candesartan (Rx)

Brand and Other Names:Atacand
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 4mg
  • 8mg
  • 16mg
  • 32mg

Hypertension

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

Renal Impairment

No dose adjustment necessary for patients with mild renal impairment

Initiate therapy at lower dose if moderate renal impairment

Hepatic Insufficiency

Mild Impairment: No dosage adjustment

Moderate Impairment: Consider initiating at lower dose

Severe Impairment: Contraindicated

Dosage Forms & Strengths

tablet

  • 4mg
  • 8mg
  • 16mg
  • 32mg

Hypertension

1-6 Years

  • Usual starting dose: 0.2 mg/kg PO qDay or divided q12hr  
  • Dosing Range: 0.05-0.4 mg/kg/day PO
  • Refer to manufacturer's recommendations for suspension preparation

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
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Interactions

Interaction Checker

and candesartan

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Peripheral edema

            Dizziness

            Hypertriglyceridemia

            Hyperuricemia

            Fatigue

            Abdominal pain

            Diarrhea

            Nausea

            Arthralgia

            Back pain

            Chest pain

            Angina

            Tachycardia

            MI

            Palpitation

            Albuminuria

            Bronchitis

            Coughing

            Pharyngitis

            Dyspepsia

            Gastroenteritis

            Rhinitis

            URI

            Rash

            Angioedema

            Postmarketing Reports

            Digestive: Abnormal hepatic function and hepatitis

            Hematologic: Neutropenia, leukopenia, and agranulocytosis

            Immunologic: Angioedema

            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

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            Warnings

            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

            Contraindications

            Hypersensitivity

            Severe hepatic impairment

            Do not coadminister with aliskiren in patients with diabetes

            Cautions

            History of angioedema

            Hypovolemia

            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

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            Pregnancy & Lactation

            Pregnancy

            Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death

            Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents;

            when pregnancy is detected, discontinue drug as soon as possible

            Disease-associated maternal/embryo/fetal risk

            • Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage)
            • Hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly
            • Pregnant women with chronic heart failure are at increased risk for preterm birth; stroke volume and heart rate increase during pregnancy, increasing cardiac output, especially during the first trimester
            • Heart failure may worsen with pregnancy and may lead to maternal death; closely monitor pregnant patients for destabilization of their heart failure
            • Oligohydramnios in pregnant women who use drugs affecting the renin-angiotensin system in the second and third trimesters of pregnancy can result in the following: reduced fetal renal function leading to anuria and renal failure fetal lung hypoplasia, skeletal deformations, including skull hypoplasia, hypotension and death
            • In the unusual case that there is no appropriate alternative to therapy with drugs affecting renin-angiotensin system for a particular patient, apprise the mother of the potential risk to fetus
            • Perform serial ultrasound examinations to assess intra-amniotic environment; fetal testing may be appropriate, based on the week of pregnancy; patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury; if oligohydramnios is observed, consider alternative drug treatment
            • Closely observe infants with histories of in utero exposure to drug for hypotension, oliguria, hyperkalemia or other symptoms of renal impairment; in neonates with a history of in utero exposure, if oliguria or hypotension occurs, support blood pressure and renal perfusion; exchange transfusions or dialysis may be required as a means of reversing hypotension and replacing renal function

            Lactation

            Not known whether drug is excreted in human milk, but shown to be present in rat milk; because of potential for serious adverse reactions in breastfed infants, advise a nursing woman that breastfeeding is not recommended during therapy

            Pregnancy Categories

            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.

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            Pharmacology

            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.

            Pharmacokinetics

            Half-Life: 5-9 hr

            Peak Plasma Time: 3-4 hr

            Metabolism: Liver (minimal)

            Excretion: Urine (26%)

            Dialyzable: No (HD)

            Bioavailability: 15%

            Onset of action: 2-3 hr

            Peak effect: 6-8hr

            Duration: >24hr

            Vd: 0.13 L/kg

            Protein binding: >99%

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            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.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.