Candesartan [8mg tablets 64 cents] ADMINISTRATION ROUTES:
ALTERNATIVE NAMES: Atacand
ICU INDICATIONS: 1. Hypertension 2. 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 hospitalizations. 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
Initially 4mg daily; increasing gradually to 32mg daily
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment [GFR (ml/min)]
<10 10-20 >20-50 Dose in renal replacement therapy CAPD initial dose 2mg and increase dose according to response HD initial dose 2mg and increase dose according to response CVVHDF initial dose 2mg and increase dose according to response
DOSAGE IN PAEDIATRICS: 0.1-0.3mg/kg daily Note: – Safety and effectiveness in paediatric patients have not been established.
CLINICAL PHARMACOLOGY: Candesartan cilexetil (atacand) is a prodrug which is hydrolyzed to candesartan during absorption from the gastrointestinal tract. Candesartan is a selective AT1 subtype angiotensin II receptor antagonist.
CONTRAINDICATIONS: 1. hypersensitivitytocandesartan(atacand) 2. cardiogenicshock
initial dose 2mg and increase dose according to response initial dose 2mg and increase dose according to response
dose as in normal renal function
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, hyperkalemia may occur, especially when taken concomitantly with ACE inhibitors and potassium-sparing diuretics such as spironolactone.
No tests additional to standard ICU investigations are required
Drug/Laboratory Test Interactions :
IMPORTANT DRUG INTERACTIONS FOR THE 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.
Body as a Whole:
Tachycardia, palpitation, hypotension.
Metabolic and Nutritional System:
Creatine phosphokinase increased, hyperglycemia, hypertriglyceridemia, hyperuricemia. Musculoskeletal System: Myalgia.