Angiotensin II receptor blocker
ATC code: C09CA06 (Candesartan)
Brand names
Atacand, Amias, Blopress
Selectively blocks AT1 angiotensin II receptors. Reduces blood pressure and left ventricular load. Alternative to ACE inhibitors for cough-intolerant patients.
First line
Candesartan reduces cardiovascular mortality and hospitalization in heart failure with reduced ejection fraction, as shown in the CHARM program (Lancet 2003): three trials in patients with EF 40 percent or below, including CHARM-Alternative in ACE-inhibitor-intolerant patients. 2023 and NG106 recommend ARBs as an alternative to ACE inhibitors in patients with cough or a history of angioedema.
Sources
First line
Candesartan lowers blood pressure and major cardiovascular events in adults. 2024 and NG136 list ARBs as first-line therapy for hypertension as monotherapy and in combination with a thiazide diuretic or calcium channel blocker. Once-daily dosing with 24-hour effect improves adherence compared with twice-daily losartan.
In patients over 75, start at 4 mg daily. With eGFR below 30 mL/min/1.73 m², start at 4 mg with potassium and creatinine monitoring.
Sources
First line
ARBs slow the progression of diabetic nephropathy in patients with type 2 diabetes and albuminuria. Pivotal trials are RENAAL (losartan) and IDNT (irbesartan). The DIRECT-Protect 2 trial with candesartan showed a reduction in the progression rate from microalbuminuria to nephropathy. KDIGO 2022 lists ARBs as first-choice agents in patients with albuminuria alongside ACE inhibitors.
Second line
Candesartan reduces migraine attack frequency by 26 percent versus placebo in the Tronvik RCT (JAMA 2003) at 16 mg daily for 12 weeks. 2019 classifies candesartan at evidence level C: considered as second-line in patients with contraindications to topiramate, propranolol, and amitriptyline, or with co-existing hypertension. Off-label in the Russian Federation.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Candesartan is an angiotensin II receptor blocker (ARB). It is prescribed for hypertension and heart failure ( 2023, SEH-LELHA, 2017). In anti-aging regimens, candesartan is given to healthy normotensives as a mild protector of the heart and vessels. In people with normal blood pressure, no clinical studies of prophylactic use exist. ARBs do not cause cough as ACE inhibitors do, but other risks remain: hyperkalemia, dizziness, acute kidney injury in renal artery stenosis, and teratogenicity (contraindicated in pregnancy). If candesartan was prescribed to a healthy person, consider seeking a second opinion.
1 pair found. Sorted from critical to minor.
Mechanism
Similar to ibuprofen + losartan. Diclofenac has a high nephrotoxic potential among NSAIDs.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and in chronic kidney disease.
Management
Avoid prolonged combination. If diclofenac is needed for a short course, use the minimum effective dose for 5–7 days with creatinine monitoring. For chronic analgesia: paracetamol or celecoxib.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
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Boxed warning
FDA boxed warning: when pregnancy is detected, candesartan is discontinued immediately. Use in the second and third trimesters is associated with oligohydramnios, pulmonary hypoplasia, and fetal renal failure.
FDA category C in the first trimester, D in the second and third. When pregnancy is planned, switch to a safer antihypertensive (methyldopa, labetalol, extended-release nifedipine).
Data on candesartan transfer into human milk are limited. LactMed suggests choosing ACE inhibitors (captopril, enalapril) or alternative classes for breastfeeding mothers when therapy is required.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Candesartan is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Heart failure with reduced ejection fraction (evidence tier A), Migraine prophylaxis (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Candesartan (≥ 1 in 100): Dizziness, orthostatic hypotension, Headache, Hyperkalemia, Serum creatinine increase, Upper respiratory tract infections. See the Safety section for uncommon and serious reactions.
FDA category D. FDA category C in the first trimester, D in the second and third. When pregnancy is planned, switch to a safer antihypertensive (methyldopa, labetalol, extended-release nifedipine).
Data on candesartan transfer into human milk are limited. LactMed suggests choosing ACE inhibitors (captopril, enalapril) or alternative classes for breastfeeding mothers when therapy is required.
Candesartan is contraindicated in: Pregnancy; Severe hepatic impairment and/or cholestasis; Bilateral renal artery stenosis or stenosis of a solitary kidney artery; Hyperkalemia above 5.5 mmol/L; Concomitant aliskiren in patients with diabetes or eGFR below 60 mL/min/1.73 m². Full list in the Safety section.
FDA boxed warning: when pregnancy is detected, candesartan is discontinued immediately. Use in the second and third trimesters is associated with oligohydramnios, pulmonary hypoplasia, and fetal renal failure.
an FDA meta-analysis in 2018 refuted a link between ARB use and cancer incidence. The 2018–2019 recalls of losartan and valsartan batches concerned N-nitrosodimethylamine impurities at specific manufacturers, not the class.
monotherapy is less effective, but combined with a thiazide or calcium channel blocker, ARBs are effective in this population too.
at equivalent doses, candesartan provides more stable 24-hour BP control and a larger event reduction in the CHARM heart failure program.