Candesartan


Generic Medicine Info
Indications and Dosage
Oral
Heart failure
Adult: Initially, 4 mg once daily, may be doubled at intervals of not <2 wk. Max: 32 mg once daily.

Oral
Hypertension
Adult: Initially, 8 mg once daily adjusted according to response. Maintenance: 8 mg once daily. Max: 32 mg/day as single or in 2 divided doses. Patients w/ intravascular volume depletion: Initially, 4 mg once daily.
Child: 1 to <6 yr Initially, 200 mcg/kg/day. May increase according to response to 50-400 mcg/kg/day. ≥6 yr <50 kg: 4-8 mg/day, adjusted according to response to 2-16 mg/day; ≥50 kg: 8-16 mg/day, adjusted according response to 4-32 mg/day. All doses may be given as a single dose or in 2 divided doses.
Renal Impairment
Hypertension: Initially, 4 mg once daily.
Hepatic Impairment
Hypertension: Mild to moderate: Initially, 4 mg once daily. Severe: Contraindicated.
Heart Failure: Severe: Contraindicated.
Administration
May be taken with or without food.
Contraindications
History of angioedema. Severe hepatic impairment or cholestasis. Concomitant use w/ aliskiren in patients w/ DM. Pregnancy.
Special Precautions
Patients w/ volume or Na depletion, CHF, aortic or mitral valve stenosis, renal artery stenosis. Patients undergoing major surgery and anaesth. Renal and mild to moderate hepatic impairment. Lactation.
Adverse Reactions
Dizziness, headache, vertigo, back pain, upper resp tract infections, pharyngitis, rhinitis, hypotension, hyperkalaemia, increased serum creatinine.
MonitoringParameters
Periodically monitor renal function, BP, K levels and volume status.
Overdosage
Symptoms: Hypotension, dizziness, tachycardia, bradycardia. Management: Symptomatic and supportive treatment. Monitor vital signs. If not sufficient, increase plasma volume by infusion of isotonic saline soln. If still insufficient, admin sympathomimetic drugs.
Drug Interactions
NSAIDs may reduce antihypertensive effect and result in deterioration of renal function including possible acute renal failure. May increase serum lithium concentration. K-sparing diuretics, K supplements or salt substitutes containing K may increase risk of hyperkalaemia.
Potentially Fatal: Coadministration w/ aliskiren in diabetic patients may increase risk of renal impairment, hypotension and hyperkalaemia.
Action
Description: Candesartan inhibits the binding of angiotensin II to AT1 receptors in many tissues (e.g. vascular smooth muscles, adrenal gland) which leads to vasoconstriction blockade and aldosterone release.
Onset: Approx 2-3 hr.
Duration: ≥24 hr.
Pharmacokinetics:
Absorption: Absorbed from the GI tract. Absolute bioavailability: Approx 15%. Time to peak plasma concentration: 3-4 hr.
Distribution: Volume of distribution: 0.13 L/kg. Plasma protein binding: >99%.
Metabolism: Candesartan cilexetil undergoes ester hydrolysis in the GI tract to active form candesartan.
Excretion: Via urine and bile (as unchanged drug and inactive metabolites). Terminal half-life: Approx 9 hr.
Storage
Store between 15-30°C.
References
Anon. Candesartan. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/12/2013.

Atacand (Astra Zeneca LP). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 10/12/2013.

Atacand. U.S. FDA. https://www.fda.gov/. Accessed 10/12/2013.

Buckingham R (ed). Candesartan Cilexetil. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/12/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Candesartan cilexetil. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 10/12/2013.

Wickersham RM. Candesartan Cilexetil. Facts and Comparisons [online]. St. Louis, MO. Wolters Kluwer Clinical Drug Information, Inc. https://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed 10/12/2013.

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