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All about: Candesartan Cilexetil/Hydrochlorothiazide

Big Image Pronouncation: (kan-deh-SAHR-tan sigh-LEX-eh-till/high-droe-klor-oh-THIGH-uh-zide)
Class: Antihypertensive combination

Trade Names:
Atacand HCT
- Tablets 16 mg candesartan, 12.5 mg hydrochlorothiazide
- Tablets 32 mg candesartan, 12.5 mg hydrochlorothiazide

Atacand Plus (Canada)

Mechanism of Action

Pharmacology

Candesartan

Antagonizes the effect of angiotensin II (vasoconstriction and aldosterone secretion) by blocking the angiotensin II receptor (AT 1 receptor) in vascular smooth muscle and the adrenal gland, producing decreased BP.

Hydrochlorothiazide

Increases chloride, sodium, and water excretion by interfering with transport of sodium ions across renal tubular epithelium.

Indications and Usage

Treatment of hypertension.

Contraindications

Any component of product; patients with anuria or hypersensitivity to sulfonamide-derived drugs.

Dosage and Administration

Adults

PO Atacand HCT may be substituted for previously titrated individual components. The daily dose range for Atacand HCT tablets is candesartan 16 mg combined with hydrochlorothiazide 12.5 mg to candesartan 32 mg combined with hydrochlorothiazide 25 mg.

General Advice

Give every day in the morning, with or without food. Administer with food if GI upset occurs.

Storage/Stability

Store tablets at controlled room temperature (59° to 86°F). Keep container tightly closed.

Drug Interactions

Candesartan Alcohol, barbiturates, narcotics

Increased risk of orthostatic hypotension.

Antidiabetic agents (oral and insulin agents)

Dosage adjustment of antidiabetic agent may be necessary.

Corticosteroids, ACTH

Increased electrolyte depletion, increasing risk of hypokalemia.

NSAIDs

The diuretic, natriuretic, and hypertensive effects of loop, potassium-sparing, and thiazide diuretics may be reduced.

Pressor amines (eg, norepinephrine)

Decreased responsiveness of the pressor amine.

Skeletal muscle relaxants, nondepolarizing (eg, tubocurarine)

Increased responsiveness of the muscle relaxant.

Hydrochlorothiazide Bile acid sequestrants

May reduce hydrochlorothiazide absorption; give hydrochlorothiazide at least 2 h before sequestrant.

Diazoxide

May cause hyperglycemia.

Digitalis glycosides

Diuretic-induced hypokalemia and hypomagnesemia may lead to digitalis-induced arrhythmias.

Lithium

Because renal excretion of lithium may be reduced, avoid use if possible.

Loop diuretics (eg, furosemide)

Synergistic effects may occur, resulting in profound diuresis and serious electrolyte abnormalities.

Sulfonylureas (eg, chlorpropamide)

Hypoglycemic effect of sulfonylurea may be decreased, necessitating an increase in sulfonylurea dosage.

Laboratory Test Interactions

Hydrochlorothiazide may decrease serum protein-bound iodine levels without signs of thyroid disturbances; may cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels, and serum uric acid levels.

Adverse Reactions

Cardiovascular

Candesartan

Tachycardia; palpitation; extrasystoles; bradycardia; abnormal ECG.

Hydrochlorothiazide

Hypotension (including orthostatic hypotension).

CNS

Candesartan

Dizziness; vertigo; paresthesia; hypesthesia; depression; insomnia; anxiety; somnolence.

Hydrochlorothiazide

Restlessness; headache.

Dermatologic

Candesartan

Eczema; increased sweating; pruritus; dermatitis; rash; urticaria.

Hydrochlorothiazide

Erythema multiforme (including Stevens-Johnson syndrome); exfoliative dermatitis (including toxic epidermal necrolysis); alopecia.

EENT

Candesartan

Sinusitis; pharyngitis; rhinitis; conjunctivitis; tinnitus.

Hydrochlorothiazide

Transient blurred vision; xanthopsia.

