Candesartan may be also used as a second line agent in the treatment of congestive heart failure, systolic dysfunction, myocardial infarction and coronary artery disease in those intolerant of ACE inhibitors. ATACAND is a prescription medicine called an angiotensin receptor blocker (ARB). Candesartan cilexetil (Atacand) is a medication prescribed to treat high blood pressure. Take with or without food. Candesartan cilexetil, 16 mg once daily, produces a significantly greater reduction in blood pressure than losartan, 50 mg once daily. The usual recommended starting dose of ATACAND is 16 mg once daily when it is used as monotherapy in patients who are not volume depleted. [, Caballero-George C, Vanderheyden PM, Solis PN, Gupta MP, Pieters L, Vauquelin G, Vlietinck A: In vitro effect of sanguinarine alkaloid on binding of [3H]candesartan to the human angiotensin AT1 receptor. Candesartan cilexetil and hydrochlorothiazide tablets may be administered with or without food. It may also be used as an alternative agent for the treatment of heart failure, systolic dysfunction, myocardial infarction and coronary artery disease. Common side effects of candesartan may include: high potassium; headache, back pain; cold symptoms such as stuffy or runny nose, sneezing, sore throat; dizziness; or. Drugs that act directly on the renin-angiotensin system (RAS) can have effects on the development of immature kidneys. The mean age was 67 years and 32% were female, 48% were NYHA II, 49% were NYHA III, 4% were NYHA IV, and the mean ejection fraction was 30%. It works by blocking the action of a substance in the body that causes the blood vessels to tighten. The prodrug candesartan cilexetil undergoes rapid and complete ester hydrolysis in the intestinal wall to form the active drug, candesartan. Closely observe infants with histories of in utero exposure to ATACAND for hypotension, oliguria, and hyperkalemia [see Use in Specific Populations]. In children 6 to < 17 years, 240 patients were randomized to receive either placebo or low, medium, or high doses of ATACAND in a ratio of 1: 2: 2: 2. Candesartan cilexetil | C33H34N6O6 | CID 2540 - structure, chemical names, physical and chemical properties, classification, patents, literature, biological . 2003 Jan 5;458(3):257-62. Because candesartan is not significantly metabolized by the cytochrome P450 system and at therapeutic concentrations has no effects on P450 enzymes, interactions with drugs that inhibit or are metabolized by those enzymes would not be expected. Angiotensin II increases blood pressure by increasing total peripheral resistance, increasing sodium and water reabsorption in the kidneys via aldosterone secretion, and altering cardiovascular structure. CHARMAdded: Primary Endpoint and its Components. [, Stanfield, Cindy L.;Germann, William J. In some patients, symptoms may include fatigue, headaches, dizziness, confusion, sweating, chest pain and vision problems. It works by blocking the action of a substance in the body that causes the blood vessels to tighten. Talk to your doctor or pharmacist before you start taking any new medicine. Many It's taken by mouth, typically once or twice daily. Learn about side effects, warnings, dosage, and more. The best ACE inhibitors for hypertension include Trandolapril, Enalapril, and Ramipril. No initial dosage adjustment is necessary in patients with mild hepatic impairment. Do not use after the expiry date stated on the bottle. The AAC considers 130/80 mm Hg. The antihypertensive effect of angiotensin II receptor antagonists, including candesartan may be attenuated by NSAIDs including selective COX-2 inhibitors. 5 - 7 Its particular benefit, however, is related not only to its blood pressure-lowering effect but more to its protective effect on end-organs such as the heart, 8 - 11 kidneys . Blood pressure readings above 180/120 mmHg are considered stroke-level and require immediate medical attention. Tell patients to report pregnancies to their physicians as soon as possible. [, Cervenka L, Navar LG: Renal responses of the nonclipped kidney of two-kidney/one-clip Goldblatt hypertensive rats to type 1 angiotensin II receptor blockade with candesartan. There were too few individuals in the age group of 1 -6 years old to determine whether Blacks respond differently than other patients to ATACAND. Take this quiz and test your IQ of