ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -18 مورد

Candesartan: Pediatric drug information

Candesartan: Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Candesartan: Drug information" and "Candesartan: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Fetal toxicity:

When pregnancy is detected, discontinue candesartan as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus.

Brand Names: US
  • Atacand
Brand Names: Canada
  • ACH-Candesartan;
  • AG-Candesartan;
  • APO-Candesartan;
  • Atacand;
  • Auro-Candesartan;
  • JAMP-Candesartan;
  • MINT-Candesartan;
  • NRA-Candesartan;
  • PMS-Candesartan;
  • SANDOZ Candesartan;
  • TARO-Candesartan;
  • TEVA-Candesartan
Therapeutic Category
  • Angiotensin II Receptor Blocker;
  • Antihypertensive Agent
Dosing: Pediatric

Note: Use of a lower initial dose is recommended in volume- and salt-depleted patients; if possible, correct volume depletion prior to administration; dosage must be individualized.

Hypertension

Hypertension:

Children 1 to <6 years: Oral: Initial: 0.2 mg/kg/day once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed); usual range: 0.05 to 0.4 mg/kg/day divided once or twice daily; maximum daily dose: 0.4 mg/kg/day; higher doses have not been studied.

Children and Adolescents 6 to <17 years: Oral:

<50 kg: Initial: 4 to 8 mg/day once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed); usual range: 2 to 16 mg/day divided once or twice daily; maximum daily dose: 32 mg/day; higher doses have not been studied.

>50 kg: Initial: 8 to 16 mg/day once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed); usual range: 4 to 32 mg/day divided once or twice daily; maximum daily dose: 32 mg/day; higher doses have not been studied.

Adolescents ≥17 years: Oral: Initial: 16 mg once daily; titrate to response (within 2 weeks, antihypertensive effect usually observed; maximum effect seen within 4 to 6 weeks); usual range: 8 to 32 mg/day divided once or twice daily; blood pressure response is dose-related over the range of 2 to 32 mg; larger doses do not appear to have a greater effect and there is relatively little experience with such doses

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Children and Adolescents 1 to <17 years:

CrCl ≥30 mL/minute/1.73 m2: There are no dosage adjustments provided in the manufacturer's labeling; has not been studied in pediatric patients with renal impairment.

CrCl <30 mL/minute/1.73 m2: Use is not recommended (has not been studied).

Not removed by dialysis.

Dosing: Liver Impairment: Pediatric

Mild hepatic impairment: No initial dosage adjustment required.

Moderate hepatic impairment: There are no pediatric-specific dosage adjustments provided in the manufacturer's labeling.

Severe hepatic impairment: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Adult

(For additional information see "Candesartan: Drug information")

Acute coronary syndrome

Acute coronary syndrome:

Note: May be used as an alternative in patients who cannot tolerate an angiotensin-converting enzyme (ACE) inhibitor (eg, due to cough or angioedema) (Ref). Angiotensin II receptor blockers (ARBs) do not appear to elevate the risk of angioedema (Ref); however, patients must be educated that angioedema due to an ACE inhibitor can sometimes reoccur within months following discontinuation (Ref); referral to an allergist may be appropriate.

Non-ST-elevation acute coronary syndrome (alternative agent) (off-label use):

Note: Patients should be hemodynamically stable before initiation. Use as a component of an appropriate medical regimen, which may also include antiplatelet agent(s), a beta-blocker, and a statin. Continue ARB therapy indefinitely for patients with concurrent diabetes, left ventricular ejection fraction ≤40%, hypertension, or stable chronic kidney disease (CKD) (Ref). Dosing is based on general dosing range in the manufacturer's labeling.

Oral: Initial: 8 mg once daily; increase dose as tolerated up to 32 mg/day under close monitoring to avoid hypotension.

ST-elevation myocardial infarction (alternative agent) (off-label use):

Note: Patients should be hemodynamically stable before initiation. Use as a component of an appropriate medical regimen, which may also include antiplatelet agent(s), a beta-blocker, and a statin. Continue ARB therapy indefinitely (Ref). Dosing is based on general dosing range in the manufacturer's labeling.

Oral: Initial: 8 mg once daily; increase dose as tolerated up to 32 mg/day under close monitoring to avoid hypotension.

Heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction (alternative agent):

Note: Alternative therapy in patients who cannot tolerate an angiotensin II receptor-neprilysin inhibitor (ARNI) or an ACE inhibitor (eg, due to cough or angioedema); consultation with a heart failure specialist and/or an allergist may be appropriate (Ref). ARBs do not appear to elevate the risk of angioedema (Ref); however, angioedema due to an ACE inhibitor can sometimes reoccur months following discontinuation (Ref).

Oral: Initial: 4 to 8 mg once daily; increase dose (eg, double) every ≥ 1 to 2 weeks based on response and tolerability to a target dose of 32 mg once daily (Ref). In hospitalized patients, may titrate more rapidly as tolerated (Ref).

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use with another appropriate agent (eg, long-acting dihydropyridine calcium channel blocker or thiazide diuretic) (Ref).

Oral: Initial: 8 mg once daily; evaluate response after approximately 2 to 4 weeks and titrate dose (eg, increase the daily dose by doubling), as needed, up to 32 mg once daily; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref).

Migraine, prevention

Migraine, prevention (alternative agent) (off-label use):

Note: Among second-line agents for migraine prevention, consider use in patients with comorbid hypertension (Ref). An adequate trial for assessment of effect is considered to be at least 2 to 3 months at a therapeutic dose (Ref).

Oral: Initial: 4 to 8 mg once daily; may increase dose (eg, by doubling) weekly based on response and tolerability up to 16 mg once daily (Ref).

Proteinuric chronic kidney disease, diabetic or nondiabetic

Proteinuric chronic kidney disease, diabetic or nondiabetic (off-label use):

Oral: Initial: 8 mg once daily; titrate gradually (eg, by doubling the dose every 2 to 4 weeks) to the maximally tolerated dose, not to exceed 32 mg/day. If proteinuria target is not met despite optimized dosage, consider additional therapies (eg, sodium-glucose cotransporter-2 inhibitor) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function:

CrCl >30 mL/minute/1.73 m2: No dosage adjustment necessary (Ref).

