Overview
Candesartan is an angiotensin II receptor blocker (ARB) used primarily for the treatment of hypertension and heart failure. It works by selectively blocking the binding of angiotensin II to the AT1 receptor, leading to vasodilation and reduced aldosterone secretion. Clinical studies demonstrate effective blood pressure reduction with once-daily dosing and benefits in heart failure management.
Mechanism of Action
Candesartan is a selective angiotensin II type 1 (AT1) receptor antagonist that blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. By inhibiting angiotensin II binding to AT1 receptors in vascular smooth muscle and adrenal glands, it produces vasodilation, decreased vascular resistance, and reduced sodium and water retention.
Indications
- Treatment of hypertension
- Treatment of heart failure (NYHA Class II-IV) to reduce cardiovascular death and hospitalization
Common Doses
- 4 mg
- 8 mg
- 16 mg
- 32 mg
Dosage
Hypertension: Initial dose 16 mg once daily, may increase to 32 mg once daily. Heart failure: Initial dose 4-8 mg once daily, titrated to target dose of 32 mg once daily as tolerated. May be taken with or without food.
Contraindications
- Hypersensitivity to candesartan or any component
- Concomitant use with aliskiren in patients with diabetes
Side Effects
- Dizziness
- Upper respiratory infection
- Back pain
- Hypotension
- Hyperkalemia
- Renal impairment
- Angioedema (rare)
Interactions
- Potassium supplements/potassium-sparing diuretics (risk of hyperkalemia)
- Lithium (increased lithium levels)
- NSAIDs (may reduce antihypertensive effect and worsen renal function)
- Aliskiren (contraindicated in diabetic patients)
Counseling Points
- Take medication at the same time each day, with or without food
- Report dizziness, lightheadedness, or fainting, especially when standing up
- Monitor blood pressure regularly
- Avoid potassium supplements unless prescribed by healthcare provider
- Report swelling of face, lips, tongue, or throat immediately
- Use effective contraception during treatment
- Notify healthcare provider if pregnancy is suspected or planned