high blood pressure (hypertension), the cardiovascular disease that causes most strokes and High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 High blood pressure (hypertension) is a disease in which pressure within the Candesartan should not be used during pregnancy or while breastfeeding. It is not known whether candesartan is excreted in human milk, but candesartan has been shown to be present in rat milk. Administering drugs that act directly on the renin-angiotensin system (RAS) can alter normal renal development. What else should I know about candesartan? The absence of an interaction does not necessarily mean no interactions exist. In Encyclopedic reference of molecular pharmacology (pp. Candesartan cilexetil had an additional blood pressure lowering effect when added to hydrochlorothiazide. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Atacand can be administered once or twice daily with total daily doses ranging from 8 mg to 32 mg. Atacand may interact with alcohol, potassium supplements or salt substitutes, diuretics (water pills), lithium; or NSAIDs (non-steroidal anti-inflammatory drugs) Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Pocock S: Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Medicines that lower your blood pressure lower your chance of having a stroke or heart attack. Candesartan has good bioavailibility and is the most potent by weight of the AT-1 . Candesartan is a selective AT1 subtype angiotensin II receptor antagonist. Read the Patient Information that comes with ATACAND before you start taking it and each time you get a refill. ATACAND may be used alone or in combination with other antihypertensive agents. The tolerability and safety of candesartan cilexetil has been evaluated in over 5000 subjects enrolled into double-blind or open-label clinical studies. Candesartan cilexetil | Drugs | BNF | NICE If blood pressure is not controlled by ATACAND alone, a diuretic may be added. Candesartan And Hydrochlorothiazide (Oral Route) - Mayo Clinic Learn about other high blood pressure medications. Candesartan cilexetil is an angiotensin receptor blocker used to treat hypertension, systolic hypertension, left ventricular hypertrophy, and delay progression of diabetic nephropathy. There is also an AT2 receptor found in many tissues, but AT2 is not known to be associated with cardiovascular homeostasis. unusual bleeding or bruising. Candesartan Cilexetil Hydrochlorothiazide, CV death or heart failure hospitalization. Candesartan cilexetil: safety and tolerability in healthy volunteers destruction of muscle) and angioedema (swelling of soft tissues including those Do not co-administer aliskiren with ATACAND in patients with diabetes. Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine This has been generally true for angiotensin II antagonists and ACE inhibitors. Candesartan cilexetil 16mg tablets - Summary of Product - medicines The adverse event profile of ATACAND in adult heart failure patients was consistent with the pharmacology of the drug and the health status of the patients. Candesartan cilexetil is an ARB prodrug that is rapidly converted to candesartan, its active metabolite, during absorption from the gastrointestinal tract. Candesartan Cilexetil Hydrochlorothiazide - RxList It undergoes minor hepatic metabolism by O-deethylation to an inactive metabolite. The 10-mg/kg/day dose in rats is approximately 2.8 times the maximum recommended daily human dose (MRHD) of 32 mg on a mg/m basis (comparison assumes human body weight of 50 kg). [, Takara K, Kakumoto M, Tanigawara Y, Funakoshi J, Sakaeda T, Okumura K: Interaction of digoxin with antihypertensive drugs via MDR1. rapid or irregular heartbeats. In spite of the effect of candesartan cilexetil on aldosterone secretion, very little effect on serum potassium was observed. Very rarely, it is caused by high blood pressure (HBP) also known as hypertension. