Candez Plus

Candesartan cilexetil 16 mg, hydrochlorothiazide 12.5 mg

Essential HTN where monotherapy is not sufficient.

Individualized dosage. 1 tab once daily. Candesartan cilexetil monotherapy Renal impairment Mild: 4 mg once daily. Moderate: 2 mg once daily. Hepatic impairment Mild to moderate: 2 mg once daily. Elderly 4 mg once daily.

May be taken with or without food.

Hypersensitivity to candesartan, hydrochlorothiazide or to other sulfonamide-derivatives. Anuria, gout, refractory hypokalemia & hypercalcemia, severe hepatic impairment &/or cholestasis. Concomitant use w/ aliskiren in patients w/ DM or renal impairment (GFR <60 mL/min/1.73 m²). Pregnancy (2nd & 3rd trimesters) or women desiring to be pregnant. Lactation.

Symptomatic hypotension in patients w/ intravascular vol- & salt-depletion (eg, patients on dialysis or treated vigorously w/ diuretics). Childn. Candesartan: Fetal/neonatal morbidity & mortality. Correct hypovolemia. Bilateral renal artery stenosis or stenosis of the artery of a solitary kidney; hemodynamically relevant aortic or mitral valve stenosis, or obstructive hypertrophic cardiomyopathy, primary hyperaldosteronism. Closely monitor BP, renal function & electrolytes in patients receiving candesartan & other agents that affect the renin-angiotensin-aldosterone system. Periodically monitor serum K & creatinine levels in hypertensive patients w/ severe renal impairment. Hepatic impairment. Anesth & surgery. Patients on hemodialysis. Hyperkalemia. Concomitant use w/ K-sparing diuretics, K supplements, salt substitutes containing K or other drugs that may increase K levels (eg, heparin). Hydrochlorothiazide: Fluid/electrolyte imbalance. Renal disease resulting in severe renal impairment; hepatic disease or progressive liver disease. Patients w/ or w/o a history of allergy or bronchial asthma. SLE. May impair glucose tolerance, decrease urinary Ca excretion & cause intermittent & slight elevation of serum Ca, increase cholesterol & triglyceride levels. Hypomagnesemia. Photosensitizing actions could act as possible mechanism for non-melanoma skin cancer. Discontinue before taking parathyroid function test. Hyperuricemia may occur or acute gout may be precipitated. Idiosyncratic reaction resulting in transient myopia & acute angle-closure glaucoma. May affect ability to drive & use machines.

Upper resp tract infection, back pain, flu-like symptoms & dizziness. Agranulocytosis, aplastic anemia, anemia, leukopenia, neutropenia, thrombocytopenia; hyponatremia; headache, lightheadedness, vertigo; abnormal vision/visual impairment; anorexia, constipation, diarrhea, epigastric pain, nausea, stomach/GI discomfort, vomiting; jaundice; photosensitivity; rash, urticaria; renal impairment/dysfunction, renal failure; weakness; increases in total cholesterol. Candesartan: Eosinophilia, leukocytosis; hyperkalemia, hypoglycemia, thirst; insomnia; numbness of limbs, numbness of tongue, sleepiness, syncope, abnormal taste; fibrillation, bradycardia, extrasystole, palpitation; hypotension, shock, hot flushes; cough, epistaxis, interstitial pneumonia, pharyngitis, rhinitis, sinusitis; gastric ulcer, stomatitis; abnormal hepatic function, hepatitis; angioedema, eczema, pruritus; arthralgia, myalgia, rhabdomyolysis; proteinuria, pollakiuria; edema, fatigue, fever, malaise, lumbar pain; increases in serum potassium, serum creatinine, BUN, AST, ALT, alkaline phosphatase, γ-glutamyl transpeptidase, lactic dehydrogenase, creatinine phosphokinase, c-reactive protein, serum uric acid; decreases in serum total protein, Hb. Hydrochlorothiazide: Anaphylactic reactions, hypersensitivity reactions; glycosuria, hypercalcemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hypophosphatemia, worsening of diabetic metabolic state; depression, sleep disturbances; paresthesia, restlessness; acute myopia & secondary angle-closure glaucoma, transient blurred vision, xanthopsia; cardiac arrhythmias; orthostatic hypotension; resp distress (including pneumonitis & pulmonary edema); cramping, gastric irritation, loss of appetite, pancreatitis, sialadenitis; alopecia, cutaneous lupus erythematosus-like reactions, erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, necrotizing angiitis (vasculitis & cutaneous vasculitis), purpura, reactivation of cutaneous lupus erythematosus; muscle cramps, muscle spasm; interstitial nephritis; impotence; asthenia, pyrexia; increases in LDL cholesterol, very LDL cholesterol & triglycerides.

Additive effect w/ other antihypertensives. Increased in serum lithium conc; lithium absorption & may cause lithium toxicity. Reduced diuretic, natriuretic & antihypertensive effects w/ NSAIDs eg, selective COX-2 inhibitors, aspirin (>3 g/day), & nonselective NSAIDs. Candesartan: May enhance antihypertensive effect w/ diuretics. Increased risk of worsening of renal function (including possible acute renal failure) & increase in serum K, particularly in patients w/ poor pre-existing renal function w/ NSAIDS. Increased risk of hypotension, hyperkalemia & changes in renal function (including acute renal failure) w/ angiotensin receptor blockers, ACE inhibitors, aliskiren. Hydrochlorothiazide: Potentiation of orthostatic hypotension w/ alcohol, barbiturates, or narcotics. Increased risk of adverse effects w/ amantadine. Diuretic-induced vol depletion can potentiate aminoglycoside nephrotoxicity. May raise level of serum uric acid; may increase hypersensitivity reaction w/ allopurinol. May increase availability by decreasing GI motility & stomach emptying rate w/ anticholinergic agents (eg, atropine, biperidine). Antidiabetics (oral agents & insulin). Symptomatic hyponatremia may occur w/ carbamazepine. Thiazide-induced hypokalemia or hypomagnesemia favor onset of digitalis-induced cardiac arrhythmias. Impaired absorption w/ cholestyramine & colestipol resins. Intensified electrolyte depletion, particularly hypokalemia w/ corticosteroids, ACTH. Decreased renal excretion; increased myelosuppressive effects w/ cytotoxic agents. Possible decreased response to pressor amines (eg, adrenaline). Possible increased responsiveness to skeletal muscle relaxants, nondepolarising (eg, tubocurarine). Increased risk of acute renal failure particularly when large doses of iodinated media are used.

Angiotensin II Antagonists / Diuretics

C09DA06 - candesartan and diuretics ; Belongs to the class of angiotensin II receptor blockers (ARBs) in combination with diuretics. Used in the treatment of cardiovascular disease.

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