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ARB / HFrEF

Candesartan (HFrEF / ACEi Intolerance)

Brand names: Amias

Used in: Hypertension

Candesartan is an angiotensin-II receptor blocker (ARB) used for hypertension and for heart failure with reduced ejection fraction, including where an ACE inhibitor is not tolerated (e.g. because of cough).

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Starting Dose Target Dose Adult Hypertension (2.1) 16 mg tablet once daily 8 to 32 mg tablet total daily dose Pediatric Hypertension (1 to ˂6 years) (2.2) 0.2 mg/kg oral suspension once daily 0.05 to 0.4 mg/kg oral suspension once daily or consider divided dose Pediatric Hypertension (6 to ˂17 years) (2.2) <50 kg 4 to 8 mg tablet once daily >50 kg 8 to 16 mg tablet once daily <50 kg 4 to 16 mg tablet once daily or consider divided dose >50 kg 4 to 32 mg tablet once daily or consider divided dose Adult Heart Failure (2.3) 4 mg tablet once daily 1 The target dose is 32 mg once daily, which is achieved by doubling the dose at approximately 2-week intervals, as tolerated by patient 2.1 Adult …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2021-10-04. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

Candesartan selectively blocks the angiotensin-II type-1 receptor, producing vasodilatation and reduced aldosterone effect without the rise in bradykinin that causes ACE-inhibitor cough.

Prescribing in practice

  • Start low and titrate; check renal function and potassium before starting and after initiation or dose increase.
  • Avoid in pregnancy and in bilateral renal artery stenosis; use caution with potassium-raising drugs and NSAIDs.
  • Do not routinely combine an ARB with an ACE inhibitor because of renal and hyperkalaemia risk.

Monitoring

Monitor U&E (renal function and potassium) at baseline, after initiation and titration, and periodically; monitor blood pressure and heart-failure status.

Counselling the patient

  • Report dizziness, especially after the first doses or dose increases.
  • Avoid potassium-based salt substitutes, and tell your prescriber if you become pregnant or unwell with vomiting or diarrhoea.

Evidence & guidelines

ARBs are an alternative to ACE inhibitors for hypertension and HFrEF (e.g. CHARM programme for candesartan in heart failure); first-line where ACE-inhibitor cough is limiting, per NICE NG136/NG106.

Reference: CHARM-Alternative Trial (Granger et al. Lancet 2003); ESC HF Guidelines 2021; NICE NG106; SPC Amias; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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