candesartan cilexetil

can·de·sar·tan ci·lex·e·til (knd-särtn s-lks-tl)

n.

An angiotensin II receptor antagonist drug used primarily to treat hypertension.

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candesartan cilexetil

Amias (UK), Atacand

Pharmacologic class: Angiotensin II receptor antagonist

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed 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 2 to 32 mg/day as a single dose or divided in two doses.

Dosage adjustment

• Renal impairment
• Hepatic insufficiency

Contraindications

• Hypersensitivity to drug
• Pregnancy or breastfeeding
• Children (safety and efficacy not established)

Precautions

Use cautiously in:
• heart failure, renal or hepatic impairment, obstructive biliary disorders
• volume- or salt-depleted patients receiving high doses of diuretics
• black patients
• females of childbearing age.

Administration

• Give with or without food.
☞ 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.

Route	Onset	Peak	Duration
P.O.	2-4 hr	6-8 hr	24 hr

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

• 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 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.