CrCl ≤30 mL/minute/1.73 m2: Start with a lower initial dose (eg, 4 mg once daily); titrate gradually based on tolerability and efficacy with frequent monitoring of BP, kidney function, and potassium (Ref). Maximum recommended dose: 16 mg once daily (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzed (Ref):

Start with a lower initial dose (eg, 4 mg once daily); titrate gradually based on tolerability and efficacy with frequent monitoring of BP, kidney function, and potassium (Ref). Maximum recommended dose: 16 mg once daily (Ref).

Peritoneal dialysis: Not likely to be significantly dialyzed (Ref):

Start with a lower initial dose (eg, 4 mg once daily); titrate gradually based on tolerability and efficacy with frequent monitoring of BP, kidney function, and potassium (Ref). Maximum recommended dose: 16 mg once daily (Ref).

CRRT: Start with lower initial dose (eg, 4 mg once daily) and titrate gradually based on tolerability and efficacy with frequent monitoring of BP, kidney function, and potassium. Maximum recommended dose: 16 mg once daily (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Start with lower initial dose (eg, 4 mg once daily) and titrate gradually based on tolerability and efficacy with frequent monitoring of BP, kidney function, and potassium. Maximum recommended dose: 16 mg once daily (Ref).

Alterations in kidney function during treatment:

Small, transient increases in serum creatinine are likely to occur within 4 weeks following initiation of therapy or an increase in dose. If serum creatinine increases by >30%, review for possible etiologies (eg, acute kidney injury, volume depletion, concomitant medications, renal artery stenosis) before determining if dose reduction or discontinuation of candesartan therapy should be considered (Ref).

Dosing: Liver Impairment: Adult

Mild impairment (Child-Pugh class A): No initial dosage adjustment necessary.

Moderate impairment (Child-Pugh class B): Initial: 4 to 8 mg daily in patients with hypertension; titrate gradually based on tolerability and efficacy.

Severe impairment (Child-Pugh class C): There are no dosage adjustments provided in the manufacturer's labeling (has not been studied); however, systemic exposure increases significantly in moderate impairment. Should be used with caution in patients with ascites due to cirrhosis (Ref).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Cardiovascular: Hypotension (19%)

Renal: Renal function abnormality (13%)

1% to 10%:

Central nervous system: Dizziness (4%)

Endocrine & metabolic: Hyperkalemia (6%)

Neuromuscular & skeletal: Back pain (3%)

Respiratory: Upper respiratory tract infection (6%), pharyngitis (2%), rhinitis (2%)

Frequency not defined:

Central nervous system: Headache

Renal: Exacerbation of renal disease (children & adolescents), increased serum creatinine

<1%, postmarketing, and/or case reports: Abnormal hepatic function tests, agranulocytosis, angioedema, cough, hepatitis, hyponatremia, leukopenia, neutropenia, pruritus, skin rash, urticaria

Contraindications

Hypersensitivity to candesartan or any component of the formulation; concomitant use with aliskiren in patients with diabetes mellitus.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Concomitant use with aliskiren in patients with moderate to severe kidney impairment (GFR <60 mL/minute/1.73 m2); pregnancy; breastfeeding; children <1 year of age; rare hereditary problems of galactose intolerance, congenital lactase deficiency or glucose-galactose malabsorption.

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: Angiotensin II receptor antagonists (ARBs) do not appear to elevate the risk of angioedema (Rasmussen 2019; Toh 2012). Patients with a history of angioedema due to an angiotensin-converting enzyme (ACE) inhibitor must be educated that sometimes there can be recurrence within months following discontinuation (Beltrami 2011). No matter the cause of angioedema, prolonged frequent monitoring is required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. IM administration of epinephrine may be necessary. Do not readminister the ARB to patients who experience angioedema from this medication.

• Hyperkalemia: May occur; risk factors include kidney dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium containing salts. Use cautiously, if at all, with these agents and monitor potassium closely.

• Hypotension: Symptomatic hypotension may occur upon initiation in patients who are salt- or volume-depleted (eg, those treated with high-dose diuretics). Consider lower initial dosages in volume depleted patients; if possible, correct volume depletion prior to administration. This transient hypotensive response is not a contraindication to further treatment with candesartan.

• Kidney function deterioration: May be associated with deterioration of kidney function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, heart failure) whose GFR is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute kidney failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation; consider discontinuation only in patients with progressive and/or significant deterioration in kidney function.

Disease-related concerns:

• Aortic/mitral stenosis: Use caution in patients with significant aortic/mitral stenosis.

• Ascites: Generally, avoid use in patients with ascites due to cirrhosis or refractory ascites; if use cannot be avoided in patients with ascites due to cirrhosis, monitor blood pressure and kidney function carefully to avoid rapid development of kidney failure (AASLD [Biggins 2021]; AASLD [Runyon 2013]).

• Hepatic impairment: Systemic exposure increases in hepatic impairment; dosage adjustment may be necessary.

• Renal artery stenosis: Use candesartan with caution in patients with unstented unilateral/bilateral kidney artery stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in kidney function unless possible benefits outweigh risks.

• Kidney impairment: Use with caution with preexisting kidney insufficiency. Pediatric patients with a GFR <30 mL/minute/1.73 m2 should not receive candesartan; has not been evaluated.

Special populations:

• Pediatric: Avoid use in infants <1 year of age due to potential effects on the development of immature kidneys.

