Candesartan

Candesartan  is an angiotensin II receptor antagonist used mainly for the treatment of hypertension. The prodrug candesartan cilexetil is marketed by AstraZeneca and Takeda Pharmaceuticals, commonly under the trade names Blopress, Atacand, Amias, and Ratacand.

2-ethoxy-1-({4-[2-(2H-1,2,3,4-tetrazol-5-yl)phenyl]phenyl}methyl)-1H-1,3-benzodiazole-7-carboxylic acid


USE
As all angiotensin II receptor antagonists, candesartan is indicated for the treatment of hypertension. Results from the CHARM study in the early 2000s demonstrated the morbidity and mortality reduction benefits of candesartan therapy in congestive heart failure. Thus, while ACE inhibitors are still considered first-line therapy in heart failure, candesartan can be used in combination with an ACE to achieve improved mortality and morbidity vs. an ACE alone and additionally is an alternative in patients intolerant of ACE inhibitor therapy.


DOSE :
Hypertension
Adult: Initially, 8 mg once daily adjusted according to response. Maintenance: 8 mg once daily. Max: 32 mg daily.
Renal impairment: For patients with renal impairment or on haemodialysis: Initially, 4 mg once daily.
Hepatic impairment: Initially, 2 mg once daily. Avoid in severe impairment.

Heart failure
Adult: Initially, 4 mg once daily, may double dose at intervals of not <2 32="" daily.="" max:="" mg="" nbsp="" p="" wk.="">Renal impairment: Reduce dose or discontinue treatment if renal function deteriorates.
Hepatic impairment: Initially, 2 mg once daily. Avoid in severe impairment.

Special Populations: Patients with renal and hepatic impairment: Initially, 2 mg once daily.

Special Precautions:  Volume or sodium depletion, preexisting renal insufficiency; aortic or mitral valve stenosis, hypertrophic obstructive cardiomyopathy, renal artery stenosis, primary hyperaldosteronism. Patients with a history of angioedema, urticaria. Monitor serum potassium levels especially in elderly and renally impaired patients. Hypotension may occur during major surgery and anaesthesia due to suppression of the renin-angiotensin system.