BLACK BOX WARNING
- fetal toxicity
candesartan cilexetil
Brand: Atacand
⚠ BBW Prototype: losartan
Drug Class: angiotensin II receptor blocker (ARB)
Drug Family: antihypertensive
Subclass: AT1 receptor antagonist
Organ Systems: cardiovascular
Mechanism of Action
Prodrug converted to candesartan; long-acting, insurmountable AT1 blockade.
AT1 receptor
Indications
- hypertension
- heart failure (NYHA class II-IV)
Contraindications
- pregnancy
- aliskiren in DM or CrCl <60
Adverse Effects
Common
- dizziness
- hyperkalemia
- URTI
Serious
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | prodrug hydrolyzed during GI absorption; 15% bioavailability |
| Distribution | high protein binding |
| Metabolism | minimal hepatic (minor CYP2C9) |
| Excretion | fecal 67%, renal 33% |
| Half-life | 9 hours |
| Onset | 2-4 hours |
| Peak | 6-8 hours |
| Duration | 24 hours |
| Protein Binding | >99% |
| Vd | 0.13 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| potassium-sparing diuretics | additive hyperkalemia | major |
| lithium | increased lithium levels | major |
Nursing Considerations
- CHARM trial: reduced CV mortality in HF
- Monitor K+, BP, creatinine
- Long duration — once-daily dosing adequate
Clinical Pearls
- CHARM trial demonstrated mortality benefit in HF with reduced EF
- Insurmountable AT1 blockade — efficacy not overcome by high angiotensin II
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.