Candesartan: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Candesartan: clinical details
Prescribing considerations
- Assess volume status and hypotension risk, particularly with diuretic treatment or heart failure.
- Use caution in renal impairment, renal artery stenosis, haemodynamically significant valve disease and obstructive hypertrophic cardiomyopathy.
- Dual renin–angiotensin system blockade is generally not recommended and, if exceptionally required, needs specialist supervision.
- Primary hyperaldosteronism is unlikely to respond adequately.
- Review pregnancy potential and plans before prescribing.
Contraindications and cautions
- Hypersensitivity to candesartan cilexetil or a formulation excipient.
- Second or third trimester of pregnancy.
- Severe hepatic impairment or cholestasis.
- Use with aliskiren in patients with diabetes or qualifying renal impairment.
- Use in children younger than 1 year.
- The selected formulation contains lactose and is unsuitable for specified rare hereditary disorders of galactose metabolism.
Monitoring
- Check blood pressure, renal function, sodium and potassium before treatment where clinically appropriate.
- Repeat renal function and electrolytes after initiation or treatment changes, sooner in higher-risk patients.
- Continue periodic monitoring, with greater frequency during acute illness, renal compromise or interacting treatment.
- Investigate clinically significant rises in creatinine or potassium and review dehydration and concurrent medicines, including NSAIDs.
Clinical pharmacology
Candesartan cilexetil is an orally absorbed prodrug rapidly hydrolysed to candesartan, a selective AT1-receptor antagonist. Candesartan is highly protein bound, is eliminated mainly unchanged in urine and bile, and does not inhibit ACE or potentiate bradykinin.
Formulation and product differences
- The selected 4 mg tablet is white to off-white, round and biconvex.
- The selected tablet contains lactose monohydrate.
- The selected product can be divided into equal halves; this cannot be assumed for every manufacturer’s tablet.
Candesartan preparations and strengths
Tablet
Route: Oral
Strengths: 2 mg, 4 mg, 8 mg, 16 mg, 32 mg
Candesartan interactions
Check all medicines, supplements and salt substitutes with a pharmacist or prescriber. Important examples include:
Potassium supplements, potassium salt substitutes, potassium-sparing diuretics or heparin
May raise blood potassium; laboratory monitoring may be required.
Lithium
May increase lithium concentrations and toxicity; the combination is generally avoided or closely monitored.
NSAIDs, including ibuprofen and COX-2 inhibitors
May reduce the blood-pressure effect and increase the risk of kidney impairment and raised potassium.
Sources
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Record learning (opens in a new tab)Prepared and reviewed by the iatroX editorial team.