Candesartan cilexetil

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.