Renal Dose Adjustment (Based on CrCl)
<30 mL/min: Use not recommended
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined, caution advised
- As drugs directly acting on the renin-angiotensin system can cause fatal/neonatal morbidity/mortality, therapy should be suspended as soon as possible if pregnancy is detected [US Black Box Warning]
- Hydrochlorothiazide may precipitate azotemia in patients with renal disease. Therefore use with caution in severe renal disease. Cumulative effects of the drug may develop in patients with impaired renal function
- Use with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma
- Use with caution in patients with or without a history of allergy or bronchial asthma to avoid sensitivity reactions
- Avoid concomitant lithium use
- Therapy may cause exacerbation or activation of systemic lupus erythematosus
- Carefully monitor fluid or electrolyte imbalance during therapy
- Hydrochlorothiazide associated hypokalemia may be avoided or treated by use of potassium sparing diuretics or potassium supplements such as foods with a high potassium content
- Carefully adjust dosage of insulin or oral hypoglycemic agents when administering hydrochlorothiazide in diabetic patients
- Hydrochlorothiazide may increase the urinary excretion of magnesium; this may result in hypomagnesemia
- Suspend hydrochlorothiazide before carrying out tests for parathyroid function because marked hypercalcemia may be evidence of hidden hyperparathyroidism
- Hydrochlorothiazide may cause increases in cholesterol and triglyceride levels
- Hypotension may occur in heart failure or post-MI patients. Use with caution when initiating therapy.
- Symptomatic hypotension may occur after initiation of candesartan therapy in patients with intravascular volume depletion (eg, those treated with diuretics). Correct these conditions prior to starting therapy with candesartan or start treatment under medical supervision
- Patients with renal artery stenosis may experience acute renal failure. In patients with severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment may be associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. Use with caution in severe CHF
Cautions: Use cautiously in
- Severe renal impairment
- Hepatic impairment
- Progressive hepatic disease
- Electrolyte abnormalities
- Hyponatremia
- Volume depletion
- Post-sympathectomy
- Diabetes mellitus
- Seizure disorder
- Pregnancy near term
- Gestational hypertension
- SLE
- History of gout
- History of pancreatitis
- Elderly patients
Pregnancy Category:C (first trimester); D (second and third trimesters)
Breastfeeding: Safety unknown. No data available for the use of candesartan during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant. Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 31 May 2011).Maternal medication usually compatible with breastfeeding, no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 31 May 2011). ). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
candesartan/hydrochlorothiazide (generic)
- TABS:
- 16 mg/12.5 mg
- 32 mg/12.5 mg
- 32 mg/25 mg
Atacand HCT (candesartan/hydrochlorothiazide)
- TABS:
- 16 mg/12.5 mg
- 32 mg/12.5 mg
- 32 mg/25 mg
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
Atacand Plus (candesartan/hydrochlorothiazide)
- TABS:
- 16 mg/12.5 mg
- 32 mg/12.5 mg
- 32 mg/25 mg
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Atacand HCT 32-12.5 MG TABS [Bottle] (ASTRAZENECA LP)
30 mg = $115.99
90 mg = $325.97 - Atacand HCT 16-12.5 MG TABS [Bottle] (ASTRAZENECA LP)
30 mg = $110.99
90 mg = $315.97 - Atacand HCT 32-25 MG TABS [Bottle] (ASTRAZENECA LP)
30 mg = $121.99
90 mg = $340.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
