Sartan: mechanism, list, side effects

A sartan is an antihypertensive drug primarily used to treat high blood pressure. What are its other indications? Heart failure? What are they ? What are the side effects and contraindications?

Definition: what is a sartan drug?

It is a drug with a property antihypertensive. It is particularly prescribed when hygiene and dietary rules (regular physical activity, diet rich in fruits and vegetables, reduction of salt intake) are insufficient to reduce blood pressure in a hypertensive patient. Molecules belonging to this family are also called angiotensin II receptor antagonists. They exert an action on the heart, blood vessels and kidneys.

What is the mechanism of action of a sartan?

A sartan is a molecule that blocks the angiotensin II receptor (substance reducing the diameter of blood vessels). Thus, the drug prevents the reduction in the caliber of blood vessels and decreases the production of certain hormones such as aldosterone and vasopressin. The resulting effects are mainly a decrease in blood pressure, Water retention and salt, and blood volume circulating in the body. In addition, a sartan results in increased blood flow to the kidneys.

What are the indications for a sartan?

All sartans are indicated in the treatment ofhigh blood pressure in adults. Some sartans (candesartan, losartan, olmesartan, valsartan) can be prescribed in children from the age of 6 years. There are other indications that differ depending on the molecule prescribed:

  • Treatment of I’heart failure chronic (in case of intolerance to recommended first-line treatments)
  • Reduced risk of stroke in case of hypertension in patients with an enlarged left ventricle (in the heart)
  • Treatment of kidney damage in patients with diabetes type 2 and taking antihypertensive medication
  • Preventive treatment of cardiovascular consequences in patients with cardiovascular disease that obstructs a blood vessel or with type 2 diabetes associated with organ disease

In general, the use of sartans is envisaged in heart failure or in case of intolerance or even contraindication to ACE inhibitors (other drugs used in cardiology and less expensive than sartans). Intolerance to ACE inhibitors is manifested by excessive coughing.

What is the list of different sartans?

The sartans currently marketed in France are:

  • the candesartan (Atacand®, Kenzen®)
  • Irbesartan (Aprovel®)
  • Losartan (Cozaar®)
  • Olmesartan (Alteis®, Olmetec®)
  • Telmisartan (Micardis®, Pritor®)
  • Valsartan (Tareg®)

Generics are also available, except for olmesartan. Several commercial specialties contain a sartan associated with another molecule (calcium channel blocker, diuretic). This is the case, for example, of Coaprovel (irbesartan + hydrochlorothiazide), Exforge® (valsartan + amlodipine), Twynsta® (telmisartan + amlodipine). Their prescription is considered when sartan alone is not sufficiently effective. All medicines containing olmesartan (alone or in combination) are no longer reimbursed due to the risk of serious intestinal disease that could lead to hospitalization in intensive care. This risk has not been demonstrated with the other sartans.

What are the side effects of sartans?

Depending on the sartan and the therapeutic indication, the side effects are not the same and do not occur with the same frequency. Generally, the most frequently reported with sartans are dizziness, vertigo and headache. More rarely, a cough and a rash were observed. Note that these effects are very common in children treated with candesartan. In addition, a renal failureexcess potassium, decreased white blood cells, hypotension can occur. These effects are common with losartan andirbesartan, but rarer with olmesartan. In addition, sartans can lead to severe anaphylactic reaction called bradykine angioedema. This side effect is very rare but can cause serious consequences such as asphyxia (if located in the larynx) and lead to death. Symptoms manifest as a violent appearance of edema in the face, tongue, mouth and throat. When initiating treatment, close monitoring of these symptoms is required. In case of occurrence, it will be interrupted and contraindicated for life.

What are the contraindications of sartans?

Sartans are contraindicated in case allergy to any of the components of the drug. Administration is strictly prohibited during the 2nd and 3rd trimester of pregnancy, and not recommended in the 1st trimester. the losartancandesartan and telmisartan should not be administered in severe hepatic impairment. In addition, olmesartan and telmisartan are contraindicated in patients with obstructed bile ducts.

Sources:
– Public drug database
– Pharmacology.org
Angioedema bradykine: consider ACE inhibitors but also angiotensin II receptor antagonists (sartans) and gliptins, ANSM, 30/12/2020

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