Dosing & Uses
Dosage Forms & Strengths
16 mg PO qDay, titrate to 8-32 mg PO qDay OR divided q12hr
CHF (NYHA Class II-IV & Ejection Fraction <40%)
Initial 4 mg PO qDay; double dose q2Weeks up to 32 mg PO qDay
No dose adjustment necessary for patients with mild renal impairment
Initiate thearpy at lower dose if moderate renal impairment
Mild Impairment: No dosage adjustment
Moderate Impairment: Consider initiating at lower dose
Severe Impairment: Contraindicated
Dosage Forms & Strengths
6-17 Years (<50 kg)
- Usual starting dose: 4-8 mg/day PO
- Dosing Range: Titrate within 2 weeks to dose range 2-16 mg/day PO; not to exceed 32 mg/day
6-17 Years (>50 kg)
- Usual starting dose: 8-16 mg/day PO
- Dosing Range: Titrate within 2 weeks to dose range 4-32 mg/day PO; not to exceed 32 mg/day
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Digestive: Abnormal hepatic function and hepatitis
Hematologic: Neutropenia, leukopenia, and agranulocytosis
Metabolic and nutritional disorders: Hyperkalemia, hyponatremia
Respiratory system disorders: Cough
Skin and appendages disorders: Pruritus, rash and urticaria
Rare reports of rhabdomyolysis have been reported with ARBs
Black Box Warnings
Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system causing oligohydramnios, which may result in fetal injury and/or death
Severe hepatic impairment
Do not coadminister with aliskiren in patients with diabetes
History of angioedema
Risk of hypotension, especially in hypovolemic/hyponatremic patients, concomitant diuretics, dialysis, or during major surgery
Renal deterioration may occur
Discontinue immediately with pregnancy (see Black Box Warnings)
Caution in patients with CHF; may need to adjust dose
Hyperkalemia may occur with renal failure or drugs that increase potassium levels; monitor serum potassium levels periodically
Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy
Risk of anaphylactoid reactions and/or angioedema
Caution in hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, anuria
Caution in patients with aortic/mitral stenosis
Caution in patients with unstented unilateral/bilateral artery stenosis
Infants <1year must not receive candesartan; may have effects on the development of immature kidneys
In-utero exposure in neonates: If oliguria or hypotension occur, exchange transfusions or dialysis may be required to reverse hypotension and/or substitute for disordered renal function
Pregnancy & Lactation
Pregnancy Category: D
Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death
Lactation: Not known if excreted in breast milk; not recommended
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Angiotensin II receptor blocker (ARB); prevents angiotensin II from binding to its receptor, which in turn blocks the vasoconstriction and aldosterone secreting effects of angiotensin II.
Half-Life: 5-9 hr
Peak Plasma Time: 3-4 hr
Metabolism: Liver (minimal)
Excretion: Urine (26%)
Dialyzable: No (HD)
Onset of action: 2-3 hr
Peak effect: 6-8hr
Vd: 0.13 L/kg
Protein binding: >99%
Adding plans allows you to compare formulary status to other drugs in the same class.
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.