Home Drug Guide Candesartan Cilexetil

Drug Guide

Generic Name

Candesartan Cilexetil

Brand Names Atacand

Classification

Therapeutic: Antihypertensive

Pharmacological: Angiotensin II Receptor Blocker (ARB)

FDA Approved Indications

Hypertension
Heart failure (as adjunct to other therapies)

Mechanism of Action

Candesartan Cilexetil selectively blocks the angiotensin II type 1 (AT1) receptor, preventing vasoconstriction and aldosterone-mediated volume expansion, thereby lowering blood pressure and reducing the workload on the heart.

Dosage and Administration

Adult: Typically, 8-32 mg once daily. Dose may be adjusted based on response.

Pediatric: Not approved for use in children.

Geriatric: Use with caution; start at lower doses and titrate as needed.

Renal Impairment: Use with caution; dosage adjustments may be necessary based on renal function.

Hepatic Impairment: Use with caution; monitor for adverse effects. No specific dose adjustment available.

Pharmacokinetics

Absorption: Well absorbed orally, with bioavailability approximately 40%.

Distribution: Vast volume of distribution; protein binding more than 99%.

Metabolism: Prodrug metabolized in the gastrointestinal tract and liver to active metabolites.

Excretion: Excreted mainly via feces and urine; active metabolites eliminated renally.

Half Life: Approximately 9 hours for candesartan; active metabolites may have longer half-lives.

Contraindications

Hypersensitivity to candesartan or other ARBs
Pregnancy (especially 2nd and 3rd trimesters)
History of angioedema related to previous use of ACE inhibitors or ARBs

Precautions

Use cautiously in patients with renal artery stenosis
Monitor renal function and potassium levels during therapy
Pregnancy category D; discontinue at confirmed pregnancy

Adverse Reactions - Common

Dizziness (Common)
Headache (Common)
Hyperkalemia (Common)
Fatigue (Common)

Adverse Reactions - Serious

Angioedema (Rare)
Hypotension (Rare)
Renal dysfunction (Rare)

Drug-Drug Interactions

Other antihypertensives (additive hypotension)
Potassium-sparing diuretics and potassium supplements (risk of hyperkalemia)
NSAIDs (may reduce antihypertensive efficacy and affect renal function)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function, and serum potassium levels.

Diagnoses:

Risk for decreased cardiac output
Risk for electrolyte imbalance

Implementation: Administer medication consistently; monitor for adverse effects; educate patient on signs of hypotension and hyperkalemia.

Evaluation: Assess blood pressure response; ensure renal function remains stable.

Patient/Family Teaching

Take medication exactly as prescribed, usually once daily.
Notify healthcare provider if symptoms of angioedema (swelling of face, lips, tongue) occur.
Be cautious about potassium-rich foods and salt substitutes containing potassium.
Avoid sudden position changes to reduce dizziness risk.

Special Considerations

Black Box Warnings:

Fetal toxicity: Discontinue as soon as pregnancy is detected.

Genetic Factors: No specific genetic considerations identified.

Lab Test Interference: May affect renal function and serum potassium levels; regular monitoring required.

Overdose Management

Signs/Symptoms: Severe hypotension, dizziness, tachycardia.

Treatment: Place patient in supine position; administer IV fluids; use vasopressors if necessary. Dialysis in severe cases may be considered.

Storage and Handling

Storage: Store at room temperature (20°C to 25°C), away from moisture and light.

Stability: Stable under recommended storage conditions; check expiration date before use.