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ARB Pregnancy: Not recommended in the first trimester; contraindicated in the second and third trimesters (fetotoxicity: decreased renal function, oligohydramnios, skull ossification retardation; neonatal renal failure, hypotension, hyperkalaemia). Not recommended during breastfeeding.

Candesartan cilexetil

Brand names: Amias

Candesartan cilexetil is an orally administered prodrug of the angiotensin receptor blocker candesartan, used for hypertension and for chronic heart failure with reduced ejection fraction.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 8 mg once daily (recommended initial and usual maintenance dose in hypertension)
Route: Oral
Frequency: once daily
Max: 32 mg once daily
Hypertension: initial and usual maintenance 8 mg once daily; if blood pressure not adequately controlled the dose can be increased to 16 mg once daily and to a maximum of 32 mg once daily, adjusted to blood pressure response. Most of the antihypertensive effect is attained within 4 weeks. Patients with intravascular volume depletion: consider an initial dose of 4 mg. Heart failure: usual initial dose 4 mg once daily, up-titrated to target 32 mg once daily (maximum) or highest tolerated dose by doubling at intervals of at least 2 weeks. Can be taken with or without food. Paediatric hypertension (6–18 years): starting dose 4 mg once daily, up-titrated by fixed weight band (<50 kg: max 8 mg; ≥50 kg: up to 16 mg) — not a per-kg dose.

Dose adjustments

Renal

Starting dose 4 mg once daily in renal impairment, including patients on haemodialysis; titrate according to response. Limited experience in very severe or end-stage renal impairment (creatinine clearance <15 ml/min).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Second and third trimester of pregnancy
  • Severe hepatic impairment and/or cholestasis
  • Children aged below 1 year
  • Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment (GFR <60 ml/min/1.73 m2)

Side effects

  • Respiratory infection (common)
  • Dizziness / vertigo (common)
  • Headache (common)
  • Hyperkalaemia and hyponatraemia (very rare)
  • Renal impairment including renal failure in susceptible patients (very rare); angioedema (very rare)

Interactions

  • Aliskiren-containing products — contraindicated in diabetes mellitus or renal impairment (GFR <60)
  • ACE inhibitors — combination increases risk of hypotension, hyperkalaemia and decreased renal function; not to be used concomitantly in diabetic nephropathy
  • Additive antihypertensive effect with hydrochlorothiazide and other antihypertensive agents

Clinical monograph

How it works

After absorption it is converted to candesartan, which selectively blocks the angiotensin II type 1 receptor, causing vasodilatation and reduced aldosterone secretion to lower blood pressure and afterload.

Prescribing in practice

  • It is contraindicated in pregnancy and can cause hyperkalaemia and renal impairment, so avoid in women who may become pregnant and use caution with renal artery stenosis, renal impairment and other renin-angiotensin agents.
  • First-dose hypotension is more likely in volume-depleted patients, such as those on high-dose diuretics.
  • In heart failure it is titrated upward gradually with monitoring rather than started at the target dose.

Monitoring

Monitor blood pressure, renal function and serum potassium at baseline and after initiation or dose increases.

Counselling the patient

  • Stop the tablet and seek advice promptly if you become pregnant.
  • Avoid potassium-containing salt substitutes unless advised.
  • Report marked dizziness, especially when starting or increasing the dose.

Evidence & guidelines

The CHARM programme demonstrated benefit of candesartan in chronic heart failure, and NICE supports angiotensin receptor blockers in hypertension and as an alternative to ACE inhibitors in heart failure.

Reference: NICE NG136; NICE NG106; ESC HF; ABN migraine; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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