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. Following oral administration, candesartan cilexetil undergoes hydrolysis at the ester link to form the active drug, candesartan, which is achiral. Candesartan is an AIIRA, selective for AT1 receptors, with tight binding to and slow dissociation from the receptor. The pharmacokinetics of candesartan were linear in patients with heart failure (NYHA class II and III) after candesartan cilexetil doses of 4, 8, and 16 mg. After repeated dosing, the AUC was approximately doubled in these patients compared with healthy, younger patients. weakness or heaviness of the legs. gets lower, and taking these pills drop it too low and I get a little dizzy at times. RAAS is a homeostatic mechanism for regulating hemodynamics, water and electrolyte balance. Both studies were international double-blind, placebo-controlled trials in patients with NYHA class II -IV heart failure and LVEF 40%. swelling of the feet or lower legs. fluid and water retention, Candesartan is a selective AT1 subtype angiotensin II receptor antagonist. The pharmacokinetics of candesartan have been studied in the elderly ( 65 years) and in both sexes. Curr Med Chem. ATACAND is indicated for the treatment of heart failure (NYHA class II-IV) in adults with left ventricular systolic dysfunction (ejection fraction 40%) to reduce cardiovascular death and to reduce heart failure hospitalizations [see Clinical Studies]. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death. There was no evidence of carcinogenicity when candesartan cilexetil was orally administered to mice and rats for up to 104 weeks at doses up to 100 and 1000 mg/kg/day, respectively. Except for a study in diabetics, all studies showed significant effects, generally dose related, of 2 to 32 mg on trough (24 hour) systolic and diastolic pressures compared to placebo, with doses of 8 to 32 mg giving effects of about 8-12/4-8 mm Hg. The antihypertensive effects of ATACAND were evaluated in hypertensive children 1 to < 6 years old and 6 to < 17 years of age in two randomized, double-blind multicenter, 4-week dose ranging studies. nosebleeds. Food with a high fat content does not affect the bioavailability of candesartan after candesartan cilexetil administration. Maximum dose: 32 mg/day. In preclinical studies, candesartan cilexetil . MedicineNet does not provide medical advice, diagnosis or treatment. Diagnosed with high blood pressure or trying to avoid it? Candesartan cilexetil is a racemic mixture containing one chiral center at the cyclohexyloxycarbonyloxy ethyl ester group. Candesartan Side Effects: Common, Severe, Long Term The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity trial in patients intolerant of ACE inhibitors (CHARMAlternative), 2. Febrile seizures, or convulsions caused by fever, can be frightening in small children or infants. Avoid use of aliskiren with ATACAND in patients with renal impairment (GFR <60 mL/min) [see CONTRAINDICATIONS]. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time. skin rash. Keep a list of your medications with you to show your doctor and pharmacist when a new medication is prescribed. Heart Healthy Diet: Hypertension & Heart Disease, Drugs: Questions to Ask Your Doctor or Pharmacist about Your Drugs, losartan and hydrochlorothiazide (Hyzaar), Types of High Blood Pressure (Hypertension) Medications, A 7-Day Diet Plan for High Blood Pressure, Drug Name Confusion: Preventing Medication Errors, Combining candesartan or other ARBs with nonsteroidal anti-inflammatory drugs (. abnormal kidney test. Candesartan cilexetil: Uses, Interactions, Mechanism of Action It is also used for reducing the chance of death or hospitalization due to heart failure. Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). Hydrochlorothiazide is a thiazide diuretic (water . If you get pregnant while taking ATACAND, tell your doctor right away. [, Baguet JP, Barone-Rochette G, Neuder Y: Candesartan cilexetil in the treatment of chronic heart failure. It happens rarely, but some people have serious side effects after taking candesartan. Active ingredient: candesartan cilexetil. Renin cleaves circulating angiotensinogen to angiotensin I, which is cleaved by angiotensin converting enzyme (ACE) to angiotensin II. Candesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. The number of tablets and volume of vehicle specified below will yield 160 mL of a 1 mg/mL suspension. The metabolism of Candesartan cilexetil can be increased when combined with Abatacept. treat high blood pressure in adults and children, 1 to 17 years of age, are dehydrated (decreased body fluids) due to vomiting and diarrhea, swelling of your face, lips, tongue or throat, cold or flu symptoms (upper respiratory tract infection), nasal congestion and stuffiness (rhinitis), Prepare the vehicle