candesartan cilexetil

Amias (UK), Atacand

Pharmacologic class: Angiotensin II receptor antagonist

Therapeutic class: Antihypertensive

Pregnancy risk category D

FDA Box Warning

• When used during second or third trimester of pregnancy, drug may cause fetal injury and death. Discontinue as soon as possible when pregnancy is detected.

Action

Blocks aldosterone-producing and vasoconstrictive effects of angiotensin II at various receptor sites, including vascular smooth muscle and adrenal glands

Availability

Tablets: 4 mg, 8 mg, 16 mg, 32 mg

Indications and dosages

➣ Hypertension

Adults: 16 mg P.O. daily. Start at lower dosage if patient is receiving diuretics or is volume depleted. Range is 8 to 32 mg/day as a single dose or divided in two doses.

Children age 6 to younger than 17 weighing more than 50 kg (110 lb): 8 to 16 mg P.O. daily. Start at lower dosage if patient is receiving diuretics or is volume depleted. Range is 4 to 32 mg/day as a single dose or divided in two doses.

Children age 6 to younger than 17 weighing less than 50 kg: 4 to 8 mg P.O. daily. Start at lower dosage if patient is receiving diuretics or is volume depleted. Range is 4 to 16 mg/day as a single dose or divided in two doses.

Children age 1 to younger than 6: 0.20 mg/kg oral suspension P.O. daily. Start at lower dosage if patient is receiving diuretics or is volume depleted. Range is 0.05 to 0.4 mg/kg oral suspension P.O. daily as a single dose or divided in two doses.

➣ Heart failure (New York Heart Association class II-IV)

Adults: 4-mg tablet P.O. daily. Increase to target maintenance dosage of 32 mg P.O. daily by doubling dose q 2 weeks, as tolerated.

Dosage adjustment

• Renal impairment

• Moderate hepatic insufficiency

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• heart failure, renal or hepatic impairment

• volume- or salt-depleted patients receiving high doses of diuretics, hyperkalemia

• pregnant or breastfeeding patients

• children younger than age 1.

Administration

• Give with or without food.

• Be aware that pharmacist can prepare a suspension from tablets for children who can't swallow tablets.

See Supervise patient closely if he is receiving concurrent diuretics or is otherwise at risk for intravascular volume depletion.

• Know that diuretic may be added to regimen if candesartan alone doesn't control blood pressure.

Adverse reactions

CNS: dizziness, syncope, fatigue, headache

CV: hypotension, chest pain, peripheral edema, mitral or aortic valve stenosis

EENT: ear congestion or pain, sinus disorders, sore throat

GI: nausea, diarrhea, constipation, abdominal pain, dry mouth

GU: albuminuria, renal failure

Hepatic: hepatitis

Metabolic: gout, hyperkalemia

Musculoskeletal: arthralgia, back pain, muscle weakness

Respiratory: upper respiratory tract infection, cough, bronchitis

Other: dental pain, fever

Interactions

Drug-drug. Diuretics, other antihypertensives: increased risk of hypotension

Lithium: increased lithium blood level

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Drug-food. Salt substitutes containing potassium: increased risk of hyperkalemia

Drug-herbs. Ephedra (ma huang), licorice, yohimbine: decreased antihypertensive effect

Patient monitoring

• Monitor electrolyte levels and kidney and liver function test results.

• Assess blood pressure regularly to gauge drug efficacy.

• Closely monitor patient with renal dysfunction who is receiving concurrent diuretics.

Patient teaching

• Tell patient to take drug with or without food.

• Inform caregiver that pharmacist will prepare a suspension for child who can't swallow tablets. Shake suspension well before each dose.

• Teach patient about lifestyle changes that help control blood pressure, such as proper diet, exercise, stress reduction, smoking cessation, and moderation of alcohol intake.

• Instruct patient to use reliable birth control method and to contact prescriber and discontinue drug if she suspects she's pregnant.

• Caution patient not to take herbs without consulting prescriber.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.