
Covalently-Bonded Unit Count:1
Compound Is Canonicalized:Yes

Drug Function and Efficacy

It selectively blocks the binding of angiotensin II to AT1 receptors in various organs and tissues, thereby blocking the pharmacological effects of angiotensin II. It does not inhibit angiotensin converting enzyme (ACE), so it does not increase the content of bradykinin in the body.

This ingredient has been used in drugs with the following functions (note: it does not mean that the ingredient itself has the following health functions)

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