Decision to fund candesartan with hydrochlorothiazide
What we're doing
We're pleased to announce that from 1 July 2023 Pharmac will fund candesartan cilexetil with hydrochlorothiazide tablets for people with high blood pressure through an agreement with Arrotex Pharmaceuticals (NZ) Limited for its Apo-Candesartan HCTZ brand of candesartan cilexetil with hydrochlorothiazide tablets.
Candesartan cilexetil with hydrochlorothiazide will be fully funded without restriction, which means that from 1 July 2023 it will be available for any New Zealander who needs it.
This proposal follows an interruption to the supply and subsequent recall of the Accuretic brand of quinapril with hydrochlorothiazide. People who have been impacted by this interruption of supply and people using other funded anti-hypertensive medicines will have the option of transitioning to candesartan cilexetil with hydrochlorothiazide.
Any changes to the original proposal?
This decision was subject to a consultation letter dated 18 May 2023. The majority of the feedback we received was supportive of the proposal being progressed. No changes have been made to the proposal as a result of the feedback received.
We are really grateful to those people who took the time to provide feedback.
Who we think will be most interested
- People with high blood pressure, heart failure, kidney disease and heart disease and their whānau.
- People currently on other hypertensive medications.
- Healthcare professionals who treat people with high blood pressure, heart failure, kidney disease and heart disease.
- Hospital and community pharmacists, Te Whatu Ora Hospitals and wholesalers.
- Suppliers of pharmaceuticals to the New Zealand market.
Detail about this decision
Candesartan cilexetil with hydrochlorothiazide tab 16 mg with hydrochlorothiazide 12.5 mg and tab 32 mg with hydrochlorothiazide 12.5 mg will be listed in Section B and in Part II of Section H of the Pharmaceutical Schedule from 1 July 2023 as follows:
|Candesartan cilexetil with hydrochlorothiazide
|Tab 16 mg with hydrochlorothiazide
|APO-Candesartan HCTZ 16/12.5
|Candesartan cilexetil with hydrochlorothiazide
|Tab 32 mg with hydrochlorothiazide
|APO-Candesartan HCTZ 32/12.5
Candesartan cilexetil with hydrochlorothiazide will be fully funded without restriction, this means from 1 July 2023 it will be available for any New Zealanders who need it.
Our response to what you told us
We’re really grateful for the time people took to respond to this consultation. A summary of the main themes raised in feedback, and our responses to the feedback received, are available on our notification webpage.
Support for funding
General support for the funding of candesartan cilexetil with hydrochlorothiazide noting that it would be a welcome addition to the currently available angiotensin receptor blockers / hydrochlorothiazide listing. Also, that combination products that include a thiazide are clinically useful when hypertension doesn’t respond sufficiently to a single agent.
We are pleased to be listing a new treatment option which will benefit the health of New Zealanders and provide further options.
General support for funding but noting that there would still be no angiotensin-converting-enzyme / hydrochlorothiazide combination available.
The clinical advice we have received [PDF, 409 KB] has noted the strong need for combination therapies to be available and has indicated that either an angiotensin receptor blocker or an angiotensin-converting-enzyme inhibitor would be suitable for meeting this need.
While angiotensin-converting-enzyme / hydrochlorothiazide products are not available on the schedule now, progressing this proposal would not prevent Pharmac from funding these in the future.
Feedback on prescribing frequency
A respondent queried whether candesartan cilexetil with hydrochlorothiazide would be supplied on ‘stat’ dispensing (3 monthly).
It is intended that once listed, candesartan cilexetil with hydrochlorothiazide would be dispensed as a ‘stat’ pharmaceutical as the supplier has sufficient stock in New Zealand to support this.
Feedback on related products
A respondent noted that telmisartan would have been a preferred angiotensin receptor blocker in a combination thiazide product.
We previously included telmisartan + hydrochlorothiazide in the 2021/2022 Annual Invitation to Tender. However, we have been unable to secure long term supply of this product.
We will continue to explore the need for a third primary angiotensin receptor blocker product, and we note that Pharmac’s Cardiovascular Specialist Advisory Committee has previously suggested that telmisartan would be an appropriate agent.
Respondents questioned why a combination including hydrochlorothiazide was being listed when there was evidence of superior clinical efficacy with other thiazide agents.
We appreciate that hydrochlorothiazide may not be the preferred thiazide agent for hypertension it is the agent most commonly available in combination products. We have been unable to source a non- hydrochlorothiazide combination angiotensin receptor blocker/ angiotensin-converting-enzyme inhibitor-thiazide product. The funding of candesartan cilexetil with hydrochlorothiazide would not prevent the funding of other thiazide products in future if they became available.
A respondent questioned the decision to fund candesartan cilexetil with hydrochlorothiazide, indicating that thiazides can cause significant issues including interaction with non-steroidal anti-inflammatory drugs, and stated that a combination product including hydrochlorothiazide is likely to be less effective than using supratherapeutic doses of candesartan as a sole agent.
Our clinical advisors have told us that candesartan cilexetil with hydrochlorothiazide would be an appropriate replacement for the majority of people who were using quinapril with hydrochlorothiazide prior to the recall of this treatment.
We note that as with all medicines, care needs to be taken in prescribing and providing information to individuals taking the medicines about possible adverse effects and possible interactions with other medications.
We understand that there is evidence to show significant benefit to adding hydrochlorothiazide to candesartan cilexetil.
The decision to use any medicine off label, or at unapproved doses is the sole responsibility of the prescriber acting within their scope of practice.
If you have any questions about this decision, you can email us at firstname.lastname@example.org; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.