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
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.