ADMINISTRATION ROUTES:
PO, NG
ALTERNATIVE NAMES:
Atacand
ICU INDICATIONS:
-
Hypertension
-
Congestive heart failure
Note: Candesartin cilexetil is indicated for the treatment of heart failure (NYHA class II-IV) in patients with left ventricular systolic dysfunction (ejection fraction <40%) to reduce cardiovascular death and to reduce heart failure hospitalisations. Candesartin cilexetil also has an added effect on these outcomes when used with an ACE inhibitor
PRESENTATION AND ADMINISTRATION:
PO / NG:
Atacand 4mg (white), 8mg (light pink), 16mg (pink), 32mg (pink) Crush tablets for NG administration
DOSAGE:
PO:
Initially 4mg once daily, increasing gradually to 32mg once daily
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | initial dose 2 mg, increase according to response |
| 10-20 | initial dose 2 mg, increase according to response |
| >20-50 | dose as in normal renal function |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | initial dose 2 mg, increase according to response |
| HD | initial dose 2 mg, increase according to response |
| CVVHDF | initial dose 2 mg, increase according to response |
DOSAGE IN PAEDIATRICS:
0.1-0.3 mg/kg once daily
Note: Safety and effectiveness in paediatric patients have not been established
CLINICAL PHARMACOLOGY:
Candesartan cilexetil (atacand) is a prodrug which is hydrolysed to candesartan during absorption from the gastrointestinal tract. Candesartan is a selective AT1 subtype angiotensin II receptor antagonist.
CONTRAINDICATIONS:
-
Hypersensitivity to candesartan (atacand)
-
Cardiogenic shock
WARNINGS:
Hypotension in Heart Failure Patients
Caution should be observed when initiating therapy in patients with heart failure. Patients with heart failure given candesartin cilexetil commonly have some reduction in blood pressure. In patients with symptomatic hypotension this may require temporarily reducing the dose of candesartin cilexetil, or diuretic, or both, and volume repletion.
Impaired Hepatic Function
A lower initiating dose should be considered for patients with moderate hepatic impairment.
Hyperkalaemia
In heart failure patients treated with candesartin cilexetil, hyperkalaemia may occur, especially when taken concomitantly with ACE inhibitors and potassium-sparing diuretics such as spironolactone
PRECAUTIONS: General:
See WARNINGS
Laboratory Tests:
No tests additional to standard ICU investigations are required
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
An increase in serum lithium concentration has been reported during concomitant administration of lithium with candesartan cilexetil, so careful monitoring of serum lithium levels is recommended during concomitant use
ADVERSE REACTIONS:
Body as a Whole:
Asthenia, fever
Nervous System:
Paraesthesia, vertigo
Gastrointestinal System:
Dyspepsia, gastroenteritis
Cardiovascular System:
Tachycardia, palpitation, hypotension
Metabolic and Nutritional System:
Creatine phosphokinase increased, hyperglycaemia, hypertriglyceridaemia, hyperuricaemia
Musculoskeletal System:
Myalgia
Respiratory System:
Dyspnoea
Urinary System:
Haematuria