• Race/Ethnicity: Some studies suggest that when used as monotherapy for hypertension, the BP-lowering effects of renin-angiotensin system (RAS) inhibitors (eg, angiotensin receptor blockers) may be somewhat less pronounced in Black patients (ACC/AHA [Whelton 2018]). The mechanism is not known but may be related to social determinants of health rather than race, as pharmacogenetic differences have not been found to adequately predict blood pressure response (Brewster 2013; Gardner 2022). These observed BP differences were not apparent when RAS inhibitors were used as part of combination therapy (eg, combined with a calcium channel blocker or thiazide diuretic) (Jamerson 2008). Drug selection should be individualized and based on multiple patient-specific factors and not purely race/ethnicity (Holt 2022).

• Surgical patients: In patients on chronic ARB therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia. Cardiopulmonary bypass, intraoperative blood loss, or vasodilating anesthesia increases endogenous renin release. Use of ARBs perioperatively will blunt angiotensin II effects and may result in hypotension; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis 2011). In patients undergoing elevated-risk noncardiac surgery who take an ARB for hypertension, it is reasonable to hold treatment 24 hours before surgery to limit intraoperative hypotension then restart postoperatively as soon as clinically feasible. In patients who take an ARB for heart failure, it is reasonable to continue therapy, uninterrupted, perioperatively (AHA/ACC [Thompson 2024]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as cilexetil:

Atacand: 4 mg, 8 mg, 16 mg, 32 mg [scored; contains corn starch]

Generic: 4 mg, 8 mg, 16 mg, 32 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Atacand Oral)

4 mg (per each): $7.70

8 mg (per each): $9.20

16 mg (per each): $9.89

32 mg (per each): $12.52

Tablets (Candesartan Cilexetil Oral)

4 mg (per each): $2.76 - $3.17

8 mg (per each): $2.76 - $3.17

16 mg (per each): $2.76 - $3.85

32 mg (per each): $4.17 - $5.39

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as cilexetil:

Atacand: 4 mg, 8 mg, 16 mg, 32 mg

Generic: 4 mg, 8 mg, 16 mg, 32 mg

Extemporaneous Preparations

Oral suspension may be made in concentrations ranging from 0.1 to 2 mg/mL; typically 1 mg/mL oral suspension suitable for majority of prescribed doses; any strength tablet may be used. A 1 mg/mL (total volume: 160 mL) oral suspension may be made with tablets and a 1:1 mixture of Ora-Plus® and Ora-Sweet SF®. Prepare the vehicle by adding 80 mL of Ora-Plus® and 80 mL of Ora-Sweet SF® or, alternatively, use 160 mL of Ora-Blend SF®. Add a small amount of vehicle to five 32 mg tablets and grind into a smooth paste using a mortar and pestle. Transfer the paste to a calibrated amber PET bottle, rinse the mortar and pestle clean using the vehicle, add this to the bottle, and then add a quantity of vehicle sufficient to make 160 mL. The suspension is stable at room temperature for 100 days unopened or 30 days after the first opening; do not freeze; label “shake well before use.” (Atacand prescribing information, 2013).

Administration: Pediatric

Oral: May be administered without regard to meals. An oral suspension may be prepared for children unable to swallow tablets (refer to Extemporaneous Preparation information).

Administration: Adult

Oral: Administer without regard to meals. An oral suspension may be prepared for patients unable to swallow tablets (refer to Extemporaneously Prepared information).

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Use

Treatment of hypertension alone or in combination with other antihypertensive agents (FDA approved in ages ≥1 year and adults); treatment of heart failure (NYHA class II-IV) (FDA approved in adults)

Medication Safety Issues
Sound-alike/look-alike issues:

Atacand may be confused with antacid

Metabolism/Transport Effects

Substrate of CYP2C9 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Aliskiren: May increase nephrotoxic effects of Angiotensin II Receptor Blockers. Aliskiren may increase hyperkalemic effects of Angiotensin II Receptor Blockers. Aliskiren may increase hypotensive effects of Angiotensin II Receptor Blockers. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider Therapy Modification

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin II: Angiotensin II Receptor Blockers may decrease therapeutic effects of Angiotensin II. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Angiotensin II Receptor Blockers may increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider Therapy Modification

Antihepaciviral Combination Products: May increase serum concentration of Candesartan. Management: Consider decreasing the candesartan dose and monitoring for evidence of hypotension and worsening renal function if these agents are used in combination. Risk D: Consider Therapy Modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Dapoxetine: May increase orthostatic hypotensive effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Dipeptidyl Peptidase-IV Inhibitors: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Specifically, the risk for angioedema may be increased with this combination. Risk C: Monitor

Drospirenone-Containing Products: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

Finerenone: Angiotensin II Receptor Blockers may increase hyperkalemic effects of Finerenone. Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Heparin: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Heparins (Low Molecular Weight): May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Lithium: Angiotensin II Receptor Blockers may increase serum concentration of Lithium. Management: Initiate lithium at lower doses in patients receiving an angiotensin II receptor blocker (ARB). Consider lithium dose reductions in patients stable on lithium therapy who are initiating an ARB. Monitor lithium concentrations closely when combined. Risk D: Consider Therapy Modification

Loop Diuretics: May increase hypotensive effects of Angiotensin II Receptor Blockers. Loop Diuretics may increase nephrotoxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Angiotensin II Receptor Blockers may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Angiotensin II Receptor Blockers may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Potassium Salts: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Potassium-Sparing Diuretics: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Ranolazine: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Sacubitril: Angiotensin II Receptor Blockers may increase adverse/toxic effects of Sacubitril. Risk X: Avoid

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sodium Phosphates: Angiotensin II Receptor Blockers may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sparsentan: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Risk X: Avoid

Tacrolimus (Systemic): Angiotensin II Receptor Blockers may increase hyperkalemic effects of Tacrolimus (Systemic). Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Tolvaptan: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Trimethoprim: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Reproductive Considerations

Avoid use of an angiotensin II receptor blocker (ARB) in patients who may become pregnant and who are not using effective contraception (ADA 2022).

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be used in patients trying to conceive. ARBs are fetotoxic. Transition patients prior to conception to an agent preferred for use during pregnancy unless treatment with an ARB is absolutely necessary (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).

