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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.
Blocks aldosterone-producing and vasoconstrictive effects of angiotensin II at various receptor sites, including vascular smooth muscle and adrenal glands
Tablets: 4 mg, 8 mg, 16 mg, 32 mg
Indications and dosages
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.
• Renal impairment
• Moderate hepatic insufficiency
• Hypersensitivity to drug or its components
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.
• Give with or without food.
• Be aware that pharmacist can prepare a suspension from tablets for children who can't swallow tablets.
☞ 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.
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
Metabolic: gout, hyperkalemia
Musculoskeletal: arthralgia, back pain, muscle weakness
Respiratory: upper respiratory tract infection, cough, bronchitis
Other: dental pain, fever
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
• 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.
• 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.