Candesartan (Oral Tablet)

Candesartan helps to relieve the effects of heart failure and high blood pressure by relaxing the body’s blood vessels, so that blood pressure is lowered, and the chance of stroke is reduced.

Overview

Candesartan is a prescription drug which is used in the treatment of high blood pressure and congestive heart failure, and is frequently used in combination with other drugs to achieve maximum desirable results. Candesartan counteracts the effects of natural substances which tend to tighten the blood vessels in the body, thereby restricting the flow of blood throughout the body. By causing the blood vessels to relax, candesartan increases the flow of blood, and restores better circulation, relieving stress on the heart.

When blood vessels become constricted, it can lead to congestive heart failure, which is a condition that occurs when the heart is unable to pump a sufficient quantity of blood to all parts of the body. High blood pressure is a related medical condition in which the circulation of blood is not as free and normal as it should be, but is constrained either by blockages or by narrowed blood vessels.

While high blood pressure does not usually cause the immediate and severe effects of congestive heart failure, over time it can lead to a number of serious problems such as damage to the heart, brain, and other organs, as well as heart attack and stroke, if it is left untreated. Candesartan is a drug which can help to relieve the problems which might otherwise bring on either high blood pressure or congestive heart failure.

Condition Treated

  • High blood pressure, heart failure

Type of Medicine

  • Angiotensin receptor blocker

Side Effects

Along with the beneficial and desirable effects that candesartan is capable of achieving, there are some undesirable reactions which appear for some patients in the form of side effects. Some of these can be very serious in nature, but most of them are relatively mild, and while they should be discussed with your doctor, they don't necessarily call for medical treatment, and are not cause for undue concern.

The first and probably the most serious possibility is an allergic reaction to candesartan. As with an allergic reaction to almost anything else, like pets or food items, the symptoms manifested during an allergic reaction can cause serious problems in your body, and in the most extreme cases can be life-threatening. After taking candesartan, you should look for signs of an allergic reaction which are: swelling in the facial area or around the lips, tongue, or throat, quickly appearing hives or rashes, or inflammation in various locations around the body.

Some of the other serious side effects need to be dealt with according to the severity of symptoms, and in most cases, you can feel how severely the symptoms are affecting your body. The more serious side effects include the following:

• low blood pressure, characterized by faintness or a dizzy feeling, possible lightheadedness, fatigue or excessive tiredness even when you haven't been active
• beginning of, or worsening of kidney problems such as shortness of breath and urinating less than normal
• high levels of potassium in the blood, which show up as muscle weakness, nausea and/or vomiting, changes in heart beat, such as irregularity or faster/slower heartbeat than normal

Some of the less serious side effects listed below may simply fade away on their own, as your body grows accustomed to the effects of candesartan:

• Sore throat or fever
• nasal congestion or runny nose
• dizziness or disorientation
• lower back pain and other unexplained muscle pains
• symptoms which act like a cold or influenza, such as coughing, sneezing, fever, and achiness throughout the body.

In the vast majority of cases, these milder side effects will go away all by themselves without medical intervention, but if they do persist in your case, be sure to discuss them with your family doctor. He/she may have recommendations which will mitigate their effects or which will relieve them entirely.

Dosage

Dosage of candesartan for any specific person will be based on several factors, including your age at the time of treatment, any existing medical conditions which you already have, the severity of your medical condition currently, the specific condition for which you are now being treated, and how you react to the first dose or two of candesartan. In addition, dosage may also depend on the strength of the particular tablets which you are taking, and how frequently these tablets are taken during the course of the day. It is always best to take your candesartan medication at the same time each day, so that your body has a chance to acclimate to its effects, and so that you remember to take the drug.

Candesartan is generally manufactured in tablets of 4 mg, 8 mg, 16 mg, and 32 mg, and the standard adult dosage for persons between the age of 18 and 64 years is 16 mg, taken orally once each day. Generally speaking, daily adult dosage will not exceed 32 mg, and will either be taken in a single dose, or for the higher amount, two equally divided dosages.