When candesartan is used for the treatment of proteinuric chronic kidney disease in patients who could become pregnant, discontinue use at the first positive pregnancy test (ADA 2022; Fakhouri 2023; Porta 2011).

Candesartan is effective for prevention of migraines. In general, preventive treatment for migraine in patients trying to become pregnant should be avoided. Options for patients planning a pregnancy should be considered as part of a shared decision-making process. Nonpharmacologic interventions should be considered initially. When needed, preventive treatment should be individualized considering the available safety data and needs of the patient should pregnancy occur. A gradual discontinuation of preventive medications is generally preferred when the decision is made to stop treatment prior to conception (ACOG 2022; AHS [Ailani 2021]).

Pregnancy Considerations

Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Exposure to an angiotensin II receptor blocker (ARB) during the first trimester of pregnancy may be associated with an increased risk of fetal malformations (ACOG 2019; ESC [Regitz-Zagrosek 2018]). Following exposure during the second or third trimesters, drugs that act on the renin-angiotensin system are associated with oligohydramnios. Oligohydramnios, due to decreased fetal kidney function, may lead to fetal lung hypoplasia and skeletal malformations. Oligohydramnios may not appear until after an irreversible fetal injury has occurred. ARB use during pregnancy is also associated with anuria, hypotension, kidney failure, skull hypoplasia, and death in the fetus/neonate. Monitor infants exposed to an ARB in utero for hyperkalemia, hypotension, and oliguria. Exchange transfusions or dialysis may be required to reverse hypotension or improve renal function.

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Discontinue ARBs as soon as possible once pregnancy is detected. Agents other than an ARB are recommended for the treatment of chronic hypertension during pregnancy (ACOG 2019; ESC [Cífková 2020]; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]). Closely monitor patients exposed to an ARB during pregnancy with serial ultrasounds.

ARBs are not recommended for the treatment of proteinuric chronic kidney disease during pregnancy. When treatment is needed in patients with diabetic nephropathy, candesartan should be discontinued at the first positive pregnancy test (Fakhouri 2023; Porta 2011).

In general, preventive treatment for migraine should be avoided during pregnancy. Options for pregnant patients should be considered as part of a shared decision-making process. Nonpharmacologic interventions should be considered initially. When needed, preventive treatment should be individualized considering the available safety data, the potential for adverse maternal and fetal events, and needs of the patient (ACOG 2022; AHS [Ailani 2021]). Candesartan is not recommended for migraine prevention during pregnancy (ACOG 2022).

Monitoring Parameters

Blood pressure, serum creatinine, BUN, baseline and periodic serum electrolytes (particularly K), urinalysis

Mechanism of Action

Candesartan is an angiotensin receptor antagonist. Angiotensin II acts as a vasoconstrictor. In addition to causing direct vasoconstriction, angiotensin II also stimulates the release of aldosterone. Once aldosterone is released, sodium as well as water are reabsorbed. The end result is an elevation in blood pressure. Candesartan binds to the AT1 angiotensin II receptor. This binding prevents angiotensin II from binding to the receptor thereby blocking the vasoconstriction and the aldosterone secreting effects of angiotensin II.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 2 to 3 hours; antihypertensive effect: Within 2 weeks

Peak effect: 6 to 8 hours; maximum antihypertensive effect: 4 to 6 weeks

Duration: >24 hours

Absorption: Candesartan: Rapid and complete following conversion from candesartan cilexetil by GI esterases

Distribution: Vd: 0.13 L/kg

Protein binding: >99%

Metabolism: Converted to active candesartan, via ester hydrolysis during absorption from GI tract; hepatic (minor) via O-deethylation to inactive metabolite

Bioavailability, absolute: Candesartan: 15%

Half-life elimination (dose dependent): 5 to 9 hours

Time to peak: Children (1 to 17 years); Adults: 3 to 4 hours

Excretion: Feces (67%); urine (33%; 26% as unchanged drug)

Clearance: Total body: 0.37 mL/minute/kg; Renal: 0.19 mL/minute/kg; decreased with severe kidney impairment

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: In hypertensive patients with CrCl <30 mL/minute/1.73 m2, the AUC and Cmax are approximately doubled. In heart failure patients with kidney impairment, AUC is 36% and 65% higher and Cmax is 15% and 55% higher in patients with mild and moderate kidney impairment, respectively.

Hepatic function impairment: The AUC and Cmax increased 30% and 56% in mild impairment and 145% and 73% in moderate impairment, respectively.

