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Australian Journal of Pharmacy : May 2008
Rate of persistence on treatment for different antihypertensive drug treatments Rate of persistence on lercanidipine vs other CCBs after 24 months of treatment p<0.05 60 100 80 60 40 20 0 6 months 12 months 24 months 50 40 * *** *** ** 20 30 diuretic beta-blocker CCB lercanidipine ACEI *p<0.05, **p<0.05, ***p<0.01 compared to ARBs The higher the persistence on treatment the better the extent of BP control in clinical practice.2 • one in five patients failed to collect a second AHT prescription • for most patients who did collect prescriptions, their adherence to treatment was good (as assessed by medication possession ratios) • in agreement with prior reports, persistence was highest for patients commencing treatment on A2RAs or ACEIs, compared to CCBs. (Other AHT classes were not assessed). • persistence on lercanidipine was 25% better than other CCBs; candesartan and telmisartan were 10-20% better than other A2RAs; perindopril was 25% better than other ACEIs. A study published last year by Veronesi et al2 prospectively evaluated persistence on AHT treatments in a single-blind study. 347 patients with mild-to-moderate hypertension were randomly allocated a single antihypertensive treatment with an A2RA, ACEI, CCB, beta-blocker or diuretic. In line with earlier retrospective findings, the investigators showed that compliance was influenced by the class of drug prescribed, with A2RAs and ACEIs showing best persistence. ARB 10 0 Other CCBs lercanidipine lercanidipine (n=46) other CCBs (n=63) Also of note was that after 24 months, persistence on Zanidip (lercanidipine) was 12.7% higher than that of other CCBs (59.3% versus 46.6%, p<0.05).2 Discontinuation of treatment was primarily due to the occurrence of adverse effects. Regarding lercanidipine, the authors write that ‘…a direct comparison of patients allocated to treatment with CCBs showed a greater persistence on therapy in those subjects treated with lercanidipine whose tolerability profile has been repeatedly demonstrated to be superior when compared with other drugs of the same class.’2 Solvay Pharmaceuticals, Level 1, Bldg 2, 20 Bridge St, Pymble NSW 2073 www.solvay.com.au Zanidip® is a registered trademark solcode 120201-273 Before prescribing Zanidip, please review the full Product Information available from SOLVAY PHARMACEUTICALS. Zanidip® (lercanidipine) 10mg and 20mg tablets. INDICATIONS: Treatment of hypertension. CONTRAINDICATIONS: Hypersensitivity to dihydropyridines or any Zanidip ingredient; severe hepatic or renal impairment (creat.clearance <12mL/min); concomitant cyclosporin. PRECAUTIONS: Ischaemic heart disease; outflow obstruction (aortic stenosis); congestive heart failure; unstable angina pectoris or within 1 month of a myocardial infarction; pregnancy (Cat C); lactation; patients <18 yrs; initiation of treatment in the elderly, hepatic or renal impairment. INTERACTIONS: Zanidip has been safely administered with diuretics, ACE -inhibitors, and ß-blockers which are eliminated unchanged (such as atenolol); negligible in vivo inhibition of CYP3A4, however exercise caution with cyclosporin, amiodarone, quinidine; inhibitors of CYP3A4 (ketoconazole, itraconazole, erythromycin, ritonavir and fluoxetine) and inducers of CYP3A4 (phenytoin, carbamazepine and rifampicin) may alter plasma levels of Zanidip; ß-blockers (metoprolol, propranolol); digoxin; cimetidine; simvastatin; grapefruit juice; alcohol (see full PI). ADVERSE REACTIONS: Treatment is generally well tolerated, with most events classified as mild to moderate in severity. Common (incidence =1%): flushing, palpitations/tachycardia, peripheral oedema, dizziness, headache, GGT increased. Serious adverse events in clinical trials occurred in <0.002% patients (see full PI). DOSAGE: 10mg once daily, 15 minutes before meal. Dose may be increased to 20mg daily. PRESENTATION: Zanidip 10mg (yellow) and 20mg (pink), 30s. PBS Dispensed Price (January 31st 2008): 10mg $21.43, 20mg $32.39. PBS Information: This product is listed on the PBS as a drug for hypertension. 1. JNC VII, 2003. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42:1206–52. 2. Veronesi et al, Vasc.Health and Risk Mang.2007; 3(6): 999-1005. 3. Nelson MR et al. MJA 2006; 185: 486-489. 4. Ho PM et al. BMC Cardiovasc.Disord.2006 6: 48. 5. Simons, et al, Persistence with Hypertension Medication Australia-wide 2004-6 MJA;188 224-227. The AusTrAliAn journAl of PhArmAcy vol.89 mAy 2008 49 Patients (%) Patients (%) advertorial