Class: Angiotensin II Receptor Antagonist
Dosage Forms. Tablet: 4 mg, 8 mg, 16 mg, and 32 mg
Common FDA Label Indication, Dosing, and Titration.
1. Heart failure: 4 mg po daily, titrate to 32 mg/d po
2. Hypertension: Adults, 16 mg po daily or in 2 divided doses, may titrate to 8-32 mg po daily; Children 1-5 y, 0.2 mg/kg po daily, may titrate to 0.4 mg/kg daily; Children 6-16 y and >50 kg, 4-8 mg po daily, may titrate to 16 mg daily; Children 6-16 y and >50 kg, 8-16 mg po daily, may titrate to 32 mg daily
1. Cerebrovascular accident prophylaxis: 4 mg po daily, may titrate to 8-16 mg po daily
2. Diabetic nephropathy: 8-16 mg po daily
3. Kidney disease: 2-8 mg po daily
MOA. Candesartan is a selective, reversible, competitive antagonist of the angiotensin II receptor type 1 (AT1).
Drug Characteristics: Candesartan
Medication Safety Issues: Candesartan
Drug Interactions: Candesartan
Adverse Reactions: Candesartan
Efficacy Monitoring Parameters. Decreased BP, resolution of CHF; may require 3-6 wk to obtain therapeutic response.
Toxicity Monitoring Parameters. Report signs/symptoms of hypotension, tachycardia. Baseline and periodic sodium, potassium, total bicarbonate, BUN, SCr, and urinalysis prior to initiating therapy.
Key Patient Counseling Points. Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated. Seek care if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs.
Clinical Pearls. Not indicated for use in children <1 y of age. Observe volume-depleted patient for hypotension with first dose. May cause progressive renal impairment and acute renal failure; those with pre-existing renal impairment, CHF, or diabetes are at increased risk.