ArticleJournal of human hypertension2021
Impact of angiotensin receptor blocker product recalls on antihypertensive prescribing in Germany.
Article in Journal of human hypertension, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- The consequences of medicine shortages on healthcare utilization and care fragmentation.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Temporal trends in the prescription of low-dose antithrombotic and anti-inflammatory therapies in Germany (2022-2024).Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Inhaler use and their carbon footprint in Germany: a 10-year analysis (2013-2022).BMJ open respiratory research · 2025Article
- Changes in blood pressure, medication adherence, and cardiovascular-related health care use associated with the 2018 angiotensin receptor blocker recalls and drug shortages among patients with hypertension.Journal of managed care & specialty pharmacy · 2025Article
- The 10 top prescribed medicines in Germany from 1985 to 2022: pharmacological analysis.Naunyn-Schmiedeberg's archives of pharmacology · 2025Article
- The Utilization of Discharge Prescriptions in Germany.Deutsches Arzteblatt international · 2024Article
- Effects of angiotensin II receptor blockers on serum potassium level and hyperkalemia risk: retrospective single-centre analysis.European journal of hospital pharmacy : science and practice · 2023Article
- A collaborative study of the impact of N-nitrosamines presence and ARB recall on ARB utilization - results from IQVIA™ Disease Analyzer Germany.European journal of clinical pharmacology · 2023Article
- Valsartan, Losartan and Irbesartan use in the USA, UK, Canada and Denmark after the nitrosamine recalls: a descriptive cohort study.BMJ open · 2023Article
- Use of fixed-dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia.Clinical research in cardiology : official journal of the German Cardiac Society · 2023Article
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- Does the Red Shift in UV-Vis Spectra Really Provide a Sensing Option for Detection ofACS omega · 2023Article
- Sacubitril/valsartan in heart failure: efficacy and safety in and outside clinical trials.ESC heart failure · 2022Review
- Angiotensin II receptor blockers (ARBs) and manufacturing contamination: A retrospective National Register Study into suspected associated adverse drug reactions.British journal of clinical pharmacology · 2022Article
- Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012-2021.Frontiers in cardiovascular medicine · 2022Article
- Utilization of drugs with reports on potential efficacy or harm on COVID-19 before, during, and after the first pandemic wave.Pharmacoepidemiology and drug safety · 2021Article
- Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014-2019.Antibiotics (Basel, Switzerland) · 2021Article
- Impact of national valsartan recalls on Veterans' outcomes.Therapeutic advances in drug safety · 2021Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In Germany, ~8 million patients take angiotensin receptor blockers (ARBs) and 2.25 million of them valsartan. In 2018, contamination of generic ARBs with probable carcinogenic nitrosamines resulted in more than 30 recalls. The impact of such a huge recall has never been explored in Europe. We analyzed the utilization of valsartan, all ARBs, and other alternative antihypertensive drugs in Germany. We used our database of anonymized dispensing data from >80% of community pharmacies at the expense of the statutory health insurance (SHI) funds from January 2017 to December 2019. We analyzed 290.8 million prescriptions, including all oral mono- and fixed-dose combinations of ARBs and plausible alternatives, i.e. ACE inhibitors (ACEi), beta-blockers (BB), and calcium channel blockers (CCB). Utilization was calculated by defined daily doses per 1000 SHI-insured persons per day (DID). Valsartan use decreased substantially after the recalls in July 2018 from 39.0 to 14.2 DID (-64%) in the second quarter of 2019 and to 16.9 DID (-57%) in the fourth quarter of 2019. Simultaneously, the use of alternative ARBs increased from 77.7 DID in the second quarter of 2018 to 121.9 DID (+57%) in the fourth quarter of 2019, mainly due to an increase of candesartan dispensing to 99.8 DID (+73%). There were no changes in the utilization of ACEi, BB, or CCB. The majority of recalled generic valsartan products were replaced by other ARBs, predominantly candesartan, despite documented drug shortages. In contrast to previous safety warnings/recalls, our data do not suggest an under-prescription of antihypertensives during this period.
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