Atacand


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candesartan cilexetil

Amias (UK), Atacand

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.

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 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.

Dosage adjustment

• Renal impairment
• Moderate hepatic insufficiency

Contraindications

• Hypersensitivity to drug or its components

Precautions

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.

Administration

• 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.

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

• 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.

Atacand

(ăt′ə-kănd′)
A trademark for the drug candesartan cilexetil.

candasartan

An antihypertensive angiotensin-II-receptor blocker.
 
Adverse events
Upper respiratory tract infection, dizziness, back pain.

Atacand®

Candasartan cilexitil Cardiology An angiotensin II receptor blocker used alone or with other agents for HTN. See ABC, CANDLE.
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Chief executive Tom McKillop said as well as the strong performance from Nexium, launched in the US in 2001, and Symbicort, launched in Europe in 2000, it had also seen continued growth from Seroquel for schizophrenia and Atacand for cardiovascular disease.
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