Candesartan tablets for treating hypertension and heart failure in adults and children

Candesartan cilexetil tablets are oral medications that belong to a class called angiotensin II receptor blockers (ARBs). They are primarily used to lower high blood pressure (hypertension) in adults and children aged 1 to less than 17 years, and to treat heart failure with reduced left ventricular function in adults. By managing blood pressure and heart function, this medicine helps reduce the risk of serious cardiovascular events such as strokes, heart attacks, hospitalizations, and cardiovascular death.

Hypertension: Candesartan tablets are used to treat high blood pressure in adults and children aged 1 to under 17 years. Lowering blood pressure helps reduce the risk of fatal and nonfatal cardiovascular events, particularly strokes and heart attacks. It can be used alone or combined with other blood pressure medicines.

Heart Failure: In adults diagnosed with heart failure classified as New York Heart Association (NYHA) class II to IV and left ventricular systolic dysfunction (ejection fraction ≤40%), candesartan reduces cardiovascular death and hospitalizations related to heart failure. It can be used in addition to ACE inhibitors for added benefit.

Candesartan cilexetil

Candesartan cilexetil works by blocking the angiotensin II receptor, a protein that normally causes blood vessels to narrow and retain salt and water. By blocking these receptors, candesartan causes blood vessels to relax and dilate, which lowers blood pressure and decreases the workload on the heart, improving symptoms of heart failure.

Adult Hypertension

• Starting dose: 16 mg once daily (oral tablets).
• Maintenance dose range: 8 to 32 mg total daily dose, given once or twice daily.
• Dose adjustments made based on blood pressure response.
• Initiate with 8 mg in patients with moderate liver impairment; no specific recommendations for severe hepatic insufficiency.

Pediatric Hypertension (1 to

• 1 to
• 6 to
• 6 to
• The antihypertensive effect is usually evident within 2 weeks and fully achieved by 4 weeks.
• Do not use in children under 1 year or with severe renal impairment (GFR

Adult Heart Failure

• Starting dose: 4 mg once daily.
• Target dose: 32 mg once daily, achieved by doubling the dose every 2 weeks as tolerated.

Additional Notes

• Tablets can be taken with or without food.
• If response is inadequate, a diuretic or other antihypertensive agents may be added.
• An oral suspension can be prepared for children unable to swallow tablets.
• Patients with volume or salt depletion should be closely monitored and corrected before starting treatment.

• Known hypersensitivity to candesartan or any formulation components.
• Co-administration with aliskiren in patients with diabetes is contraindicated.

Fetal Toxicity

Use during pregnancy, especially in the second and third trimesters, can cause injury or death to the developing fetus. If pregnancy is detected, discontinue candesartan as soon as possible.

Hypotension

Symptomatic low blood pressure may occur, particularly in patients who are volume- or salt-depleted due to diuretics, diet, dialysis, diarrhea, or vomiting. This may require dose reduction or temporary cessation of candesartan or diuretics and correcting volume status. Monitor blood pressure especially during dose increases.

Renal Function

Candesartan can cause changes in kidney function, including acute renal failure, particularly in patients with conditions like renal artery stenosis, chronic kidney disease, severe heart failure, or volume depletion. Regular monitoring of kidney function is recommended. Consider stopping the medication if significant kidney impairment develops.

Hyperkalemia

The drug can increase potassium levels, risk is higher with other potassium-increasing medicines. Periodic monitoring of serum potassium is advised.

Major Surgery/Anesthesia

Hypotension may occur during surgery or anesthesia and may require intravenous fluids or vasopressors.

Common adverse reactions causing discontinuation in adults with hypertension: headache (0.6%) and dizziness (0.3%).

In adults with heart failure: hypotension (4.1%), abnormal renal function (6.3%), and hyperkalemia (2.4%) are noted as causes for treatment discontinuation.

• Do not co-administer aliskiren with candesartan in patients with diabetes due to risk of adverse effects.
• Concurrent use with potassium-sparing drugs or potassium supplements may increase hyperkalemia risk; monitor potassium levels.
• Use with ACE inhibitors increases risk of hypotension, renal impairment, and hyperkalemia; monitor accordingly.

Pregnancy

Candesartan causes fetal toxicity when used during pregnancy, particularly second and third trimesters, leading to fetal renal dysfunction, oligohydramnios, lung underdevelopment, skeletal deformities, and neonatal complications. Discontinue immediately upon pregnancy detection.

Lactation

No specific information provided.

Information on overdose manifestations or management is not provided in the supplied evidence.

Store tablets at room temperature below 30°C (86°F). For oral suspension, store at room temperature below 30°C, do not freeze, use within 30 days after opening, and shake well before use.