Older adult: Cmax is ~50% higher; AUC is ~80% higher.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Atacand | Blopress | Candemax;
  • (AR) Argentina: Atacand | Candesartan richet | Dacten | Ronar | Tiadyl;
  • (AT) Austria: Atacand | Blopress | Candeblo | Candesartan 1A Pharma | Candesartan a-med | Candesartan actavis | Candesartan Arcana | Candesartan G.L. | Candesartan Genericon | Candesartan krka | Candesartan Pluspharma | Candesartan ratiopharm | Candesartan sandoz | Candesartan Stada;
  • (AU) Australia: Adesan | Apo candesartan | Atacand | Auro candesartan | Btc candesartan | Candesan | Candesartan an | Candesartan aspen | Candesartan ga | Candesartan gh | Candesartan rbx | Candesartan sandoz | Pharmacor candesartan | Stada candesartan;
  • (BD) Bangladesh: Arb | Candesa | Giran | Vesotan;
  • (BE) Belgium: Atacand | Candesartan Apotex | Candesartan EG | Candesartan krka | Candesartan mylan | Candesartan sandoz | Candesartan teva;
  • (BF) Burkina Faso: Aderan;
  • (BG) Bulgaria: Acrux | Atacand | Candecard | Candecon | Candegamma | Candesartan actavis | Candesartan ecopharm | Cantab | Cardesart | Carzap | Hyposart | Karbis | Repido;
  • (BR) Brazil: Atacand | Blopress | Cadenza | Candecor | Candemed | Candesartana cilexetila | Candessa | Cansarcor | Desarcor | Venzer;
  • (CH) Switzerland: Atacand | Blopress | Candesartan actavis | Candesartan Helvepharm | Candesartan Mepha | Candesartan sandoz | Candesartan spirig hc | Candesartan Takeda | Candesartan zentiva | Cansartan | Pemzek;
  • (CI) Côte d'Ivoire: Aderan | Atacand | Candisar;
  • (CL) Chile: Atacand | Bilaten | Blopress | Blox;
  • (CN) China: Ao bi xin | Blopress | Bo li gao | Da mai | Di zhi ya | Wei er ya | Xi jun ning;
  • (CO) Colombia: Atacand | Blopress | Candeprex | Candesam | Candesartan | Candesartan cilexetilo | Candesartan cilexetilo sandoz | Candesartan mk | Dexartan | Europres | Minart;
  • (CR) Costa Rica: Safebul;
  • (CZ) Czech Republic: Atacand | Candegamma | Canocord | Carzap | Xaleec;
  • (DE) Germany: Amias | Atacand | Atacand protect | Blopress | Candaxiro | Cande Q | Candecor | Candegamma | Candesartan 1 a pharma | Candesartan aaa | Candesartan abz | Candesartan actavis | Candesartan al | Candesartan aurobindo | Candesartan Basics | Candesartan biomo | Candesartan cilexetil mylan | Candesartan hennig | Candesartan heumann | Candesartan Hexal | Candesartan hormosan | Candesartan krka | Candesartan puren | Candesartan ratiopharm | Candesartan Stada | Candesartan zentiva | Ratacand;
  • (DO) Dominican Republic: Acrosar | Adepra | Akavar | Aracure | Atacand | Balpress | Blopress | Blox | Calmex | Candersil | Candesar | Candesartan | Candesartan 8 mg wemed | Candesartan 8 nespharma | Candesartan Calox | Candesartan cilexetilo sandoz | Candesartan if | Candesartan Lam | Candevex | Capsartan | Cardres | Coriarten | Coropres | Corprexia | Cuidat | Decora | Eucand | Indutenol | Inlosep | Kerala | Minart | Safebul | Sulartan | Tensinex | Tovax | Xiletil;
  • (EC) Ecuador: Atacand | Blopress | Blox | Candesartan | Candesartan Genfar | Coropres | Minart;
  • (EE) Estonia: Atacand | Candesartan actavis | Canocord | Cantar | Carzan | Prescanden;
  • (EG) Egypt: Albustix | Atacand | Blopress | Candalkan | Candeblock | Candepressin | Candesar | Candesartan | Globacand;
  • (ES) Spain: Atacand | Blopress | Candesartan actavis | Candesartan Almus | Candesartan Alter | Candesartan Apotex | Candesartan apotex ag | Candesartan cinfa | Candesartan Combix | Candesartan Davur | Candesartan Kern | Candesartan krka | Candesartan Mabo | Candesartan mylan | Candesartan Normon | Candesartan pensa | Candesartan qualigen | Candesartan ranbaxy | Candesartan ratio | Candesartan ratiopharm | Candesartan sandoz | Candesartan Stada | Candesartan tarbis | Candesartan tecnigen | Candesartan teva | Karbis | Parapres;
  • (ET) Ethiopia: Candesartan sandoz;
  • (FI) Finland: Atacand | Candemox | Candesartan actavis | Candesartan aspen | Candesartan krka | Candesartan orion | Candesartan ranbaxy | Candestad | Candexetil | Kandrozid;
  • (FR) France: Atacand | Candesartan | Candesartan actavis | Candesartan Arrow | Candesartan biogaran | Candesartan cristers | Candesartan EG | Candesartan Evolugen | Candesartan krka | Candesartan mylan | Candesartan ranbaxy | Candesartan sandoz | Candesartan teva | Candesartan Zydus | Kenzen;
  • (GB) United Kingdom: Amias | Candesartan | Candesartan ranbaxy;
  • (GR) Greece: Atacand | Candesartan tad | Fyronexe;
  • (GT) Guatemala: Donosartan;
  • (HK) Hong Kong: Advant | Amican | Blopress | Candesartan;
  • (HR) Croatia: Atacand | Kandepres;
  • (HU) Hungary: Atacand | Karbis;
  • (ID) Indonesia: Blocand | Blopress | Candefar | Candepress | Canderin | Candersatan cilexetil | Candesartan | Candetens | Candotens;
  • (IE) Ireland: Atacand | Blopress | Candesartan | Candesartan krka | Candesartan mylan | Candesartan teva | Candist | Catasart;
  • (IL) Israel: Atacand | Candor;
  • (IN) India: Candelong | Candes | Candesar | Candestan | Candez | Cantar | Dilsave | Ipsita;
  • (IQ) Iraq: Candasart | Kandesat;
  • (IS) Iceland: Candpress;
  • (IT) Italy: Blopress | Candesartan | Candesartan actavis | Candesartan aurobindo italia | Candesartan doc generici | Candesartan EG | Candesartan krka | Candesartan mylan pharma | Candesartan pensa | Candesartan ranbaxy | Candesartan sandoz | Candesartan zentiva | Flortitens | Karbis | Ratacand;
  • (JO) Jordan: Andesart | Atacand | Blopress | Coronasart;
