Because candesartan does not inhibit ACE kininase II , it does not affect the response to bradykinin. Whether this difference has clinical relevance is not yet known. Candesartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation. Blockade of the angiotensin II receptor inhibits the negative regulatory feedback of angiotensin II on renin secretion, but the resulting increased plasma renin activity and angiotensin II circulating levels do not overcome the effect of candesartan on blood pressure.
Pharmacodynamics Candesartan inhibits the pressor effects of angiotensin II infusion in a dose-dependent manner. Plasma concentrations of angiotensin I and angiotensin II, and plasma renin activity PRA , increased in a dose-dependent manner after single and repeated administration of candesartan cilexetil to healthy subjects, hypertensive , and heart failure patients.
ACE activity was not altered in healthy subjects after repeated candesartan cilexetil administration. The once-daily administration of up to 16 mg of candesartan cilexetil to healthy subjects did not influence plasma aldosterone concentrations, but a decrease in the plasma concentration of aldosterone was observed when 32 mg of candesartan cilexetil was administered to hypertensive patients.
In spite of the effect of candesartan cilexetil on aldosterone secretion, very little effect on serum potassium was observed. Hypertension Adults In multiple-dose studies with hypertensive patients, there were no clinically significant changes in metabolic function, including serum levels of total cholesterol , triglycerides , glucose, or uric acid. In a week study of patients with non-insulin-dependent type 2 diabetes mellitus and hypertension, there was no change in the level of HbA1c.
It may take 2 to 4 weeks of using this medicine before your blood pressure is under control. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 4 weeks of treatment.
If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms.
You may need to use blood pressure medication for the rest of your life. If you need surgery, tell the surgeon ahead of time that you are using candesartan. In controlled clinical trials comparing candesartan with ACE inhibitors, the incidence of cough was lower in patients receiving candesartan cilexetil. Candesartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation.
The antagonism of the angiotensin II AT1 receptors results in dose related increases in plasma renin levels, angiotensin I and angiotensin II levels, and a decrease in plasma aldosterone concentration. ONTARGET was a study conducted in patients with a history of cardiovascular or cerebrovascular disease, or type 2 diabetes mellitus accompanied by evidence of end-organ damage.
Given their similar pharmacodynamic properties, these results are also relevant for other ACE-inhibitors and angiotensin II receptor blockers. ACE-inhibitors and angiotensin II receptor blockers should therefore not be used concomitantly in patients with diabetic nephropathy.
The study was terminated early because of an increased risk of adverse outcomes. Cardiovascular death and stroke were both numerically more frequent in the aliskiren group than in the placebo group and adverse events and serious adverse events of interest hyperkalaemia, hypotension and renal dysfunction were more frequently reported in the aliskiren group than in the placebo group.
Hypertension In hypertension, candesartan causes a dose-dependent, long-lasting reduction in arterial blood pressure. The antihypertensive action is due to decreased systemic peripheral resistance, without reflex increase in heart rate. There is no indication of serious or exaggerated first dose hypotension or rebound effect after cessation of treatment.
After administration of a single dose of candesartan cilexetil, onset of antihypertensive effect generally occurs within 2 hours. With continuous treatment, most of the reduction in blood pressure with any dose is generally attained within four weeks and is sustained during long-term treatment.
According to a meta-analysis, the average additional effect of a dose increase from 16 mg to 32 mg once daily was small. Many ARBs, but not specifically candesartan, have been linked to cases of a severe sprue-like enteropathy that presents with severe diarrhea and weight loss and villous flattening and atrophy on intestinal biopsy arising after months or years of ARB use. The enteropathy resembles celiac disease but does not repond to a gluten-free diet, but resolves promptly with stopping the angiotensin receptor blocker.
These elevations were transient and rarely required dose modification. In particular, tell your doctor if you are using any of the following medicines: Other medicines to help lower your blood pressure, including beta-blockers, diazoxide and ACE inhibitors such as enalapril, captopril, lisinopril or ramipril.
Non-steroidal anti-inflammatory drugs NSAIDs such as ibuprofen, naproxen, diclofenac, celecoxib or etoricoxib medicines to relieve pain and inflammation. Aspirin if you are taking more than 3g each day medicine to relieve pain and inflammation. Potassium supplements or salt substitutes containing potassium medicines that increase the amount of potassium in your blood. Heparin a medicine for thinning the blood. Lithium a medicine for mental health problems. If you are being treated with an ACE-inhibitor together with certain other medicines to treat your heart failure, which are known as mineralocorticoid receptors antagonists MRA for example spironolactone, eplerenone.
Candesartan tablets with food and drink You can take Candesartan tablets with or without food. When you are prescribed Candesartan tablets, discuss with your doctor before drinking alcohol. Alcohol may make you feel faint or dizzy. For these reasons, before you start taking candesartan it is important that your doctor knows: If you are pregnant, trying for a baby or breast-feeding.
If you have a problem with your kidneys, particularly if it is a blockage of the artery which supplies blood to your kidneys. If you have any problems with your heart valves or heart muscle. If you have a problem with the way your liver works, or if you have a condition which blocks the flow of bile from your liver called cholestasis. If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine. How to take candesartan Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about candesartan and will provide you with a full list of the side-effects which you may experience from taking it.
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