Candesartan Cilexetil

  Action Antagonizes the effect angiotension II (vasoconstriction and aldosterone secretion) by blocking the angiotension II receptor (AT1 receptor) in vascular smooth muscle and the adrenal gland, producing decreased BP.

  Indications Treatment of hypertension.

  Contraindications Standard considerations.

  Route/Dosage

Adults: Initial dose: PO 16 mg/day; consider lower dose if volume-depleted. Total daily doses range from 8 to 32 mg in 1 or 2 doses.

  Interactions

Lithium: Plasma concentrations may be increased by candesartan, resulting in an increase in the pharmacologic and adverse effects of lithium.

  Lab Test Interferences None well documented.

  Adverse Reactions

CNS: Headache; dizziness; fatigue. EENT: Rhinitis; sinusitis; pharynigitis. GI: Nausea; abdominal pain; diarrhea; vomiting. RESPIRATORY: Upper respiratory tract infection; bronchitis; cough. OTHER: Back pain; chest pain; edema; arthralgia; albuminuria.

  Precautions

Pregnancy: Category D (second and third trimester); Category C (first trimester). Can cause injury or death to fetus if used during second or third trimester. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Renal function impairment: Use caution in treating patients whose renal function may depend on the activity of the renin-angiotensin-aldosterone system (eg, patients with severe CHF). Hypotension/Volume-depleted patients: Symptomatic hypotension may occur after initiation of candesarten in patients who are intravascularly volume depleted (eg, those treated with diuretics). Correct these conditions prior to administration of candesaratan or use a lower starting dose. African-Americans: Candesartan may not be as effective in African-Americans.

  Administration/Storage

• Administer without regard to food.
• Check BP before administration.
• Anticipate a synergistic or additive effect with concomitant use of thiazides and other antihypertensive medications.
• Do not administer if patient is pregnant or breastfeeding or otherwise contraindicated.
• Store at controlled room temperature in a tightly closed container. Protect from moisture.

  Assessment/Interventions

• Obtain complete drug history including any known allergies.
• Closely monitor infants exposed to candesartan in utero for hypotension, oliguria, and hyperkalemia. Supportive measures for renal perfusion and BP stabilization may be necessary. Exchange transfusions and dialysis may be required.
• Monitor BP and pulse. Should hypotension, tachycardia, or bradycardia result, withhold the medication and notify health care provider.
• Monitor for symptomatic hypotension especially in salt- or volume-depleted patients such as those on diuretics. Correct condition prior to treatment or monitored under close medical supervision. If hypotension occurs, place the patient in the supine position and have an IV infusion of normal saline available.
• Institute fall precautions in unstable patients.
• Closely monitor patients with severe CHF or progressive azotemia and (rarely) symptoms of acute renal failure.
• Monitor patients with impaired renal function for decreased urinary output and for adverse reactions.
• Assess patient for signs of hyperkalemia, especially if they are using a potassium-sparing diuretic.
• Review available laboratory tests for the following abnormal findings: creatine and BUN, hemoglobin, hematocrit, WBCs, platelets, LFTs.
• Monitor for signs of hypersensitivity, which includes angioedema, involving swelling of the face, lips, and tongue. Where there is involvement of the tongue, glottis, or larynx likely to cause airway obstruction, promptly administer emergency therapy, which could include epinephrine.

  Patient/Family Education

• Provide patient information pamphlet.
• Instruct patient to take the medication as prescribed at the same time each day.
• Inform patient that candesartan can control but does not cure hypertension.
• Caution patient to take the dose exactly as prescribed and not to stop taking the medication even if they feel better.
• Instruct patient not to decrease or increase their dosage without talking with their health care provider.
• Inform patient of the following possible adverse effects: dry cough, renal function impairment, fetal injury.
• Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
• Instruct the patient in BP and pulse measurement skills. Caution patient to call health care provider should abnormal readings occur.
• Instruct patient that other methods of fall prevention, including rising slowly and sitting on the side of the bed before standing, especially early in therapy.
• Instruct patient that other medications, especially hypertensive medications, can have additive or synergistic effects. Have patient inform health care provider of all medication including OTC drugs they are presently taking.
• Inform patient of the importance of adjunct therapies such as dietary planning, a regular exercise program, weight reduction, a low sodium diet, smoking cessation program, alcohol reduction, and stress management.
• Instruct patient to monitor renal, hepatic, and hematologic symptoms including urinary output and any discomfort during urination, weakness, fatigue, dizziness, lightheadedness, and jaundice. Patient should inform primary caregiver if symptoms occur.
• Warn patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting, resulting in reduced fluid volume, may lead to an excessive fall in BP, lightheadness, and possible fainting.
• Tell patient not to use potassium supplement or salt substitutes containing potassium to prevent possible hyperkalemia.
• Instruct patient to report any indications of an infection such as a sore throat, which could indicate neutropenia.
• Caution patient to inform health care provider or dentist of drug therapy prior to surgery or treatment.