  • (JP) Japan: Blopress | Candesartan | Candesartan amel | Candesartan aska | Candesartan chemiphar | Candesartan isei | Candesartan jg | Candesartan kaken | Candesartan ko | Candesartan kyorin | Candesartan nichiiko | Candesartan nissin | Candesartan ohara | Candesartan pfizer | Candesartan sandoz | Candesartan teva | Candesartan towa | Candesartan zeria;
  • (KE) Kenya: Aderan | Advant | Arb | Atacand | Candecard | Candez | Gardia | Treatan;
  • (KR) Korea, Republic of: Acande | Adetan | Anatan | Atacand | Cancetil | Candecan | Candelotan | Candeltan | Candemore | Candera | Candertan | Candesan | Candesar | Candeta | Cansartan | Cansata | Cantacan | Cartan | Cavadil | Decartan | Dezaltan | Gloata | Hisartan | Hutecan | Kdc candesartan | Neocande | Samsung candesartan;
  • (KW) Kuwait: Atacand | Blopress;
  • (LB) Lebanon: Andesart | Atacand | Blopress | Candesartan biogaran | Pms candesartan;
  • (LT) Lithuania: Atacand | Candesartan actavis | Canocord | Carzan;
  • (LU) Luxembourg: Atacand | Candesartan EG | Candesartan ratiopharm;
  • (LV) Latvia: Atacand | Candegamma | Candesartan actavis | Canocord | Cantar | Carzan;
  • (MA) Morocco: Atacand;
  • (MX) Mexico: Atacand | Blopress | Candesartan | Chat | Coriatros | Safebul | Sarcan;
  • (MY) Malaysia: Atacand | Blopress | Candesartan sandoz;
  • (NG) Nigeria: Advant | Atacand | Candesartan;
  • (NL) Netherlands: Amias | Atacand | Blopress | Candesartan | Candesartan cilexetil auro | Candesartan cilexetil Aurobindo | Candesartan cilexetil Focus | Candesartan cilexetil Krka | Candesartan cilexetil teva | Candesartan cilexetil Xiromed | Candesartan ratiopharm | Ratacand;
  • (NO) Norway: Amias | Atacand | Candesartan aspen | Candesartan krka | Candesartan orion | Candesartan sandoz | Kandesartan;
  • (NZ) New Zealand: Atacand | Candestar;
  • (PE) Peru: Atacand | Babapress | Blopress | Blox | Candeless | Candesartan | Flosartan | Midopress;
  • (PH) Philippines: Atasart | Babapress | Blopress | Candez | Desaren | Frepan | Giran | Torcand;
  • (PK) Pakistan: Advant | Blopress | Candera | Candesar | Candia | Canditensin | Canex | Cansaar | Cansart | Carac | Cartex | Glocand | Kancand | Miscand | Prosartan | Quartz | Raysartan | Sedanta | Treatan;
  • (PL) Poland: Atacand | Candepres | Candesartan genoptim | Carzap | Kandesar | Kangen | Karbis | Ranacand;
  • (PR) Puerto Rico: Atacand;
  • (PT) Portugal: Atacand | Blopress | Candesartan | Candesartan actavis | Candesartan Alter | Candesartan aurobindo | Candesartan azevedos | Candesartan Basi | Candesartan cinfa | Candesartan Generis | Candesartan Generis Phar | Candesartan germed | Candesartan labesfal | Candesartan mylan | Candesartan osir | Candesartan pharmakern | Candesartan sandoz | Candesartan tad | Candesartan teva;
  • (PY) Paraguay: Atacand | Blox | Coropres | Dacten | Eticard | Indutenol | Prexin | Tadivon | Tiadyl | Vanox;
  • (QA) Qatar: Atacand | Blopress;
  • (RO) Romania: Atacand | Candesartan | Candesartan atb | Candesartan aurobindo | Candesartan cilexetil mcc | Candesartan labormed | Candesartan mylan | Candesartan sandoz | Candesartan torrent | Candesartan vim spectrum | Canzeno | Clastinol | Hipostyn | Karbis | Tandesar;
  • (RU) Russian Federation: Angiakand | Atacand | Candecor | Candesartan | Candesartan sz | Candesartan vertex | Hyposart | Ordiss | Xarten;
  • (SA) Saudi Arabia: Atacand | Blopress | Candepress | Candeza | Diceran | Gardia;
  • (SE) Sweden: Amias | Atacand | Atacand ebb | Candesarstad | Candesartan actavis | Candesartan aspen | Candesartan krka | Candesartan orion | Candesartan ranbaxy | Candesartan sandoz | Candexetil | Kairasec | Kandesartan ebb | Kandrozid;
  • (SG) Singapore: Atacand | Blopress | Candesartan sandoz;
  • (SI) Slovenia: Atacand | Candea;
  • (SK) Slovakia: Atacand | Candesartan mylan | Candesartan ratiopharm | Candesartan sandoz | Carzap | Karbis | Stadacand;
  • (SR) Suriname: Candesartan cilexetil Xiromed;
  • (TH) Thailand: Blopress | Finil | Todesaar;
  • (TN) Tunisia: Aralead | Atacand | Blopress | Mono etiken;
  • (TR) Turkey: Atacand | Ayra | Candecard | Candenact | Candexil | Cantab | Tensart | Ucand;
  • (TW) Taiwan: Blopress | Candesartan | Candis | Karprotec | Lizhensin | Sartanin;
  • (UA) Ukraine: Atacand | Candesar | Casark | Kasark;
  • (UG) Uganda: Aderan | Advant | Atacand;
  • (UY) Uruguay: Atacand | Blopress | Cancor | Diapresan;
  • (VE) Venezuela, Bolivarian Republic of: Atacand | Blocax | Blopress | Calmex | Candepra | Candesartan | Candesartan cilexetilo | Candesartana cilexetila | Candetique | Coropres | Minart | Xartamed;
  • (VN) Viet Nam: Acantan | Candekern | Synartan;
  • (ZA) South Africa: Abecard | Atacand | Aterwin | Candagen | Mylacand;
  • (ZM) Zambia: Aderan;
  • (ZW) Zimbabwe: Atacand
  1. Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153 [PubMed 34160823]
  2. Alwan S, Polifka JE, Friedman JM. Angiotensin II receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol. 2005;73(2):123-130.
  3. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 203: Chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1):e26-e50. doi:10.1097/AOG.0000000000003020 [PubMed 30575676]
  4. American College of Obstetricians and Gynecologists (ACOG). Headaches in pregnancy and postpartum: ACOG clinical practice guideline no. 3. Obstet Gynecol. 2022;139(5):944-972. doi:10.1097/AOG.0000000000004766 [PubMed 35576364]
  5. American Diabetes Association (ADA) Professional Practice Committee; Draznin B, Aroda VR, Bakris G, et al. Management of diabetes in pregnancy: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(suppl 1):S232-S243. doi:10.2337/dc22-S015 [PubMed 34964864]
  6. Amsterdam EA, Wenger NK, Brindis RG, et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. doi:10.1016/j.jacc.2014.09.017 [PubMed 25260718]