For children aged 6 to 17 years, the following standard dosages are indicated:

• children who are unable to swallow tablets might be able to use an oral suspension, which would have to be prepared specially by a pharmacist
• children weighing more than 50 kg – dosages can range anywhere between 4 and 32 mg per day, although between 8 and 16 mg is a good initial dosage
• children weighing less than 50 kg – dosages can range anywhere between 2 and 16 mg per day, with somewhere between 4 and 8 mg being a good starting point
• dosages should be taken once per day in a single dose, or in two equally divided doses

Children between 1 and 5 years of age are generally administered candesartan in the following dosages:

• a standard dosage in this age group is .05 to .4 mg per kilogram of body weight in any given day, with a typical starting dosage being at .2 mg per kilograms in a day
• dosage should be taken orally once per day, or divided into two equal doses
• for children who are unable to swallow tablets, an oral suspension preparation is possible, although this would have to be custom-made by a pharmacist

Seniors who are prescribed candesartan have no standard dosage recommended, because as mentioned above, older bodies process drugs more slowly, and this is specific to the individual, so standardization is not indicated. Doctors will generally develop a senior program of treatment for candesartan after observing how initial dosages impact a patient, and making any adjustments which might be necessary.

There are a few special dosage considerations for people with existing medical conditions as follows:

• children less than 18 with kidney problems – should not take candesartan at all
• adults with severe kidney problems – an initial dosage of 8 mg or less in a single day
• adults with moderate kidney problems – 8 mg per day
• children less than 18 with heart failure – should not take candesartan at all
• adult dosage with heart failure – 4 mg taken orally each day, with the possibility of an upper limit of 32 mg
• seniors with heart failure – no standard guidelines are available for this age group, so your doctor will have to work out precise dosages during treatment.

Interactions

It is possible that there may be interactions between candesartan and other drugs, and some of these interactions could be beneficial, and are actually anticipated as part of the program of medical treatment. However, there are also some drugs which interact negatively with candesartan, causing either a reduction of effectiveness, or more severe reactions.

For this reason, it is important that if you're considering a program of treatment which includes candesartan, that you make a complete list of all the other medications you are currently taking. This list should include all other prescription medications, over-the-counter drugs, vitamins, and herbal supplements, and it should also list the dosages of each one of these, so that your doctor can make a determination on whether there might be interactions between items on your list and candesartan.

It's worth compiling this list of medications and supplements for another reason as well, because if you ever have to go to a health care clinic or an emergency room for treatment, it will be very helpful to have a list of all your medications to show the doctor there, so that he/she can avoid unwanted interactions between two or more drugs.

Generally speaking, you can avoid highly undesirable interactions between drugs by having all of your prescriptions prepared by the same pharmacist, because part of their process is to check for interactions between drugs before filling prescriptions.

Candesartan may lose some degree of effectiveness when coupled with non-steroidal anti-inflammatory drugs (NSAIDs). Senior citizens especially need to be alert to the possibility of combining candesartan with water pills or medications which treat kidney problems, because there is a potential for any kidney problems to be worsened. Some specific drugs in this category include naproxen, ibuprofen, and diclofenac.

Another class of drugs which could have serious negative reactions when taken with candesartan are those used in the treatment of seizures. There is a potential for candesartan to increase the level of seizure drugs in the body to a point where dangerous reactions are possible. Lithium, for example, is a drug commonly used in the treatment of convulsions and seizures, and should probably not be used in conjunction with candesartan.

Since candesartan is itself a medication used in the treatment of high blood pressure, the potential exists for a dangerous condition when it is used in tandem with other high blood pressure medications, because their combined effect may lower blood pressure levels to a critical state. Combining two or more high blood pressure medications in this way can also trigger high levels of blood potassium, and degraded function of the kidneys.

Among the high blood pressure medications which are angiotensin receptor blockers, drugs to avoid combining with candesartan are valsartan, telmisartan, and losartan. Among the angiotensin-converting enzyme inhibitors, drugs to avoid are lisinopril, captopril, and enalapril.

Still another class of drugs which may produce unwanted interactions with candesartan are those that work to increase potassium levels, such as potassium supplements, salt substitutes containing potassium, and potassium-sparing diuretics like triamterene, amiloride, and spironolactone.

