Medical Description
Angiotensin II receptor blocker used in the treatment of chronic hypertension, acute coronary syndromes, heart failure and proteinuric chronic kidney disease.
Indication & Usage
-Chronic hypertension: Oral: Initial: 8 mg once daily; evaluate response after approximately 2 to 4 weeks and titrate dose (eg, increase the daily dose by doubling), as needed, up to 32 mg once daily; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week.
-Acute coronary syndromes:1-Non-ST-elevation acute coronary syndrome: Oral: Initial: 8 mg once daily; increase dose as tolerated up to 32 mg/day under close monitoring to avoid hypotension. 2-ST-elevation myocardial infarction: Oral: Initial: 8 mg once daily; increase dose as tolerated up to 32 mg/day under close monitoring to avoid hypotension.
-Heart failure with reduced ejection fraction: Oral: Initial: 4 to 8 mg once daily; increase dose (eg, double) every ≥2 weeks based on response and tolerability to a target dose of 32 mg once daily.
-Proteinuric chronic kidney disease: Oral: Initial: 8 mg once daily; can be increased to 32 mg once daily based on blood pressure response and tolerability. Target to an appropriate blood pressure goal and a proteinuria goal of <1 g/day.
-Pediatric dosing:
Hypertension:
A-In case of children 1 to <6 years: Oral: Initial: 0.2 mg/kg/day once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed); usual range: 0.05 to 0.4 mg/kg/day divided once or twice daily; maximum daily dose: 0.4 mg/kg/day.
-For the rest of pediatric dosing refer to Dosage and Administration.
Active Ingredients
Candesartan Cilexetil
Dosage & Administration
-Administer without regard to meals.
-Pediatric dosing (continue):
B-In case of children and adolescents 6 to <17 years: Oral:1-if the patient weight is <50 kg: Initial: 4 to 8 mg/day once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed); usual range: 2 to 16 mg/day divided once or twice daily; maximum daily dose: 32 mg/day, 2-if the patient weight is >50 kg: Initial: 8 to 16 mg/day once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed); usual range: 4 to 32 mg/day divided once or twice daily; maximum daily dose: 32 mg/day.
C-In case of adolescents ≥17 years: Oral: Initial: 16 mg once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed; maximum effect seen within 4 to 6 weeks); usual range: 8 to 32 mg/day divided once or twice daily.
Side Effects
Hypotension, renal function abnormality, dizziness, hyperkalemia, back pain, upper respiratory tract infection, pharyngitis, rhinitis, headache, exacerbation of renal disease (children & adolescents) and increased serum creatinine.
Safety Advice
-Should not be given to patients suffering from hypersensitivity to candesartan.
-May cause hyperkalemia, risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium containing salts.
-Symptomatic hypotension may occur upon initiation in patients who are salt- or volume-depleted.
-May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, heart failure).
-Use caution in patients with significant aortic/mitral stenosis.
-Avoid use in patients with ascites due to cirrhosis.
-Use with caution when initiating in heart failure patients.
-Dosage adjustment is required in patients with moderate hepatic impairment.
-Use candesartan with caution in patients with unstented unilateral/bilateral renal artery stenosis.
-Use with caution with preexisting renal insufficiency.
-Avoid use in infants <1 year of age due to potential effects on the development of immature kidneys.
-The blood pressure-lowering effects of ARBs may be less pronounced in black patients.
-In case of over dose be ready to tell or show what was taken, how much and when it happened, and seek immediate medical attention. For additional information call us on 16676. Always tell your physician your detailed medical history.
Storage
Store at room temperature.
Drug Interactions
-Alfuzosin: May enhance the hypotensive effect of blood pressure lowering agents.
-Angiotensin-converting enzyme inhibitors: Angiotensin II receptor blockers may enhance the adverse/toxic effect of angiotensin-converting enzyme inhibitors.
-Antipsychotic agents: blood pressure lowering agents may enhance the hypotensive effect of Antipsychotic Agents.
-Dapoxetine: May enhance the orthostatic hypotensive effect of angiotensin II receptor blockers.
-Duloxetine: blood pressure lowering agents may enhance the hypotensive effect of duloxetine.
-Heparin: May enhance the hyperkalemic effect of angiotensin II receptor blockers.
-Levodopa-containing products: blood pressure lowering agents may enhance the hypotensive effect of Levodopa-containing products.
-Lithium: Angiotensin II receptor blockers may increase the serum concentration of Lithium.
-Nicorandil: May enhance the hyperkalemic effect of angiotensin II receptor blockers.
-Nonsteroidal Anti-Inflammatory Agents: Angiotensin II receptor blockers may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.
-Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of blood pressure lowering agents.
-Potassium Salts: May enhance the hyperkalemic effect of angiotensin II receptor blockers.
-Potassium-sparing diuretics: Angiotensin II receptor blockers may enhance the hyperkalemic effect of potassium-sparing diuretics.
-Trimethoprim: May enhance the hyperkalemic effect of angiotensin II receptor blockers.
Pregnancy & Lactation
-Drugs that act on the renin-angiotensin system can cause injury to the developing fetus. The use of drugs which act on the renin-angiotensin system are associated with oligohydramnios. The use of angiotensin II receptor blockers is generally not recommended to treat chronic hypertension in pregnant women.
-Candesartan is present in breast milk. Due to the potential for serious adverse reactions in the breastfeeding infant, breastfeeding is not recommended during the treatment.
-Ask your physician before taking any medication during pregnancy or lactation.