  7. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  8. Atacand (candesartan) [prescribing information]. Baudette, MN: ANI Pharmaceuticals; June 2020.
  9. Atacand (candesartan) [product monograph]. Oakville, Ontario, Canada: Xedition Pharmaceuticals Inc; July 2024.
  10. Beltrami L, Zanichelli A, Zingale L, Vacchini R, Carugo S, Cicardi M. Long-term follow-up of 111 patients with angiotensin-converting enzyme inhibitor-related angioedema. J Hypertens. 2011;29(11):2273-2277. doi: 10.1097/HJH.0b013e32834b4b9b. [PubMed 21970934]
  11. Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 [PubMed 33942342]
  12. Brewster LM, Seedat YK. Why do hypertensive patients of African ancestry respond better to calcium blockers and diuretics than to ACE inhibitors and β-adrenergic blockers? A systematic review. BMC Med. 2013;11:141. doi:10.1186/1741-7015-11-141 [PubMed 23721258]
  13. Buter H, Navis GY, Woittiez AJ, de Zeeuw D, de Jong PE. Pharmacokinetics and pharmacodynamics of candesartan cilexetil in patients with normal to severely impaired renal function. Eur J Clin Pharmacol. 1999;54(12):953-958. doi:10.1007/s002280050581 [PubMed 10192757]
  14. Cattran DC, Appel GB, Coppo R. IgA nephropathy: treatment and prognosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 13, 2023.
  15. Cífková R, Johnson MR, Kahan T, et al. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2020;6(6):384-393. doi:10.1093/ehjcvp/pvz082 [PubMed 31841131]
  16. Coberger ED, Jensen BP, Dalrymple JM. Transfer of candesartan into human breast milk. Obstet Gynecol. 2019;134(3):481-484. [PubMed 31403599]
  17. Easthope SE, Jarvis B. Candesartan cilexetil: an update of its use in essential hypertension. Drugs. 2002;62(8):1253-1287. doi: 10.2165/00003495-200262080-00016 [PubMed 12010090]
  18. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  19. Fakhouri F, Schwotzer N, Cabiddu G, et al. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int. 2023;103(2):264-281. doi:10.1016/j.kint.2022.10.029 [PubMed 36481180]
  20. Franks AM, O'Brien CE, Stowe CD, et al. Candesartan cilexetil effectively reduces blood pressure in hypertensive children. Ann Pharmacother. 2008;42(10):1388-1395. [PubMed 18664605]
  21. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi:10.1210/jc.2015-4061 [PubMed 26934393]
  22. Gardner NJ. Treating hypertension in Black patients. JAAPA. 2022;35(2):15-18. doi:10.1097/01.JAA.0000791512.37549.64 [PubMed 35076435]
  23. Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-alternative trial. Lancet. 2003;362(9386):772-776. [PubMed 13678870]
  24. Guyer AC, Banerji A. ACE inhibitor-induced angioedema. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 2, 2021.
  25. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 [PubMed 35363499]
  26. Helmer A, Slater N, Smithgall S. A review of ACE inhibitors and ARBs in black patients with hypertension. Ann Pharmacother. 2018;52(11):1143-1151. doi:10.1177/1060028018779082 [PubMed 29808707]
  27. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):2610-2642. [PubMed 22064600]
  28. Holt HK, Gildengorin G, Karliner L, Fontil V, Pramanik R, Potter MB. Differences in hypertension medication prescribing for Black Americans and their association with hypertension outcomes. J Am Board Fam Med. 2022;35(1):26-34. doi:10.3122/jabfm.2022.01.210276 [PubMed 35039409]
  29. Hoy SM, Keating GM. Candesartan cilexetil: in children and adolescents aged 1 to <17 years with hypertension. Am J Cardiovasc Drugs. 2010;10(5):335-342. [PubMed 20860416]
  30. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
  31. Jamerson KA, Basile J. Prompt, aggressive BP lowering in high-risk patients. J Clin Hypertens (Greenwich). 2008;10(suppl 1):40-48. doi:10.1111/j.1524-6175.2007.08145.x [PubMed 18174783]
  32. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071-2104. [PubMed 24682348]
  33. Kidney Disease: Improving Global Outcomes (KDIGO). Chapter 10: Immunoglobulin A nephropathy. Kidney Int Suppl (2011). 2012;2(2):209-217. [PubMed 25018935]
  34. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021b;99(3S):S1-S87. doi:10.1016/j.kint.2020.11.003 [PubMed 33637192]
  35. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2022;102(suppl 5):S1-S127. doi:10.1016/j.kint.2022.06.008 [PubMed 36272764]
  36. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021a;100(suppl 4):S1-S276. doi:10.1016/j.kint.2021.05.021 [PubMed 34556256]
  37. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl (2013). 2013;3(1):1-150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf.
  38. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(4S):S1-S115. doi:10.1016/j.kint.2020.06.019 [PubMed 32998798]
  39. Maddox TM, Januzzi JL Jr, Allen LA, et al. 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;77(6):772-810. doi:10.1016/j.jacc.2020.11.022 [PubMed 33446410]
  40. Magee LA, Smith GN, Bloch C, et al. Guideline no. 426: hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022;44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002 [PubMed 35577426]
  41. Mann JFE. Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 16, 2019.
  42. Mann JFE, Flack JM. Hypertension in adults: Initial drug therapy. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 7, 2023.
  43. Meyer TE. Primary pharmacologic therapy of heart failure with reduced ejection fraction in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 2, 2021.
  44. National Institute for Health and Care Excellence (NICE). NICE guideline hypertension in pregnancy: diagnosis and management. www.nice.org.uk/guidance/ng133. Published June 25, 2019. Accessed December 1, 2022.
