Monitor serum potassium during the 1st month of drospirenone treatment if ARBs are used concurrently and thereafter as clinically indicated. Coadministration may also result in increases in serum creatinine in heart failure patients. Nefazodone: (Minor) Although relatively infrequent, nefazodone may cause orthostatic hypotension in some patients; this effect may be additive with antihypertensive agents. Because candesartan does not inhibit angiotensin-converting enzyme, it does not inhibit the breakdown of bradykinin. Dose as for GFR<10 mL/min, Unlikely to be dialysed. The trial was stopped early because aliskiren was associated with an increased risk of non-fatal stroke, renal complications, hyperkalemia, and hypotension. If these drugs are used together, closely monitor for changes in blood pressure. There is some evidence that ARB medications also reduce protenuria in patients with renal disease and diabetic retinopathy. Duloxetine: (Moderate) Orthostatic hypotension and syncope have been reported during duloxetine administration. Metformin: (Moderate) Monitor blood glucose during concomitant metformin and angiotensin receptor blocker use. Monitor heart rate and blood pressure. In persons who are elderly, volume-depleted, or with compromised renal function, coadministration of angiotensin II blockers and NSAIDs may result in deterioration of renal function, including possible acute renal failure; these effects are usually reversible. Dosage adjustments of the antihypertensive medication may be required. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. When used during the second and third trimesters, medications that affect the renin-angiotensin system (e.g., ACE inhibitors, angiotensin II receptor antagonists) have been associated with reduced fetal renal function and increased fetal and neonatal morbidity and death. While candesartan has a much greater affinity (10,000-fold or greater) for the AT1 subtype than the AT2 subtype, the AT2 subtype is not known to mediate cardiovascular homeostasis. tan kan-d-sr-tan. Although no dosage adjustment is recommended for geriatric patients, the plasma concentrations of candesartan are higher in the elderly, with a 50% increase in Cmax and 80% increase in AUC, compared to younger subjects. Angiotensin-converting enzyme inhibitors: (Major) In general, avoid combined use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) due to lack of benefit with concomitant use in most patients. This effect is of particular concern in the setting of acute myocardial infarction, unstable angina, or other acute hemodynamic compromise. In addition, angiotensin II receptor antagonists have been associated with a reduced incidence in the development of new-onset diabetes in patients with hypertension or other cardiac disease. Candesartan may cause death or serious injury to the fetus when taken in the last 6 months of pregnancy. Decreased dosage of the antihypertensive agent may be required when given with trazodone. Monitor heart rate and blood pressure. Alternative therapies may be considered. Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Amyl Nitrite: (Moderate) Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Patients should be informed about measures to prevent orthostatic hypotension, such as sitting on the edge of the bed for several minutes prior to standing in the morning, or rising slowly from a seated position. Use the oral suspension within 30 days after first opening the bottle. When volume-depletion is suspected (e.g., in patients taking diuretics, particularly those with impaired renal function), initiate therapy with a lower dose (e.g., 8 mg PO once daily). This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Candesartan cilexetil tablets can cause harm or death to an unborn baby. Clinical practice guidelines classify candesartan as possibly effective for migraine prophylaxis. 16 mg PO daily. Anaphylactic reactions (anaphylactoid reactions) and angioedema have been reported with angiotensin II receptor antagonists. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. The concurrent use of angiotensin II receptor antagonists (ARBs) may increase the risk of hyperkalemia, especially in the presence of renal impairment. Dosage adjustments may be necessary. Apomorphine: (Moderate) Use of angiotensin II receptor antagonists and apomorphine together can increase the hypotensive effects of apomorphine. Systemic drug interactions with the urethral suppository (MUSE) or alprostadil intracavernous injection are unlikely in most patients because low or undetectable amounts of the drug are found in the peripheral venous circulation following administration. Sparsentan: (Contraindicated) Concomitant use of sparsentan and angiotensin receptor blockers (ARBs) is contraindicated due to the additive risk for serious adverse effects such as hypotension, syncope, hyperkalemia, and renal dysfunction. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. If oligohydramnios is observed, discontinue candesartan unless it is considered life-saving for the mother. Small decreases in blood pressure have been observed in some patients treated with pentoxifylline; periodic systemic blood pressure monitoring is recommended for patients receiving concomitant antihypertensives. This Patient Information has been approved by the U.S. Food and Drug Administration. Epoprostenol: (Moderate) Angiotensin II receptor antagonists can enhance the hypotensive effects of antihypertensive agents if given concomitantly. The concurrent use of angiotensin II receptor antagonists (ARBs) may increase the risk of hyperkalemia, especially in the presence of renal impairment. In patients with mild hepatic impairment (Child-Pugh class A), the AUC and Cmax for candesartan are increased by 30% and 56%, respectively, compared to normal subjects. Desloratadine; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions. Use extreme caution with the concomitant use of tetracaine and antihypertensive agents. Due to low levels in breast milk, guidelines generally consider the ACE inhibitors captopril and enalapril to be compatible with breast-feeding unless high doses are required. No initial dosage adjustment is necessary in patients with mild hepatic disease. Register Now. In patients with prior or current symptoms of chronic HFrEF who are intolerant to angiotensin-converting enzyme (ACE) inhibitors because of cough or angioedema, use of an ARB is recommended. Linagliptin; Metformin: (Moderate) Monitor blood glucose during concomitant metformin and angiotensin receptor blocker use. Well-controlled hypertensive patients receiving phenylephrine at recommended doses do not appear at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Dosage adjustments may be necessary. Indications and Contraindications. Protein-binding is > 99%. Greater sensitivity to the hypotensive effects and renal-related adverse reactions of candesartan is possible in geriatric patients due to an age-related decline in renal function. Candesartan therefore is able to reduce blood pressure and improve cardiovascular health. Volume depletion should be corrected prior to the administration of candesartan. When volume-depletion is suspected (e.g., in patients taking diuretics, particularly those with impaired renal function), initiate therapy with a lower dose under close medical supervision. In the Veterans Affairs Nephropathy in Diabetes (VA NEPHRON-D) trial, no additional benefit over monotherapy was seen in patients receiving the combination of losartan and lisinopril compared to monotherapy; however, there was an increased incidence of hyperkalemia and acute renal injury. Candesartan should be used with caution in patients with hypovolemia, including patients Heart Monitor heart rate and blood pressure. Although candesartan has not been studied in renal artery stenosis, similar effects to the ACEIs might be anticipated due to candesartan's pharmacology. Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Double the dose every 2 weeks as tolerated up to 32 mg/day. Dextromethorphan; Quinidine: (Moderate) Quinidine can decrease blood pressure and should be used cautiously in patients receiving antihypertensive agents due to the potential for additive hypotension. Theoretically, angiotensin II receptor antagonists should be less likely than angiotensin converting enzyme inhibitors (ACEIs) to precipitate angioedema because angiotensin II receptor antagonists do not cause accumulation of kinins. Trimethoprim: (Moderate) Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Adjust dosage to attain clinical goals. Dosage adjustments may be necessary. Manufactured by: What are the possible side effects of Candesartan cilexetil tablets? Any strength of candesartan tablets can be used in the preparation of the suspension. In heart failure patients with symptomatic hypotension and/or an increase in serum creatinine, these complications may require temporarily holding or reducing the dose of candesartan or the adjunctive diuretic, and administering volume repletion. Circulating levels of renin and angiotensin II rise in response to blockade of AT1 receptors. Blood pressure and heart rates should be monitored closely to confirm that the desired antihypertensive effect is achieved. Combination therapy increases the risk for hyperkalemia, renal impairment, hypotension, and other side effects. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 25 June 2023), ASHP (updated 11 June 2023) and others. Monitor heart rate and blood pressure. Adjust the dosage according to blood pressure response. Tab Candesartan 4/8/16/32mg - Indications, Contraindication, Patients using cardiovascular drugs concomitantly with apraclonidine should have their pulse and blood pressure monitored periodically. About 26% of an oral dose is excreted unchanged in urine. tan kan-d-sr-tan. Patients receiving amifostine at doses recommended for chemotherapy should have antihypertensive therapy interrupted 24 hours preceding administration of amifostine. Inactive ingredients in Candesartan cilexetil tablets and Candesartan cilexetil oral suspension are: hydroxypropyl cellulose, lactose monohydrate, corn starch, glycerin, carboxymethylcellulose calcium, and magnesium