(ACE) inhibitor / Angiotensin-II Receptor Antagonist (A2RA)
(ACE) inhibitor / Angiotensin-II Receptor Antagonist (A2RA)
(ACE) inhibitor / Angiotensin-II Receptor Antagonist (A2RA)
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LosartanIrbesartanCandesartanValsartanEprosartanOlmesartanTelmisartanCost ComparisonDrug Strength Cost per 28/7(£) 350mg 1.07100mg 1.24150mg 11.84300mg 15.9316mg 12.7232mg 16.1380mg 13.97160mg 18.41400mg 15.77600mg 14.3110mg 10.9520mg 12.9540mg 17.5020mg 8.0040mg 12.50References1. MeReC Bulletin <strong>Angiotensin</strong>-<strong>II</strong> receptor antagonists: what is the evidence for theirplace in therapy? Volume 20 Number 2 March 20102. SPCs available at http://emc.medicines.org.uk3. Drug Tariff December 2011Page 3 of 5
4. Protocol for Review of <strong>Angiotensin</strong>-<strong>II</strong> <strong>Receptor</strong> <strong>Antagonist</strong>sConsider <strong>ACE</strong> <strong>inhibitor</strong>s (lisinopril or ramipril) or losartan (alternativecandesartan)1. Identify patients prescribed angiotensin <strong>II</strong> receptor antagonists,prescribed for uncomplicated hypertension.Patients with an indication of heart failure, diabetes mellitus, diabeticnephropathy, or microalbuminuria should not be switchedYesDocumented history of <strong>ACE</strong><strong>inhibitor</strong> intolerance(Intolerable Cough or other sideeffects)NoSwitch to Losartan50mg or equivalentdose of CandesartanSwitch to equivalent doseof Lisinopril(Alternative Ramipril)Use the lower of these doses if patient has mild hypertension, or on diuretics. The higherdose may be used if currently on multiple antihypertensive therapies/more difficult to controlhypertension. If in doubt use the lower dose and titrate up later as necessary.2. Issue patient letter or see patients explaining switch, attaching bloodform for test two weeks after start of treatment, and requirement tomake appointment 4 weeks after start of treatment to monitor BP.3. Make changes on practice computer system.4. Check blood results before second issue of new prescription, actappropriately on results, reducing dose or switching back if renalfunction worsens.5. If U&Es are satisfactory check BP- below 150/90mmHg issue further prescriptions- above 150/90mmHg increase to next dose and follow up as previousPage 4 of 5
Dose equivalentsOriginal drug Original Equivalent Dosedose Cost for Lisinopril Ramipril Candesartan28/7 (£)*Losartan 25mg 1.64 2.5mg 1.25mg 2mg50mg 1.54 5mg 2.5mg/5mg 4mg100mg 1.74 10-20mg 5mg/10mg 8-16mgCandesartan 2mg 11.96 2.5mg 1.25mg4mg 8.15 5mg 1.25mg8mg 9.89 10mg 2.5mg/5mg16mg 12.72 20mg 5mg/10mgValsartan 40mg 14.76 2.5mg 1.25mg 2mg80mg 16.44 5mg 2.5mg/5mg 4mg160mg 21.66 10-20mg 5mg/10mg 8-16mgIrbesartan 75mg 10.29 2.5mg 1.25mg 2mg150mg 12.57 5mg 2.5mg/5mg 4mg300mg 16.91 10-20mg 5mg/10mg 8-16mgEprosartan 300mg 11.63 2.5mg 1.25mg 2mg400mg 7.89 5mg 2.5mg/5mg 4mg600mg 14.31 10-20mg 5mg/10mg 8-16mgOlmesartan 10mg 10.95 2.5mg 1.25mg 2mg20mg 12.95 5mg 2.5mg/5mg 4mg40mg 17.50 10-20mg 5mg/10mg 8-16mgTelmisartan 20mg 11.34 2.5mg 1.25mg 2mg40mg 11.34 5mg 2.5mg/5mg 4mg80mg 14.18 10-20mg 5mg/10mg 8-16mgThese figures are based on appropriate doses for elderly and standard initiation doses from Prodigy(accessed 10.7.06) and current prescribing information from SPCs accessed December 2010. NBLocal opinion suggests that dose of Candesartan required to reach targets is usually in excess of8mgDate of preparation Date of last review Approved by LMSG Date of next review VersionNovember 2006 December 2011 January 2012 January 2013 3.3Page 5 of 5
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