by adding equal volumes of Ora-Plus. Add a small amount of vehicle to the required number of ATACAND tablets (five 32 mg tablets) and grind into a smooth paste using a mortar and pestle. Symptomatic hypotension is most likely to occur in patients who have been volume and/or salt depleted as a result of prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea, or vomiting. Candesartan (Oral Route) Proper Use - Mayo Clinic ATACAND Tablets, 32 mg, are pink, circular/biconvex-shaped, non-film-coated scored tablets, coded ACL on one side and 032 on the other. ACE activity was not altered in healthy subjects after repeated candesartan cilexetil administration. Candesartan may be used to treat hypertension, isolated systolic hypertension, left ventricular hypertrophy and diabetic nephropathy. For patients with possible depletion of intravascular volume (e.g., patients treated with diuretics, particularly those with impaired renal function), initiate ATACAND under close medical supervision and consider administration of a lower dose [see WARNINGS AND PRECAUTIONS]. 2009;5(1):257-64. [, Engelhorn T, Doerfler A, Heusch G, Schulz R: Reduction of cerebral infarct size by the AT1-receptor blocker candesartan, the HMG-CoA reductase inhibitor rosuvastatin and their combination. or greater (either number) stage 1 The primary method of analysis was slope of the change in systolic blood pressure (SBP) as a function of dose. Candesartan cilexetil is better tolerated than enalapril, primarily because of a reduced incidence of cough, and was not associated with the hypokalaemia or hyperuricaemia seen with hydrochlorothiazide in a study in patients aged > or = 75 years. Your doctor or pharmacist will know what medicines are safe to take together. What are the possible side effects of ATACAND? Candesartan and its O-deethyl metabolite tested positive for genotoxicity in the in vitro Chinese hamster lung (CHL) chromosomal aberration assay. After repeated dosing, the AUC and Cmax were approximately doubled in patients with severe renal impairment (creatinine clearance <30 mL/min/1.73m2) compared to patients with normal kidney function. May be used as a first line agent to treat uncomplicated hypertension, isolated systolic hypertension and left ventricular hypertrophy. This inhibits the AT1-mediated vasoconstrictive and aldosterone-secreting effects of angiotensin II and results in an overall decrease in blood pressure. If oliguria or hypotension occurs, direct attention toward support of blood pressure and renal perfusion. The risk or severity of renal failure, hyperkalemia, and hypertension can be increased when Candesartan cilexetil is combined with Acemetacin. If you have high blood pressure you are at risk of developing life The antihypertensive effects of twice daily dosing of either candesartan cilexetil or losartan potassium were not studied. Curr Med Res Opin. If your child switches between taking the tablet and the suspension, your doctor will change the dose as needed. Know the warning signs and symptoms of high blood High blood pressure puts you at risk for a number of other conditions. RxList does not provide medical advice, diagnosis or treatment. Proper Use. There is no difference in the pharmacokinetics of candesartan between male and female subjects. It is not known whether candesartan is secreted in human milk. Check with your physician for additional information about side effects. Description and Brand Names. See additional information. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. painful or difficult urination. Treatment, prognosis, and doubled at 2 week intervals as tolerated by patients. An antihypertensive effect is usually present within 2 weeks, with full effect generally obtained within 4 weeks of treatment with ATACAND. The association between candesartan and exacerbation of the underlying condition could not be excluded. Oral doses 10 mg of candesartan cilexetil/kg/day administered to pregnant rats during late gestation and continued through lactation were associated with reduced survival and an increased incidence of hydronephrosis in the offspring. There may be new information. The renin-angiotensin system (RAS) plays a critical role in kidney development. Candesartan cilexetil is a prodrug suitable for oral use. blood pressure. The drug has an adverse events profile similar to that of losartan