candesartan

Absorption: Candesartan cilexetil is a prodrug that is converted to candesartan (the active component); 15% bioavailability of candesartan.

Distribution: Minimally distributed to tissues.

Protein Binding: >99%.

Metabolism/Excretion: Minor metabolism by the liver; 33% excreted in urine; 67% in feces (via bile).

Half-Life: 9 hr.

Time/Action Profile ⬆ ⬇

(antihypertensive effect)

ROUTE	ONSET	PEAK	DURATION
PO	within 2 wk	4–6 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Bilateral renal artery stenosis;
Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr <60 mL/min);
Severe hepatic impairment;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Volume- or salt-depleted patients or patients receiving large doses of diuretics (correct deficits before initiating therapy or initiate at lower doses);
Black patients (may not be as effective);
Impaired renal function due to primary renal disease or HF (may worsen renal function);
Rep: Women of reproductive potential;
Pedi: Children 1 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, chest pain, edema

F and E: hyperkalemia

GI: abdominal pain, diarrhea, nausea

GU: renal impairment

MS: arthralgia, back pain

Neuro: dizziness, fatigue, headache, dizziness, fatigue, headache

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal impairment.
Additive hypotension with other antihypertensives.
Excessive hypotension may occur with concurrent use of diuretics.
Concurrent use of potassium-sparing diuretics, potassium-containing salt substitutes, or potassium supplements may ↑ risk of hyperkalemia.
↑risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min
May ↑ lithium levels and risk of toxicity.

Route/Dosage ⬆ ⬇

Hypertension

PO (Adults ): 16 mg once daily; may ↑ up to 32 mg/day in 1–2 divided doses (initiate therapy at a lower dose in patients who are receiving diuretics or are volume depleted).
PO (Children 6–16 yr and >50 kg): 8–16 mg/day (in 1–2 divided doses); may ↑ up to 32 mg/day (in 1–2 divided doses).
PO (Children 6–16 yr and <50 kg): 4–8 mg/day (in 1–2 divided doses); may ↑ up to 16 mg/day (in 1–2 divided doses).
PO (Children 1–5 yr): 0.2 mg/kg/day (in 1–2 divided doses); may ↑ up to 0.4 mg/kg/day (in 1–2 divided doses).

Hepatic Impairment

(Adults ): Moderate hepatic impairment: Initiate at 8 mg once daily.

Heart Failure

PO (Adults ): 4 mg once daily initially, dose may be doubled at 2-wk intervals up to target dose of 32 mg once daily.

Availability ⬆ ⬇

(Generic available)

Tablets: 4 mg; 8 mg; 16 mg; 32 mg
In combination with: hydrochlorothiazide (Atacand HCT). See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess BP (lying, sitting, standing) and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
Monitor frequency of prescription refills to determine compliance.
Assess patients for signs of angioedema (dyspnea, facial swelling). May rarely cause angioedema.
HF: Monitor daily weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

Lab Test Considerations:

Monitor renal function. May cause ↑ in BUN and serum creatinine.
- May cause ↑ AST, ALT, and serum bilirubin.
- May cause hyperkalemia.
- May rarely cause hyperuricemia.
- May cause slight ↓ in hemoglobin and hematocrit. May cause neutropenia, leukopenia, and agranulocytosis.

Implementation ⬆ ⬇

Do not confuse Atacand with antacid.
Correct volume depletion, if possible, before starting therapy.
PO: An oral solution may be prepared by crushing the tablets.

Patient/Family Teaching ⬆ ⬇

Emphasize the importance of continuing to take as directed, even if feeling well. Take missed doses as soon as remembered if not almost time for next dose; do not double doses. Instruct patient to take medication at the same time each day. Warn patient not to discontinue therapy unless directed by health care professional. Advise patient to read Patient Information prior to starting and with each Rx refill in case of changes.
Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See Food Sources for Specific Nutrients.
Advise patient to avoid sudden position changes to decrease orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs and cough, cold, or allergy remedies.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Instruct patient to notify health care professional if swelling of face, eyes, lips, or tongue or if difficulty swallowing or breathing occur.
Rep: May cause fetal harm. Advise women of reproductive potential to use contraception and notify health care professional immediately if pregnancy is planned or suspected or if breastfeeding.
Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on proper technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