Contents

Search

candesartan (Atacand)

Tradname: Atacand. (candesartan cilexetil) Generic Dec 2012 [8] Indications: - an ACE inhibitor is indicated, but not tolerated a) hypertension b) heart failure (see CHARM trials) c) diabetes mellitus* - diabetic nephropathy d) nondiabetic proteinuric nephropathy [8] e) stroke prevention [2] f) migraine prophylaxis [4,10] g) may improve executive function# after 1 year in elderly independent of antihypertensive effect [9] * Only irbesartan (Avapro) & losartan (Cozaar) shown to have beneficial effects [3]; candesartan probably does as well # measured by Trail Making Test Part B [9] Contraindications: 1) pregnancy, trimesters 2 & 3, probably 1 as well 2) angioedema with ACE inhibitor Dosage: - start: 16 mg QD when used as monotherapy - CHF: start 4-8 mg QD; max 32 mg QD Tabs: 4, 8, 16, 32 mg. Addition of 12.5 mg of HCTZ may improve BP response. Dosage adjustment in renal failure: - No dose adjustment is required for elderly or patients with mild renal insufficiency or hepatic insufficiency Pharmacokinetics: - bioavailability 15%, enhanced by foot - onset of action 2-3 hours - peak effect 6-8 hours - 1/life 9 hours (dose-dependent) - volume of distribution 0.13 L/kg - protein binding 99% - clearance 60% renal, 36% biliary Adverse effects: - cardiovascular: flushing, chest pain, peripheral edema, tachycardia, palpitations - no increased risk of myocardial infarction in high-risk patients [5] - CNS: dizziness, lightheadedness, drowsiness, fatigue, headache, vertigo, anxiety, depression, somnolence, fever - dermatologic: rash, angioedema (occurs within 30 minutes-30 days of 1st dose) - metabolic: hyperglycemia, hypertriglyceridemia, hyperuricemia small increases in serum K+ as with ACE inhibitors - gastrointestinal: nausea, vomiting, diarrhea, dyspepsia, gastroenteritis - musculoskeletal: back pain, arthralgia, increased CPK, myalgia weakness - neurologic: paresthesia - renal: hematuria - respiratory: upper respiratory tract infection, pharyngitis, rhinitis, bronchitis, cough, sinusitis, epistaxis, dyspnea - diaphoresis [6] Mechanism of action: 1) angiotensin II receptor antagonist 2) BP reduction of 8-12/4-8 mm of Hg with 8-32 mg QD 3) limited effectiveness for diabetic retinopathy [7] a) diabetes type 1: - modest reduction in the incidence of retinopathy - was no effect on progression of retinopathy. b) diabetes type 2 - may risk for progression of retinopathy - may facilitate regression of early retinopathy

Interactions

drug interactions drug adverse effects (more general classes) monitor with ARBs

Related

CHARM program (clinical trials)

General

angiotensin II receptor antagonist (ARB)

Properties

Database Correlations

PUBCHEM correlations

References

  1. Internal Medicine Alert 20(21):165 1998
  2. Journal Watch 23(4):34, 2003 Tronvik E et al, JAMA 289:65, 2003
  3. Prescriber's Letter 9(11):61 2002
  4. Journal Watch 23(21):165, 2003
  5. Demers C, McMurray JJ, Swedberg K, Pfeffer MA, Granger CB, Olofsson B, McKelvie RS, Ostergren J, Michelson EL, Johansson PA, Wang D, Yusuf S; CHARM Investigators. Impact of candesartan on nonfatal myocardial infarction and cardiovascular death in patients with heart failure. JAMA. 2005 Oct 12;294(14):1794-8. PMID: 16219883
  6. Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
  7. Chaturvedi N et al, Effect of candesartan on prevention (DIRECT-Prevent 1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials Lancet. 2008 Oct 18;372(9647):1394-402. Epub 2008 Sep 25. PMID: 18823656 - Sjolie AK et al, Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial Lancet. 2008 Oct 18;372(9647):1361-3. PMID: 18823658
  8. Prescriber's Letter 19(4): 2012 CHART: Anticipated Availability of First-Time Generics Detail-Document#: 280401 (subscription needed) http://www.prescribersletter.com
  9. Lou N ARB Slows Cognitive Decline in Trial... But How? - Consequence of lowered blood pressure, or perhaps a direct effect -- or just a fluke Mhttps://www.medpagetoday.com/neurology/dementia/87929 - Hajjar I, Okafor M, McDaniel D et al ffects of Candesartan vs Lisinopril on Neurocognitive Function in Older Adults With Executive Mild Cognitive Impairment. A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012252. August 6. PMID: 32761160 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769104
  10. Sanchez-Rodriguez C, Sierra A, Planchuelo-Gomez A et al Real world effectiveness and tolerability of candesartan in the treatment of migraine: a retrospective cohort study. Sci Rep. 2021 Feb 15;11(1):3846. doi: 10.1038/s41598-021-83508-2. PMID: 33589682 Free PMC article.

Component-of

candesartan/hydrochlorothiazide