Names and pronunciation
(can-deh-sar′tan) Atacand
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Individual generic drug information
Extracted information for candesartan only.
(can-deh-sar′tan) Atacand
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Func. class.: Antihypertensive
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Chem. class.: Angiotensin II receptor (type AT1) antagonist
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ACTION: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
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USES: Hypertension, alone or in com- bination; diabetic nephropathy in hyper- tension and type 2 diabetes
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Extracted information for candesartan only.
CONTRAINDICATIONS: Hyper sensitivity, child GFR <30 mL/min/1.73 m2, child <1 yr
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Black Box Warning: Pregnancy Precautions: Breastfeeding, children, geriatric patients, hypersensitivity to ACE inhibitors, volume/sodium depletion, renal/hepatic impairment, renal artery stenosis, hypotension, electrolyte abnormalities Black Box Warning: Pregnancy/breast- feeding: This product can cause fetal death when given during pregnancy; do not breastfeed
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SIDE EFFECTS CNS: Dizziness, fatigue, headache, syn- cope, insomnia CV: Chest pain, peripheral edema, hypo- tension, palpitations EENT: Sinusitis, rhinitis, pharyngitis GI: Diarrhea, nausea, abdominal pain, vomiting GU: Renal dysfunction MS: Arthralgia, back pain, myalgia SYST: Angioedema, hypersensitivity reac tions
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INTERACTIONS Increase: lithium level—lithium Increase: hyperkalemia—potassium, potassium-sparing diuretics, ACE inhibitors Increase: hypotension—ACE inhibitors, beta-blockers, calcium channel blockers, alpha-blockers, MAOIs, diuretics Decrease: hypotensive effect—COX-2 inhibitors, NSAIDs Drug/Herb Increase: antihypertensive effect— hawthorn Decrease: antihypertensive effect—ephedra Drug/Lab Increase: albumin, ALT/AST, potassium, serum creatinine
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Extracted information for candesartan only.
DOSAGE AND ROUTES Hypertension • Adult: PO single agent 16 mg/day ini- tially in patients who are not volume de- pleted, range 8-32 mg/day, with diuretic or volume depletion 8-32 mg/day as sin- gle dose or divided bid • Adolescent and child ≥6 yr and weight >50 kg: PO 8-16 mg/day or di- vided bid, adjust to B/P; usual range 4-32 mg/day, max 32 mg/day • Child ≥6 yr, weight <50 kg: PO 2-16 mg/day divided 1-2 doses, max 16 mg/day • Child ≥1 yr and <6 yr: PO 0.2 mg/kg/ day in 1 dose or in 2 divided doses, adjust to B/P, max 0.4 mg/kg/day Heart failure (Class II to IV) • Adult: PO 4 mg/day, double ≥2 wk, target dose 32 mg/day Renal/hepatic disease • Adult: PO ≤8 mg/day for severe renal disease/moderate hepatic disease; adjust dose as needed
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Available forms: Tablets 4, 8, 16, 32 mg
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Administer: • Without regard to meals • Oral liquid (compounded): shake well, do not freeze, use opened within 30 days
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Extracted information for candesartan only.
Evaluate: • Therapeutic response: decreased B/P, decreased heart failure–related compli- cations, death
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CLINICAL CONSIDERATIONS Assess • Hypotension: B/P, pulse; note rate, rhythm, quality; notify prescriber of sig- nificant changes, if hypotension is sig- nificant, have patient lie down, effect of product may take 2 wk • Electrolytes: potassium, sodium, cal- cium; baselines of renal/hepatic studies before therapy begins • Hydration: skin turgor, dryness of mu- cous membranes, correct volume depletion • Blood studies: BUN, creatinine, LFTs baseline, all may be increased • Serious hypersensitivity reaction: angioedema, anaphylaxis: facial swelling, difficulty breathing (rare) • Hyperkalemia: more common with other diuretics • Response and adverse reactions, es- pecially with renal disease; diuretic may be added • Heart failure: monitor for jugular ve- nous distention, weight, peripheral edema, dyspnea, crackles
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Patient and caregiver information: • To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain • That excessive perspiration, dehydra- C tion, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur • To avoid all OTC medications unless approved by prescriber; to inform all health care providers of use, full effect 4 wk, onset 2 wk; that product may be taken with or without meals; to store at room temperature, to comply with dosage schedule, even if feeling better • To use proper technique for obtaining B/P; to understand acceptable parame- ters; to rise slowly to sitting or standing position to minimize orthostatic hypoten- sion; that product may cause dizziness, fainting, light headedness • To continue to follow other require- ments, no smoking, lose weight, exercise • To limit potassium foods or salt sub- stitutes/supplements containing potas- sium unless discussed with health care professional
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Extracted information for candesartan only.
PHARMACOKINETICS Onset unknown, peak 3-4 hr, protein binding 90%, half-life 9-12 hr, duration 24 hr, extensively metabolized, excreted in urine (33%) and feces (67%)
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Filter the extracted dose blocks for this individual drug.
Hypertension
• Adult: PO single agent 16 mg/day ini- tially in patients who are not volume de- pleted, range 8-32 mg/day, with diuretic or volume depletion 8-32 mg/day as sin- gle dose or divided bid
Candidate age grouping · source page 224
Hypertension
• Adult: PO 4 mg/day, double ≥2 wk, target dose 32 mg/day Renal/hepatic disease
Candidate age grouping · source page 224
Hypertension
• Adult: PO ≤8 mg/day for severe renal disease/moderate hepatic disease; adjust dose as needed
Candidate age grouping · source page 224