Candesartan Cilexetil

Indications

Candesartan Cilexetil is used for: Hypertension, Congestive heart failure

Adult Dose

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. Heart failure Adult: Initially, 4 mg once daily, may be doubled at intervals of not <2 wk. Max: 32 mg once daily. Hepatic impairment: Mild to moderate: Initially, 4 mg once daily. Severe: Contraindicated.

Child Dose

Oral Hypertension 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 single or in 2 divided doses.

Renal Dose

Renal Impairment No dose adjustment necessary for patients with mild renal impairment Initiate thearpy at lower dose if moderate renal impairment

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity. Pregnancy (2nd and 3rd trimester) and lactation.

Precautions

Volume or sodium depletion, preexisting renal insufficiency; aortic or mitral valve stenosis, hypertrophic obstructive cardiomyopathy, renal artery stenosis, primary hyperaldosteronism. Patients with a history of angioedema, urticaria. Monitor serum potassium levels especially in elderly and renally impaired patients. Hypotension may occur during major surgery and anaesthesia due to suppression of the renin-angiotensin system. Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: Not known if excreted in breast milk; not recommended

Pregnancy-Lactation

Pregnancy Category: D Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: Not known if excreted in breast milk; not recommended

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.

Side Effects

Side effects of Candesartan Cilexetil : Dizziness, headache, vertigo, back pain, upper resp tract infections, pharyngitis, rhinitis, hypotension, hyperkalaemia, increased serum creatinine.

Mode of Action

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.