GI

Candesartan

Nausea; abdominal pain; diarrhea; dyspepsia; gastritis; gastroenteritis; vomiting.

Hydrochlorothiazide

Pancreatitis; sialadenitis; cramping; constipation; gastric irritation; anorexia.

Genitourinary

Candesartan

UTI; hematuria; cystitis; albuminuria.

Hydrochlorothiazide

Renal failure; renal function impairment; interstitial nephritis; impotence.

Hematologic

Candesartan

Epistaxis; neutropenia; leukopenia; agranulocytosis.

Hydrochlorothiazide

Aplastic anemia; hemolytic anemia; thrombocytopenia.

Hepatic

Candesartan

Hepatic function impairment; increased transaminase levels.

Metabolic

Candesartan

Hyperuricemia; hyperglycemia; hypokalemia; increased BUN; increased creatine phosphokinase; hypertriglyceridemia.

Hydrochlorothiazide

Electrolyte imbalance; glycosuria.

Respiratory

Candesartan

Upper respiratory tract infection; influenza-like symptoms; bronchitis; cough; dyspnea.

Hydrochlorothiazide

Respiratory distress (including pneumonitis and pulmonary edema).

Miscellaneous

Candesartan

Back pain; fatigue; pain; chest pain; peripheral edema; asthenia; arthralgia; myalgia; arthrosis; arthritis; leg cramps; sciatica; infection; viral infection.

Hydrochlorothiazide

Fever; weakness; anaphylactic reactions; necrotizing angiitis; photosensitivity; muscle spasm; purpura.

Precautions

Warnings

When used in pregnancy during the second and third trimesters, drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible.


Monitor

Blood sugar

Monitor blood sugar in diabetic patient when drug is started or dose is changed. Report significant changes to health care provider.

BP

Monitor and record BP and pulse. Should hypotension result, hold medication and notify health care provider.

Serum electrolytes

Ensure that serum electrolytes are monitored periodically.


Pregnancy

Category D (second and third trimester); Category C (first trimester). Can cause injury and death to fetus if used during second or third trimester.

Lactation

Candesartan: Undetermined; hydrochlorothiazide: excreted in breast milk.

Children

Safety and efficacy in children younger than 18 yr of age not established.

Renal Function

Use with caution.

Hepatic Function

Use with caution.

Diabetics

May require adjustments of insulin or oral hypoglycemic agents; hyperglycemia may occur.

Hyperuricemia

May occur, or acute gout may be precipitated.

Hypotension/Volume-depleted patients

Symptomatic hypotension may occur after initiation of therapy in patients who are intravascularly volume depleted. Correct these conditions prior to administration.

Systemic lupus erythematosus

May be activated or exacerbated.

Overdosage

Symptoms

Candesartan

Hypotension, dizziness, tachycardia, bradycardia.

Hydrochlorothiazide

Electrolyte depletion (eg, hypokalemia, hypochloremia, hyponatremia), dehydration.

Patient Information

  • Advise patient to take every day as prescribed, without regard to meals.
  • Advise patient to try to take each dose at about the same time every day.
  • Inform patient that drug controls, but does not cure, hypertension and to continue taking drug as prescribed even when BP is not elevated.
  • Caution patient not to change the dose or stop taking unless advised by health care provider.
  • Instruct patient to continue taking other BP medications as prescribed by health care provider.
  • Instruct patient in BP and pulse measurement skills.
  • Advise patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Also advise patient to take record of BP and pulse to each follow-up visit.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing.
  • Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting.
  • Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
  • Caution patient to avoid unnecessary exposure to UV light (sunlight, tanning booths), use sunscreen, and wear protective clothing when exposed to UV light to avoid photosensitivity reaction.
  • Emphasize to hypertensive patient importance of other modalities on BP: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt.
  • Instruct patient to stop taking drug and immediately report any of the following symptoms to health care provider: fainting, swelling of the face, lips, eyelids, or tongue.
  • Caution patient to not take any prescription or OTC medications, potassium salt substitutes, or potassium dietary supplements unless advised by health care provider.

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