title: Glycosuria medicated with ipragliflozin and nifedipine or ipragliflozin and candesartan: a case report.
abstract: BACKGROUND
  Animal studies have reported that treatment with angiotensin II receptor blockers reduced kidney sodium-dependent glucose cotransporter expression. We therefore hypothesized that patients with hypertension treated with an angiotensin II receptor blocker (candesartan) would probably have an increased response to sodium-dependent glucose cotransporter inhibitor therapy (ipragliflozin) compared with patients treated with alternative hypertensive medications such as calcium channel blockers (nifedipine). Although sodium-dependent glucose cotransporter inhibitor (ipragliflozin) is a new anti-diabetic medicine, the clinical efficacy in the Japanese population has not been fully evaluated. We compared the combined effect of angiotensin II receptor blocker candesartan plus ipragliflozin with nifedipine plus ipragliflozin therapy and found that the combination of candesartan plus ipragliflozin was more effective in increasing glycosuria and lowering plasma glucose.
  
  
  METHODS
  A 57-year-old Japanese man with essential hypertension was treated with candesartan. Candesartan was switched to nifedipine for the initial 10 days of an observation period and 5 days later he was started on ipragliflozin (day 6 of nifedipine treatment) with nifedipine for the next 5 days. Thereafter (from day 11 to day 20), candesartan was started instead of nifedipine and ipragliflozin was continued. In the last 5 days ipragliflozin was stopped and he was treated with candesartan alone. Neither nifedipine alone (0.038+/-0.004) nor candesartan alone (0.048+/-0.006) produce any trace amount of glycosuria. However, the extent of glycosuria under ipragliflozin with candesartan treatment (37.5+/-8.45) was significantly greater than that of ipragliflozin with nifedipine (23.75+/-0.35; P<0.05).
  
  
  CONCLUSIONS
  Candesartan demonstrated additive actions with ipragliflozin to increase glycosuria compared to ipragliflozin with nifedipine treatment.
authors.affiliation: Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan. okadash@gunma-u.ac.jp.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Okada
authors.forename: Ryo
authors.initials: R
authors.lastname: Shibusawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tagaya
authors.forename: Tsugumichi
authors.initials: T
authors.lastname: Saito
authors.forename: Eijiro
authors.initials: E
authors.lastname: Yamada
authors.forename: Yoko
authors.initials: Y
authors.lastname: Shimoda
authors.forename: Tetsurou
authors.initials: T
authors.lastname: Satoh
authors.forename: Junichi
authors.initials: J
authors.lastname: Okada
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005960:Glucosides / Q000627:therapeutic use*; D006029:Glycosuria / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D002121:Calcium Channel Blockers; D005960:Glucosides; D013777:Tetrazoles; D013876:Thiophenes; C572941:ipragliflozin; D009543:Nifedipine; C081643:candesartan