potassium in patients with mild . As a result, candesartan relaxes the blood vessels. REFERENCE: What is candesartan, and what is it used for? For more information, visit www.anipharmaceuticals.com or call 1-800-308-6755. Candesartan cilexetil prevented bandinginduced prolonged action potential duration and reduced the occurrence of triggered activity in LV papillary muscles. Monitor serum lithium levels. Following administration of candesartan cilexetil, the absolute bioavailability of candesartan was estimated to be 15%. Atacandmay cause serious side effects including: Get medical help right away, if you have any of the symptoms listed above. Some of the features of a febrile seizure include losing consciousness, shaking, moving limbs on both sides of the body, and lasts 1-2 minutes. the starting dose for treating heart failure is 4 mg once daily. In CHARMAdded, 2548 subjects receiving an ACE inhibitor were randomized to ATACAND or placebo. Turmeric may help lower blood pressure, but talk to your doctor if you take medication to make sure it doesn't interact with it. 16 mg are pink, circular/biconvex-shaped, non-film-coated scored tablets, coded ACH on one side and 016 on the other. There were no changes in the heart rate of patients treated with candesartan cilexetil in controlled trials. ATACAND may cause serious side effects, including: If you feel dizzy or faint lie down and call your doctor right away. In hypertensive patients with renal insufficiency, serum concentrations of candesartan were elevated. The recommended dose range of candesartan for adults is 4 to Candesartan (Atacand) is a first-choice medication for treating high blood pressure and heart failure. Candesartan Cilexetil 8 mg Tablets - Summary of Product - medicines Closely monitor blood pressure, renal function and electrolytes in patients on ATACAND and other agents that affect the RAS. Neurosci Lett. Treatment of hypertension in adults and children 1 to < 17 years of age, to lower blood pressure. Candesartan and its inactive metabolite do not accumulate in serum upon repeated once-daily dosing. Candesartan cannot be removed by hemodialysis. After tablet ingestion, the peak serum concentration (Cmax) is reached after 3 to 4 hours. In the CHARM-Added program, where candesartan or placebo was given in addition to ACE inhibitors, hypotension was reported in 22.6% of patients treated with ATACAND versus 13.8% treated with placebo [see DRUG INTERACTIONS]. Do not give ATACAND to other people, even if they have the same problem you have. fatigue and A growing number of studies indicate that candesartan cilexetil can produce end organ protection in addition to lowering blood pressure. No initial dosage adjustment is necessary in patients with renal insufficiency [see DOSAGE AND ADMINISTRATION]. Candesartan (Atacand) can be taken by adult and children (for blood pressure only). other medicines for high blood pressure, especially water pills (diuretics), non-steroidal anti-inflammatory drugs (NSAIDs). Candesartan is used to treat high blood pressure (hypertension). ATACAND is taken by mouth with or without food. Candesartan cilexetil-treated banded rat hearts displayed shorter QT intervals and lower vulnerability to atrial and ventricular tachyarrhythmias than vehicletreated banded hearts. Sixty-two percent had a history of myocardial infarction, 50% had a history of hypertension, and 27% had diabetes. ATACAND (candesartan cilexetil), a prodrug, is hydrolyzed to candesartan during absorption from the gastrointestinal tract. Candesartan should not be used during pregnancy. This is not a complete list of side effects and others may occur. Ferric oxide (reddish brown) is added to the 8-mg, 16-mg, and 32-mg tablets as a colorant. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal. How is Candesartan and Hydrochlorothiazide Tablets Supplied. Advise female patients of childbearing age should be told about the consequences of exposure to ATACAND during pregnancy. Patients whose renal function may depend, in part, on the activity of the renin-angiotensin system (e.g., patient with renal artery stenosis, chronic kidney disease, severe heart failure, or volume depletion) may be at particular risk of developing oliguria, progressive azotemia or acute renal failure when treated with ATACAND. DailyMed - CANDESARTAN CILEXETIL AND HYDROCHLOROTHIAZIDE tablet Table 1. Marina Etinger, Boris Fedotev, Ben-Zion Dolitzky, "Preparation of candesartan cilexetil." Atacand; Descriptions. Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system. Do not use after the expiration date stated on the bottle. Expert Opin Pharmacother. Dosage must be individualized. 8 mg are light pink, circular/biconvex-shaped, non-film-coated scored tablets, coded ACG on one side and 008 on the other. It may harm them. Candesartan confers blood pressure lowering effects by antagonizing the hypertensive effects of angiotensin II via the RAAS. Children < 1 year of age must not receive ATACAND for hypertension. CHARM Added in patients already receiving ACE inhibitors. It has also been demonstrated in rats that candesartan passes across the placental barrier and is distributed in the fetus. In double-blind clinical trials in patients with primary hypertension, candesartan cilexetil 2-16 mg once-daily was associated with a low incidence Candesartan is an angiotensin II receptor blocker (ARB). home Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue ATACAND, taking into account the importance of the drug to the mother. InChI=1S/C33H34N6O6/c1-3-42-32-34-28-15-9-14-27(31(40)43-21(2)44-33(41)45-24-10-5-4-6-11-24)29(28)39(32)20-22-16-18-23(19-17-22)25-12-7-8-13-26(25)30-35-37-38-36-30/h7-9,12-19,21,24H,3-6,10-11,20H2,1-2H3,(H,35,36,37,38), 1-{[(cyclohexyloxy)carbonyl]oxy}ethyl 2-ethoxy-1-{[2'-(1H-1,2,3,4-tetrazol-5-yl)-[1,1'-biphenyl]-4-yl]methyl}-1H-1,3-benzodiazole-7-carboxylate, CCOC1=NC2=C(N1CC1=CC=C(C=C1)C1=CC=CC=C1C1=NN=NN1)C(=CC=C2)C(=O)OC(C)OC(=O)OC1CCCCC1, Use our structured and evidence-based datasets to. Hypertension occurs when blood pressure readings are 130/80 mmHg or higher. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including candesartan, may result in deterioration of renal function, including possible acute renal failure. Most of the antihypertensive effect is present within 2 weeks, and maximal blood pressure reduction is generally obtained within 4 to 6 weeks of treatment with ATACAND. No lethality was observed in acute toxicity studies in mice, rats and dogs given single oral doses of up to 2000 mg/kg of candesartan cilexetil or in rats given single oral doses of up to 2000 mg/kg of candesartan cilexetil in combination with 1000 mg/kg of hydrochlorothiazide. These considerations may guide selection of therapy. Angiotensin II is the principal pressor agent of the renin-angiotensin system, with effects that include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation, and renal reabsorption of sodium. Maintenance dose: 8 to 32 mg/day orally in 1 to 2 divided doses. The pharmacokinetics in heart failure patients is similar to that in healthy elderly volunteers [see DOSAGE AND ADMINISTRATION]. ATACAND can be administered once or twice daily with total daily doses ranging from 8 mg to 32 mg. In a total of 1268 patients with mild to moderate hypertension who were not receiving other antihypertensive therapy, candesartan cilexetil 32 mg lowered systolic and diastolic blood pressure by 2 to 3 mm Hg on average more than losartan potassium 100 mg, when measured at the time of either peak or trough effect. See What should I tell my doctor before taking ATACAND?. Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice. Fertility and reproductive performance were not affected in studies with male and female rats given oral doses of up to 300 mg/kg/day (83 times the maximum daily human dose of 32 mg on a body surface area basis). The elimination half-life of candesartan is approximately 9 hours. Unfortunately, yes. Unlike angiotensin-converting enzyme (ACE) inhibitors, ARBs do not have the adverse effect of dry cough. Pharmacol Rev. 2006 Mar;24(1):S23-30. Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents. For some reason the pill, though small, is hard to swallow without water. Candesartan cilexetil and hydrochlorothiazide tablets may be administered with or without food. ATACAND and other medicines may affect each other causing serious side effects. Candesartan is mainly excreted unchanged in urine and feces (via bile). Candesartan has a very low maintenance dose. The following have been very rarely reported in post-marketing experience: Digestive: Abnormal hepatic function and hepatitis. Increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists, including ATACAND.