candesartan cilexetil

Candesartan cilexetil (candesartan) is a drug used for treating high blood pressure (hypertension). It is in a class of drugs called angiotensin receptor blockers (ARBs) which includes losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro).

Angiotensin, formed in the blood by the action of angiotensin converting enzyme (ACE), is a powerful chemical that attaches to angiotensin receptors found in many tissues but primarily on smooth muscle cells surrounding blood vessels. Angiotensin's attachment to the receptors causes the muscle cells to contract and the blood vessels to narrow (vasoconstrict) which leads to an increase in blood pressure. Candesartan blocks the angiotensin receptor and therby prevents the action of angiotensin. As a result blood vessels expand and blood pressure is reduced.

Candesartan was approved by the FDA in 1998.

The most common side effects of candesartan are:

• headache,
• dizziness,
• fatigue, abdominal discomfort,
• diarrhea, and
• upper respiratory infections.

Other important side effects include:

• hyperkalemia,
• impotence,
• reduced renal function, and
• allergic reactions.

Rhabdomyolysis (inflammation and destruction of muscle) and angioedema (swelling of soft tissues including those of the throat and larynx) are rare but serious side effects of candesartan.

The recommended dose range of candesartan for adults is 4 to 32 mg once daily. The usual starting dose for hypertension is 16 mg daily, and the starting dose for treating heart failure is 4 mg once daily. Doses may be doubled at 2 week intervals as tolerated by patients. The maximum dose is 32 mg daily.

Since ARBs can increase the concentrations of potassium in the blood, combining candesartan with other medications that can increase the concentration of potassium in the blood, such as hydrodiuril (Dyazide), spironolactone (Aldactone), and potassium supplements, may lead to dangerous increases in potassium blood levels.

• Combining candesartan or other ARBs with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who are elderly, fluid-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.
• There have been reports that aspirin and other NSAIDs such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ARBs.
• An increase in lithium (Eskolith, Lithobid) blood levels has been reported when lithium is combined with candesartan. Careful monitoring of lithium levels is recommended when candesartan and lithium are used concomitantly.

When used in the second or third trimester of pregnancy, ARBs can cause injury and even death to the fetus. Candesartan should not be used during pregnancy. When pregnancy is first detected, candesartan should be stopped.

It is not known whether candesartan is secreted in human milk. Candesartan is secreted in rat milk. Due to the possibility of harm to the nursing infant, if possible, candesartan should be discontinued by nursing mothers.

What preparations of candesartan are available?

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

How should I keep candesartan stored?

Tablets should be stored at room temperature, between 15-30 C (59-86 F).