Candesartan

Candesartan is a prescription medication used to treat High Blood Pressure (hypertension) and Chronic Heart Failure (NYHA Class II-IV and Ejection Fraction less than 40%)

• Candesartan is available under the following different brand names: Atacand.

Adult and pediatric dosage

Tablet

• 4mg
• 8mg
• 16mg
• 32mg

Hypertension

Adult dosage

• 16mg orally once daily, titrate to 8-32 mg each day or divided every 12 hours

Pediatric dosage

Children 1-6 years

• Usual starting dose: 0.2 mg/kg orally once per day or divided every 12 hours
• Dosing range: 0.05-0.4 mg/kg/day orally
• Refer to manufacturer’s recommendations for suspension preparation

Children 6-17 years (weighing less than 50 kg)

• Usual starting dose: 4-8 mg per day orally
• Dosing range: Titrate within 2 weeks to dose range 2-16 mg/day orally; not to exceed 32 mg/day

Children 6-17 years (weighing over 50 kg)

• Usual starting dose: 8-16 mg/day orally
• Dosing Range: Titrate within 2 weeks to dose range 4-32 mg/day orally; not to exceed 32 mg per day.

Chronic Heart Failure

Adult dosage

• Initial dose 4 mg orally once daily; double dose every two weeks up to 32 mg orally once daily

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Candesartan include:

• high potassium, 
• headache, 
• back pain, 
• runny nose, 
• sneezing, 
• sore throat, 
• dizziness, and
• abnormal kidney tests

Serious side effects of Candesartan include:

• hives, 
• difficulty breathing, 
• swelling in the face, lips, tongue, or throat, 
• lightheadedness, 
• little or no urination, 
• nausea, 
• weakness, 
• tingly feeling, 
• chest pain, 
• irregular heartbeats, and 
• loss of movement

Rare side effects of Candesartan include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Candesartan has severe interactions with the following drugs:
  • aliskiren 
• Candesartan has serious interactions with at least 13 other drugs. 
• Candesartan has moderate interactions with at least 121 other drugs.
• Candesartan has minor interactions with the following drugs:
  • agrimony
  • cornsilk
  • entevcavir
  • noni juice
  • octacosaniol 
  • reishi
  • shepherd’s purse

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity
• severe hepatitis impairment
• Do not coadminister with aliskiren in patients with diabetes 

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Candesartan?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Candesartan?”

Cautions

• History of angioedema
• Hypovolemia
• Risk of hypotension, especially in hypovolemic/hyponatremic patients, concomitant diuretics, dialysis, or during major surgery
• Renal deterioration may occur
• Discontinue immediately with pregnancy (see Black Box Warnings)
• Caution in patients with CHF; may need to adjust the dose
• Hyperkalemia may occur with renal failure or drugs that increase potassium levels; monitor serum potassium levels periodically
• Dual blockade of the renin-angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy
• Risk of anaphylactoid reactions and/or angioedema
• Caution in hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, anuria
• Caution in patients with aortic/mitral stenosis
• Caution in patients with unstented unilateral/bilateral artery stenosis
• Infants younger than 1 year of age must not receive candesartan; may have effects on the development of immature kidneys
• In-utero exposure in neonates: If oliguria or hypotension occurs, exchange transfusions or dialysis may be required to reverse hypotension and/or substitute for disordered renal function

Pregnancy and Lactation

• Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on the renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death
• Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents;
• when pregnancy is detected, discontinue the drug as soon as possible
  • Disease-associated maternal/embryo/fetal risk
  • Hypertension in pregnancy increases the maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage)
  • Hypertension increases the fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly
  • Pregnant women with chronic heart failure are at increased risk for preterm birth; stroke volume and heart rate increase during pregnancy, increasing cardiac output, especially during the first trimester
  • Heart failure may worsen with pregnancy and may lead to maternal death; closely monitor pregnant patients for destabilization of their heart failure
  • Oligohydramnios in pregnant women who use drugs affecting the renin-angiotensin system in the second and third trimesters of pregnancy can result in the following: reduced fetal renal function leading to anuria and renal failure fetal lung hypoplasia, skeletal deformations, including skull hypoplasia, hypotension, and death
  • In the unusual case that there is no appropriate alternative to therapy with drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of the potential risk to the fetus
  • Perform serial ultrasound examinations to assess intra-amniotic environment; fetal testing may be appropriate, based on the week of pregnancy; patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained an irreversible injury; if oligohydramnios is observed, consider alternative drug treatment
  • Closely observe infants with histories of in utero exposure to the drug for hypotension, oliguria, hyperkalemia or other symptoms of renal impairment; in neonates with a history of in utero exposure, if oliguria or hypotension occurs, support blood pressure and renal perfusion; exchange transfusions or dialysis may be required as a means of reversing hypotension and replacing the renal function
• Not known whether a drug is excreted in human milk, but shown to be present in rat milk; because of potential for serious adverse reactions in breastfed infants, advise a nursing woman that breastfeeding is not recommended during therapy