Candesartan Cilexetil + Hydrochlorothiazide

Indications

Candesartan Cilexetil + Hydrochlorothiazide is used for: Hypertension, Congestive heart failure

Adult Dose

Hypertension 16-32 mg candesartan/12.5-25 mg HCTZ PO: 1 tablet once daily. Elderly: No dosage adjustment is necessary in elderly patients. Impaired Hepatic Function: Patients with Hepatic Impairment: Dose titration is recommended in patients with mild to moderate chronic liver disease. This should not be used in patients with severe hepatic impairment and/or cholestasis.

Child Dose

The safety and efficacy have not been established in children.

Renal Dose

Impaired Renal Function: In patients with mild to moderate renal impairment (ie, creatinine clearance between 30-80 mL/min/1.73m2 BSA), a dose titration is recommended. This should not be used in patients with severe renal impairment (creatinine clearance <30 mL/min/1.73 m2 BSA).

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity.

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. Lactation: enters breast milk/contraindicated

Pregnancy-Lactation

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimesters) Lactation: enters breast milk/contraindicated

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 + Hydrochlorothiazide : 1-10% Headache (3%), Dizziness (3%), Upper respiratory tract infection (4%), Back pain (3%), Flu-like syndrome (2%) Frequency Not Defined Candesartan Dizziness, headache, vertigo, back pain, upper resp tract infections, pharyngitis, rhinitis, hypotension, hyperkalaemia, increased serum creatinine. Hydrochlorothiazide Anorexia, Epigastric distress, Hypotension, Orthostatic hypotension, Photosensitivity, Anaphylaxis, Anemia, Confusion, Erythema multiforme, Stevens-Johnson syndrome, Exfoliative dermatitis including toxic epidermal necrolysis, Dizziness, Headache, Hyperuricemia, Hypokalemia and/or hypomagnesemia

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. Hydrochlorothiazide inhibits the reabsorption of Na and chloride in the distal tubules causing increased excretion of Na and water K and hydrogen ions.