stearate. Nonsteroidal antiinflammatory drugs: (Moderate) Monitor blood pressure and renal function periodically during concomitant angiotensin II blocker and nonsteroidal anti-inflammatory drug (NSAID) use. Angiotensin II is a naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and an increase in blood pressure. Angiotensin-Converting Enzyme Inhibitors (ACEI) - StatPearls After single or multiple oral doses, the pharmacokinetics of candesartan are linear up to 32 mg of candesartan. If concomitant use is necessary, closely monitor serum potassium concentrations. Brompheniramine; Pseudoephedrine; Dextromethorphan: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Candesartan Pentoxifylline: (Moderate) Pentoxifylline has been used concurrently with antihypertensive drugs (beta blockers, diuretics) without observed problems. Although only limited data are available, a lower starting dose (e.g., <= 8 mg/day) may be initiated in patients with severe renal impairment, requiring dialysis. Nateglinide: (Moderate) Angiotensin II receptor antagonists (ARB) may enhance the hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Concomitant use may increase the risk of hyperkalemia, especially in elderly patients or patients with impaired renal function. Find out when your doctor may prescribe them. If you would like more information, talk with your doctor. The site does not guarantee the accuracy or authenticity of the information. Correct volume and/or sodium depletion prior to administration when possible. Candesartan should be used with caution patients with hyperkalemia. Candesartan is a CYP2C9 substrate and aprepitant is a CYP2C9 inducer. Contemporary Use of Digoxin in the Management of The usual dosage range is 8 to 32 mg/day PO, given in 1 to 2 divided doses. Close monitoring of blood pressure is advised. Candesartan should be used with caution in patients whose renal function is critically dependent on the activity of the renin-angiotensin-aldosterone system (RAS) (e.g., patients with heart failure). Important considerations Alternatives Highlights for candesartan Candesartan is available as both a generic and brand-name drug. It may harm them. Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Do not give Candesartan cilexetil tablets to other people, even if they have the same problem you have. It may be advisable to monitor blood pressure. document.write(new Date().getFullYear()) PDR, LLC. Metformin; Saxagliptin: (Moderate) Monitor blood glucose during concomitant metformin and angiotensin receptor blocker use. Adjust the dosage according to blood pressure response. Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) Concomitant use of medicines with potential to alter renal perfusion or function such as angiotensin II receptor antagonists, may increase the risk of acute phosphate nephropathy in patients taking sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous. Well-controlled hypertensive patients receiving phenylephrine at recommended doses do not appear at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Etomidate: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents. It is available as a pro-drug, candesartan cilexetil, which undergoes hydrolysis in the Atacand (candesartan cilexetil) dose, indications, Miglitol: (Moderate) Angiotensin II receptor antagonists (ARBs) may enhance the hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Well-controlled hypertensive patients receiving phenylephrine at recommended doses do not appear at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. In patients with severe renal impairment (CrCl less than 30 mL/min), the AUC and Cmax of candesartan are about double the values observed in patients with normal renal function. Intravenous administration of procainamide is more likely to cause hypotensive effects. Carbidopa; Levodopa; Entacapone: (Moderate) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. Coadministration may also result in increases in serum creatinine in heart failure patients. Intravenous Lipid Emulsions: (Moderate) High doses of fish oil supplements may produce a blood pressure lowering effect. Hyponatremia or hypovolemia predisposes patients to acute hypotensive episodes following initiation of ACE inhibitor therapy. No dosage adjustment is necessary. Hyperkalaemia, hyponatraemia. Mestranol; Norethindrone: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients; monitor patients receiving concurrent therapy to confirm that the desired antihypertensive effect is being obtained. Glyburide; Metformin: (Moderate) Monitor blood glucose during concomitant metformin and angiotensin receptor blocker use. Closely monitor blood pressure, renal function, and electrolytes if aliskiren must be combined with another RAAS inhibitor. Blood pressure response is dose-related over the range of 216 mg. After 1 week of candesartan administration, the pressor effect of angiotensin II was inhibited by 50% at 24 hours post-dose. Acetaminophen; Dichloralphenazone; Isometheptene: (Moderate) Isometheptene has sympathomimetic properties. Fenofibric Acid: (Minor) At therapeutic concentrations, fenofibric