Formulary
Candesartan cilexetil: Indications, Dosing, Side Effects and Interactions
Candesartan cilexetil clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Candesartan cilexetil: Indications, Dosing, Side Effects and Interactions
Candesartan cilexetil clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 8 mg once daily, increased if necessary up to 32 mg once daily, dose to be increased at intervals of 4 weeks; usual dose 8 mg once daily.
**Hypertension with intravascular volume depletion**
- **Adult** (By Mouth): Initially 4 mg once daily, increased if necessary up to 32 mg once daily, dose to be increased at intervals of 4 weeks; usual dose 8 mg once daily.
**Heart failure with impaired left ventricular systolic function when ACE inhibitors are not tolerated**
- **Adult** (By Mouth): Initially 4 mg once daily, increased to up to 32 mg once daily, dose to be increased at intervals of at least 2 weeks to 'target' dose of 32 mg once daily or to maximum tolerated dose.
**Heart failure with impaired left ventricular systolic function in conjunction with an ACE inhibitor (under expert supervision)**
- **Adult** (By Mouth): Initially 4 mg once daily, increased to up to 32 mg once daily, dose to be increased at intervals of at least 2 weeks to 'target' dose of 32 mg once daily or to maximum tolerated dose.
**Migraine prophylaxis**
- **Adult** (By Mouth): 16 mg once daily.
**Hypertension for candesartan cilexetil**
- **Child 6-17 years (under expert supervision) (body-weight up to 50 kg)** (By mouth): Initially 4 mg once daily, lower dose may be used in intravascular volume depletion; increased if necessary up to 8 mg once daily.
- **Child 6-17 years (under expert supervision) (body-weight 50 kg and above)** (By mouth): Initially 4 mg once daily, lower dose may be used in intravascular volume depletion; increased if necessary up to 16 mg once daily.
Cautions
II receptor antagonists Aortic or mitral valve stenosis; elderly (lower initial doses may be appropriate); hypertrophic cardiomyopathy; patients of black African or African-Caribbean origin; patients with a history of angioedema; patients with primary aldosteronism (may not benefit from an angiotensin-II receptor antagonist); renal artery stenosis Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
II receptor antagonists The combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with diabetes mellitus Contra-indications For candesartan cilexetil Cholestasis
Side effects
II receptor antagonists Common or very common Abdominal pain; asthenia; back pain; cough; diarrhoea; dizziness; headache; hyperkalaemia; hypotension; nausea; postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics); renal impairment; vertigo; vomiting Uncommon Angioedema; myalgia; skin reactions; thrombocytopenia Rare or very rare Arthralgia; hepatic function abnormal Side-effects For candesartan cilexetil Common or very common Increased risk of infection Rare or very rare Agranulocytosis; hepatitis; hyponatraemia; leucopenia; neutropenia
Interactions
**Other interactions (6):**
- Compounds which have been investigated in clinical pharmacokinetic studies include hydrochlorothiazide, warfarin, digoxin, oral contraceptives (i.e.
- Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other medicinal products (e.g.
- Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors.
- Use of candesartan with lithium is not recommended.
- If the combination proves necessary, careful monitoring of serum lithium levels is recommended.
- Clinical trial data has shown that dual blockade of the renin-angiotensin-aldosterone-system (RAAS) through the combined use of ACE-inhibitors, angiotensin II receptor blockers or aliskiren is...
Pregnancy
Important safety information For all angiotensin II receptor antagonists MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
II receptor antagonists Information on the use of angiotensin-II receptor antagonists in breast-feeding is limited. They are not recommended in breast-feeding. Alternative treatment options, with better established safety profile during breast-feeding, are preferable M (recommendation also supported by specialist sources).
Hepatic impairment
II receptor antagonists In general, manufacturers advise caution in mild to moderate impairment (limited information available); avoid in severe impairment (no information available). Hepatic impairment For candesartan cilexetil Manufacturer advises avoid in severe impairment or cholestasis. Dose adjustments Manufacturer advises initial dose reduction to 4 mg once daily in mild to moderate impairment; adjust according to response.
Renal impairment
II receptor antagonists Dose adjustments In general, manufacturers advise start with low dose and adjust according to response. Renal impairment For candesartan cilexetil See Prescribing in renal impairment . Caution if creatinine clearance less than 15 mL/minute (limited experience). M Dose adjustments Initially 4 mg daily. M
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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