  45. Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92. doi: 10.1161/CIR.0000000000000029. [PubMed 24589852]
  46. O'Gara PT, Kushner FG, Ascheim DD, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425. doi:10.1161/CIR.0b013e3182742cf6 [PubMed 23247304]
  47. Ottosson P, Attman PO, Agren AC, Samuelsson O. Candesartan cilexetil in haemodialysis patients. Clin Drug Investig. 2003;23(8):545-550. doi:10.2165/00044011-200323080-00007 [PubMed 17535067]
  48. Perkovic V. Treatment of diabetic kidney disease. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 2, 2023.
  49. Pfeffer MA, Swedberg K, Granger CB, et al; CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet. 2003;362(9386):759-766. doi:10.1016/s0140-6736(03)14282-1 [PubMed 13678868]
  50. Pfister M, Schaedeli F, Frey FJ, Uehlinger DE. Pharmacokinetics and haemodynamics of candesartan cilexetil in hypertensive patients on regular haemodialysis. Br J Clin Pharmacol. 1999;47(6):645-651. doi:10.1046/j.1365-2125.1999.00939.x [PubMed 10383542]
  51. Porta M, Hainer JW, Jansson SO, et al. Exposure to candesartan during the first trimester of pregnancy in type 1 diabetes: experience from the placebo-controlled DIabetic REtinopathy Candesartan Trials. Diabetologia. 2011;54(6):1298-1303. [PubMed 21225239]
  52. Pringsheim T, Davenport W, Mackie G, et al; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 suppl 2):S1-S59. [PubMed 22683887]
  53. Rasmussen ER, Pottegård A, Bygum A, von Buchwald C, Homøe P, Hallas J. Angiotensin II receptor blockers are safe in patients with prior angioedema related to angiotensin-converting enzyme inhibitors – a nationwide registry-based cohort study. J Intern Med. 2019;285(5):553-561. doi: 10.1111/joim.12867. [PubMed 30618189]
  54. Refer to manufacturer's labeling.
  55. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al; ESC Scientific Document Group. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. doi:10.1093/eurheartj/ehy340 [PubMed 30165544]
  56. Rosendorff C, Lackland DT, Allison M, et al; American Heart Association, American College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. 2015;9(6):453-498. doi: 10.1016/j.jash.2015.03.002. [PubMed 25840695]
  57. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651-1653. doi:10.1002/hep.26359 [PubMed 23463403]
  58. Sánchez-Rodríguez C, Sierra Á, Planchuelo-Gómez Á, Martínez-Pías E, Guerrero ÁL, García-Azorín D. Real world effectiveness and tolerability of candesartan in the treatment of migraine: a retrospective cohort study. Sci Rep. 2021;11(1):3846. doi:10.1038/s41598-021-83508-2 [PubMed 33589682]
  59. Schaefer F, van de Walle J, Zurowska A, et al. Efficacy, safety and pharmacokinetics of candesartan cilexetil in hypertensive children from 1 to less than 6 years of age. J Hypertens. 2010;28(5):1083-1090. [PubMed 20160654]
  60. Schulz EG, Bahri S, Schettler V, Popov AF, Hermann M. Pharmacokinetics and antihypertensive effects of candesartan cilexetil in patients undergoing haemodialysis: an open-label, single-centre study. Clin Drug Investig. 2009;29(11):713-719. doi:10.2165/11319410-000000000-00000 [PubMed 19813774]
  61. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1337-1345. doi:10.1212/WNL.0b013e3182535d20 [PubMed 22529202]
  62. Sipahi I, Debanne SM, Rowland DY, et al. Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials. Lancet Oncol. 2010;11(7):627-636. [PubMed 20542468]
  63. Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124(22):2458-2473. [PubMed 22052934]
  64. Steiner TJ, Jensen R, Katsarava Z, et al. Aids to management of headache disorders in primary care (2nd edition): on behalf of the European Headache Federation and Lifting the Burden: the Global Campaign against Headache. J Headache Pain. 2019;20(1):57. doi:10.1186/s10194-018-0899-2 [PubMed 31113373]
  65. Stovner LJ, Linde M, Gravdahl GB, et al. A comparative study of candesartan versus propranolol for migraine prophylaxis: A randomised, triple-blind, placebo-controlled, double cross-over study. Cephalalgia. 2014;34(7):523-532. doi:10.1177/0333102413515348 [PubMed 24335848]
  66. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;150(19):e351-e442. doi:10.1161/CIR.0000000000001285 [PubMed 39316661]
  67. Toh S, Reichman ME, Houstoun M, et al. Comparative risk for angioedema associated with the use of drugs that target the renin-angiotensin-aldosterone system [published correction appears in Arch Intern Med. 2013;173(1):14]. Arch Intern Med. 2012;172(20):1582-1589. doi: 10.1001/2013.jamainternmed.34. [PubMed 23147456]
  68. Trachtman H, Hainer JW, Sugg J, et al. Efficacy, safety, and pharmacokinetics of candesartan cilexetil in hypertensive children aged 6 to 17 years. J Clin Hypertens (Greenwich). 2008;10(10):743-750. [PubMed 19090875]
  69. Tronvik E, Stovner LJ, Helde G, Sand T, Bovim G. Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. JAMA. 2003;289(1):65-69. doi:10.1001/jama.289.1.65 [PubMed 12503978]
  70. US Department of Veterans Affairs/US Department of Defense. VA/DoD clinical practice guideline for management of headache. https://www.healthquality.va.gov/guidelines/pain/headache/VA-DoD-CPG-Headache-Full-CPG.pdf. Published September 2023. Accessed August 15, 2024.
  71. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hyperten (Greenwich). 2014;16(1):14-26. [PubMed 24341872]
  72. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138(17):e484-e594. [PubMed 30354654]
  73. Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-e327. [PubMed 23741058]
  74. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. Lancet. 2003;362(9386):777-781. [PubMed 13678871]
Topic 17058 Version 349.0