What are the most commonly prescribed Angiotensin Receptor Blockers (ARBs) in Canada and their prices?

Most Common ARBs in Canada and Their Prices

The most commonly prescribed Angiotensin Receptor Blockers (ARBs) in Canada are losartan, candesartan, valsartan, telmisartan, and irbesartan, with candesartan ranking highest among ARBs in prescription volume. 1

Most Common ARBs by Prescription Volume

Based on prescription data from hypertension medications, the ranking of ARBs in Canada and other regions shows:

1. Candesartan - Ranked 5th overall among all antihypertensives in the European Union, making it the most commonly prescribed ARB 1
2. Losartan - Ranked 4th in the US and 5th in the UK among all antihypertensives 1
3. Valsartan - Ranked 12th in the US and 14th in the EU 1
4. Telmisartan - Ranked 15th in the EU 1
5. Irbesartan - Ranked 16th in the EU and 18th in the UK 1

Dosing and Price Considerations

Standard Dosing Ranges

• Losartan: 50-100 mg daily 1
• Valsartan: 80-320 mg daily 1
• Irbesartan: 150-300 mg daily 1
• Candesartan cilexetil: 4-16 mg daily 1
• Telmisartan: 40-80 mg daily 1
• Eprosartan: 400-800 mg daily 1

Price Factors

While specific Canadian prices aren't detailed in the evidence, several factors affect ARB pricing:

1. Generic Availability: Many ARBs are now available as generics, which has significantly reduced their cost 1

2. Combination Products: Many ARBs are available in fixed-dose combinations with diuretics (particularly hydrochlorothiazide) or calcium channel blockers, which may affect pricing 1

3. Prescription Volume: Higher volume medications like candesartan and losartan may benefit from economies of scale in production and distribution

Clinical Considerations When Selecting ARBs

When choosing among ARBs, consider:

1. Efficacy: All ARBs are effective antihypertensive agents with no major differences in blood pressure-lowering efficacy among older drugs in this class 2

2. Tolerability: ARBs have excellent tolerability compared to ACE inhibitors, with significantly less cough as a side effect 1, 3

3. Special Populations:

   • Diabetes: ARBs provide renoprotective effects in patients with type 2 diabetes 1
   • Heart Failure: ARBs improve outcomes in patients with heart failure 1
   • Chronic Kidney Disease: ARBs are recommended for patients with albuminuria (UACR ≥30 mg/g creatinine) 1

4. Combination Therapy: ARBs work effectively in combination with thiazide diuretics or calcium channel blockers 2

Practical Prescribing Tips

• For patients under 55 years of age, ARBs (or ACE inhibitors) are often recommended as first-line therapy 1
• For patients with diabetes or chronic kidney disease, an ARB should be included in the treatment regimen 1
• ARBs are contraindicated during pregnancy 4
• Consider monitoring renal function and potassium levels when initiating ARB therapy 1

ARBs remain a cornerstone of hypertension management due to their efficacy, tolerability, and beneficial effects on cardiovascular and renal outcomes. The selection of a specific ARB should be based on availability, cost considerations, and patient-specific factors.