Atacand

Atacand (candesartan cilexetil) is an angiotensin II receptor blocker (ARB) prescribed for the management of hypertension in adults. It works by blocking the action of certain natural substances that tighten blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. This medication may also be used to treat heart failure in adults and to improve survival following a heart attack in certain clinically stable patients with left ventricular systolic dysfunction. Clinical evidence supports its efficacy in providing sustained 24-hour blood pressure reduction with a single daily dose. Proper use under medical supervision is essential for optimal therapeutic outcomes.

Features

• Active ingredient: Candesartan cilexetil
• Available in tablet strengths: 4 mg, 8 mg, 16 mg, 32 mg
• Administration: Oral, once or twice daily as directed
• Mechanism: Selective AT1 subtype angiotensin II receptor antagonist
• Onset of action: Within 2–4 hours post-dose
• Peak effect: 4–8 hours after administration
• Duration: Provides 24-hour antihypertensive effect
• Bioavailability: Approximately 15% following oral administration
• Protein binding: >99%
• Metabolism: Hepatic ester hydrolysis to active metabolite candesartan
• Elimination half-life: Approximately 9 hours
• Excretion: Primarily renal (60%) and fecal (40%)

Benefits

• Provides consistent 24-hour blood pressure control with once-daily dosing
• Reduces the risk of cardiovascular events in hypertensive patients
• Demonstrates excellent tolerability profile with low incidence of side effects
• Shows proven efficacy in heart failure management when combined with standard therapy
• Offers flexible dosing options for individualized treatment approaches
• Maintains therapeutic effect regardless of food intake

Common use

Atacand is primarily indicated for the treatment of hypertension in adults, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the treatment of heart failure (NYHA Class II-IV) in adults with reduced ejection fraction, to reduce cardiovascular death and hospitalizations for heart failure. Additionally, it is used in clinically stable patients with left ventricular systolic dysfunction (ejection fraction ≤40%) following myocardial infarction to reduce cardiovascular mortality. Off-label uses may include diabetic nephropathy and migraine prophylaxis, though these applications require specialist supervision.

Dosage and direction

Hypertension: The recommended initial dose is 16 mg once daily. Dosage may be increased to 32 mg once daily based on blood pressure response. The maintenance dose is typically 8–32 mg daily, administered as a single dose or divided into two doses.

Heart Failure: The recommended initial dose is 4 mg once daily. The target maintenance dose is 32 mg once daily, achieved by doubling the dose at intervals of at least 2 weeks as tolerated by the patient.

Post-Myocardial Infarction: Treatment should be initiated between 3 days and 4 weeks after infarction. The initial dose is 4 mg once daily, titrated to 32 mg once daily as tolerated.

Tablets should be swallowed whole with a glass of water, with or without food. Dose titration should be performed under medical supervision, particularly in patients with renal impairment, hepatic impairment, or volume depletion.

Precautions

• Monitor blood pressure regularly during therapy initiation and dose adjustments
• Assess renal function before and during treatment, particularly in patients with renal impairment
• Use caution in patients with hepatic impairment; consider lower starting doses
• Monitor serum potassium levels, especially in patients with renal impairment, diabetes, or those taking potassium supplements
• Avoid use in pregnancy due to potential fetal harm; discontinue immediately if pregnancy is detected
• Exercise caution in patients with bilateral renal artery stenosis or solitary kidney
• May cause dizziness or somnolence; advise patients regarding driving or operating machinery
• Volume-depleted patients may experience symptomatic hypotension; correct volume depletion prior to initiation

Contraindications

• Hypersensitivity to candesartan cilexetil or any component of the formulation
• Concomitant use with aliskiren in patients with diabetes
• Pregnancy (second and third trimesters)
• Severe hepatic impairment (Child-Pugh class C)
• Bilateral renal artery stenosis
• History of angioedema related to previous ACE inhibitor or ARB therapy

Possible side effect

Common (≥1/100 to <1/10):

• Dizziness
• Headache
• Respiratory tract infection
• Back pain
• Upper respiratory tract symptoms

Uncommon (≥1/1,000 to <1/100):

• Hypotension
• Hyperkalemia
• Renal impairment
• Increased serum creatinine
• Fatigue
• Nausea
• Abdominal pain
• Rash

Rare (<1/1,000):

• Angioedema
• Neutropenia
• Thrombocytopenia
• Hepatitis
• Hyponatremia
• Syncope
• Tinnitus
• Palpitations

Drug interaction

• Diuretics: Enhanced hypotensive effect; risk of first-dose hypotension
• Potassium-sparing diuretics/potassium supplements: Increased risk of hyperkalemia
• Lithium: Increased lithium concentrations and toxicity risk
• NSAIDs: May reduce antihypertensive effect and increase risk of renal impairment
• ACE inhibitors: Increased risk of hyperkalemia, hypotension, and renal impairment
• Aliskiren: Contraindicated in patients with diabetes due to increased risk of adverse events
• Warfarin: Minor interaction; monitor INR periodically
• Digoxin: Possible increase in digoxin plasma concentration

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is nearly time for the next dose, skip the missed dose and continue with the regular dosing schedule. Do not take a double dose to make up for a missed dose. Patients should maintain a consistent dosing schedule and consult their healthcare provider if multiple doses are missed.

Overdose

Symptoms of overdose may include hypotension, tachycardia, bradycardia, dizziness, and renal failure. Management involves supportive care with volume expansion with normal saline. Hemodialysis may be effective due to partial dialyzability of candesartan. Symptomatic treatment should be provided based on clinical presentation. Close monitoring of vital signs, electrolyte balance, and renal function is essential.

Storage

Store at room temperature (15–30°C/59–86°F) in the original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not use after the expiration date printed on the packaging. Do not store in bathroom or damp places. Discard any unused medication properly according to local regulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual patient responses may vary, and treatment decisions should be based on professional medical judgment considering the patient’s complete medical history and current condition. The prescribing physician should be consulted regarding specific indications, contraindications, and dosing recommendations.

Reviews

Clinical studies demonstrate Atacand’s efficacy in blood pressure control, with meta-analyses showing consistent reduction in systolic and diastolic pressures. The CHARM program established its benefit in heart failure, showing significant reduction in cardiovascular mortality and heart failure hospitalizations. Long-term extension studies confirm maintained efficacy and good tolerability over extended periods. Real-world evidence supports the clinical trial findings, with physicians reporting reliable antihypertensive effects and patient satisfaction with once-daily dosing convenience. Some studies note particularly good efficacy in elderly patients and those with isolated systolic hypertension.