acid is a mild-to-moderate inhibitor of CYP2C9. An oral suspension may be prepared for children unable to swallow tablets. Ephedrine: (Moderate) The cardiovascular effects of sympathomimetics, such as ephedrine, may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. In patients with moderate hepatic impairment (Child-Pugh class B), the AUC and Cmax are increased by 145% and 73% respectively. Acrivastine; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Hyperkalemia risk is increased when eplerenone is used with ARBs. General information about Candesartan cilexetil tablets. Loop diuretics: (Moderate) Coadministration of furosemide and Angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor antagonists may result in severe hypotension and deterioration in renal function, including renal failure. Ibritumomab Tiuxetan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). Loratadine; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Before you take Candesartan cilexetil tablets, tell your doctor if you: are pregnant or planning to become pregnant, are breast-feeding or plan to breast-feed, Tell your doctor about all the medicines you take, How should I take Candesartan cilexetil tablets. Isocarboxazid: (Moderate) Additive hypotensive effects may be seen when isocarboxazid is combined with angiotensin II receptor antagonists. Avoid concomitant use and consider alternative antibiotic therapy in patients with additional risk factors for hyperkalemia, including patients older than 65 years, those with underlying disorders of potassium metabolism, renal insufficiency, or those requiring high doses of trimethoprim. In patients undergoing major surgery or during anesthesia with agents that lower blood pressure, candesartan may enhance hypotensive effects via angiotensin II blockade. Candesartan Definition & Meaning | Merriam-Webster Medical Monitor heart rate and blood pressure. Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. Aliskiren: Increases the toxicity of both the drugs. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known. Calcium channel blockers Candesartan cilexetil: Uses, Interactions, Mechanism of Action General anesthetics: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Candesartan - Mechanism, Indication, Contraindications, Ziprasidone: (Minor) Ziprasidone is a moderate antagonist of alpha-1 receptors and may cause orthostatic hypotension with or without tachycardia, dizziness, or syncope. This leaflet summarizes the most important information about Candesartan cilexetil tablets. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Following an oral dose of radiolabeled candesartan, approximately 33% of radioactivity is recovered in urine and about 67% in feces. Candesartan: Package Insert - Drugs.com In the Veterans Affairs Nephropathy in Diabetes (VA NEPHRON-D) trial, no additional benefit over monotherapy was seen in patients receiving the combination of losartan and lisinopril compared to monotherapy; however, there was an increased incidence of hyperkalemia and acute renal injury. Close monitoring of blood pressure is advised. Adjust dosage to attain clinical goals. Levodopa: (Moderate) Concomitant use of antihypertensive agents with levodopa can result in additive hypotensive effects. SGLT2 Inhibitors: (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and angiotensin receptor blocker use. WebIndication Associated Conditions Contraindications & Blackbox Warnings Pharmacodynamics Mechanism of action Absorption Volume of distribution Protein binding Metabolism Route of elimination Half-life Clearance Adverse Effects Toxicity Pathways Pharmacogenomic Effects/ADRs Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by angiotensin II receptor antagonists. Empagliflozin; Linagliptin; Metformin: (Moderate) Monitor blood glucose during concomitant metformin and angiotensin receptor blocker use. Angiotensin II receptor blockers treat high blood pressure. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. This inhibits the AT1-mediated vasoconstrictive and aldosterone-secreting effects of angiotensin II and results in an overall decrease in blood pressure. Monitor heart rate and blood pressure. Co-administration may lead to increased exposure to CYP2C9 substrates; however, the clinical impact of this has not yet been determined. Also monitor for any changes in blood pressure, fluid retention, or renal function. The potential reduction in blood pressure can precipitate orthostatic hypotension and associated dizziness, tachycardia, and syncope. Candesartan is an angiotensin II receptor blocker (sometimes called an ARB). Use of any information is solely at the user's own risk. Note: Candesartan is marketed Anhydramnios and oligohydramnios have also been reported. Ketamine: (Moderate) General anesthetics can potentiate the hypotensive effects of antihypertensive agents. Monitoring blood pressure is recommended during dose titration and periodically during followup in treating patients with heart failure. Patients receiving an ARB in combination with antidiabetic agents should be monitored for changes in glycemic control.