Candesartan
Mechanism :
Candesartan selectively blocks the binding of angiotensin II to AT1 in many tissues including vascular smooth muscle and the adrenal glands. This inhibits the AT1-mediated vasoconstrictive and aldosterone-secreting effects of angiotensin II and results in an overall decrease in blood pressure. Candesartan is greater than 10,000 times more selective for AT1 than AT2. Inhibition of aldosterone secretion may increase sodium and water excretion while decreasing potassium excretion.
Indication :
Contraindications :
Hypersensitivity, Severe hepatic impairment, Do not coadminister with aliskiren in patients with diabetes.
Dosing :
1-6 years:
Start with 0.2 mg/kg orally once daily or in two divided doses. Dose range: 0.05-0.4 mg/kg/day orally.
6-17 years, <50 kg:
Start with 4-8 mg/day orally once a day. Dose Range: Adjust within 2 weeks to dose range 2-16 mg/day orally once a day; Max: 32 mg/day.
6-17 years, >50 kg:
Start with 8-16 mg/day PO. Dose range: Adjust within 2 weeks to dose range 4-32 mg/day PO; not to exceed 32 mg/day.
Adverse Effect :
Hives, difficulty breathing, angioedema, rhabdomyolysis.
Interaction :
Aliskiren: Increases the toxicity of both the drugs.
ACE Inhibitors: Increases the toxicity by pharmacodynamic synergism.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Initial dose 2 mg and increase according to response |
| <10 | Initial dose 2 mg and increase according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as for GFR<10 mL/min |
| HD | Not dialysed. Dose as for GFR<10 mL/min |
| HDF/High flux | Not dialysed. Dose as for GFR<10 mL/min |
| CAV/VVHD | Unlikely to be dialysed. Dose as for GFR=10–20 mL/min |
Hepatic Dose :
Mild hepatic impairment: No dosage adjustments are recommended.
Moderate hepatic impairment: Dose reduction may be required. Adjust dose as per clinical response.
Severe hepatic impairment: Avoid using the drug.