Warnings

When you are being considered for a treatment program which includes candesartan, there are several precautions and warnings which should be taken into account, and thoroughly discussed with your family doctor. This should be a ‘pros and cons’ conversation, which considers the benefits achievable by candesartan, as well as the risks of taking the drug.

The first warning which should be observed is that of an allergic reaction, and if you know you have had an allergic reaction to candesartan in the past, you need to mention that immediately to your doctor before treatment is even considered. A second allergic reaction to candesartan can prove to be fatal for a patient.

People who have diabetes and are being treated for that condition with aliskiren, should not take candesartan, because it can increase the level of potassium in your blood, degrade kidney function, and trigger very low blood pressure.

Any patients who demonstrate risk factors for very low blood pressure are well advised to consider the risk of taking candesartan, especially if you take water pills, are on dialysis, have a low salt diet, suffer from regular diarrhea, or have frequent nausea and vomiting. Any or all of these conditions can be worsened by candesartan, and can lead to dangerously low blood pressure.

People who have existing kidney problems should avoid taking candesartan, because it is very possible that this drug will worsen your kidney problems. In cases where your doctor recommends candesartan even though you have minor kidney problems, it will probably be necessary to monitor kidney function throughout the period of treatment with candesartan, adjusting dosages as needed to maintain safe treatment.

Candesartan is a drug which is considered a category D pregnancy drug, which means that studies have shown there is a significant risk of harm to the fetus, when the mother is being treated with candesartan. It also means that there is a good likelihood of the risk in taking candesartan exceeding the possible benefits which might accrue, in terms of managing high blood pressure or heart failure.

There have been some reports of birth defects occurring in fetuses whose mothers were being treated with candesartan, and there have even been some deaths which have occurred to fetuses. Obviously, the impact of taking candesartan during pregnancy can have some very serious effects, and this means you should immediately discuss with your doctor if you find out that you're pregnant, so that treatment with candesartan can be discontinued.

While it is not known with certainty whether or not candesartan is passed on to an infant through breast milk, it is likely that if the drug should be passed on through breast milk, it would impart some kind of physical damage to the infant. It is therefore highly inadvisable to be breastfeeding while also being treated with candesartan. In cases where women are thinking of becoming pregnant or are intending to breast feed, your doctor will more than likely change your medication from candesartan to something less harmful.

There is a warning that seniors should be aware of when taking candesartan, simply because at an older age, the body processes drugs much more slowly. This means that a normal dosage of candesartan will stay in the system longer, and have a tendency to accumulate. This may cause your doctor to lower your dosage, or prescribe less frequent ingestion of candesartan because less is being used by your body.

Since candesartan usage has not been extensively studied in youngsters, it is infrequently prescribed for persons under 18 years of age. People in this age group are somewhat less likely to develop high blood pressure or congestive heart failure, so a treatment program including candesartan will have less historical data to rely upon.

Storage

Candesartan should be stored at room temperature, well below 86 degrees Fahrenheit, and it should neve be frozen. It should be kept away from locations which are humid, for instance the bathroom, where showering and bathing inject high levels of moisture into the air.

It should be kept in a tightly sealed container, and not put in a pill reminder container, because these containers seldom have safety features which prevent them from being opened by children. Candesartan should always be stored well out of the reach of children and pets, to prevent accidental ingestion. If you suspect your child has swallowed candesartan, you should call your doctor immediately, as well as the Poison Control Center, and follow any instructions you are given.

Summary

Candesartan is a drug which is commonly used in the treatment of high blood pressure and congestive heart failure, and it works by relaxing the blood vessels in the body. When blood vessels have become tightened, narrowed, or obstructed, the flow of blood throughout the body is restricted, and this can lead to dangerous situations.

This drug is often used in conjunction with other medications, but there are some drug combinations which have to be avoided, because their interactions can produce unwanted side effects. Candesartan should not be used with drugs that are treating seizures, kidney problems, or some high blood pressure conditions.

It is important to remember that candesartan improves those conditions which it is used for, but does not really cure them, so the likelihood is that it will be a long-term treatment program, unless lifestyle changes bring about positive changes and eliminate the condition being treated.