This is indicated for the treatment of hypertension, congestive heart failure.

Combined antihypertensive preparations

Candesartan Cilexetil-Hydrochlorothiazide combines an angiotensin II receptor blocker, Candesartan Cilexetil and a diuretic, Hydrochlorothiazide.

Candesartan Cilexetil is an ester prodrug that is hydrolysed in the body to the active form Candesartan during absorption from the gastrointestinal tract. 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 (eg, vascular smooth muscle, adrenal gland).

Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly by increasing sodium excreation. Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume with consequent increase in plasma renin activity, aldosterone secretion, urinary potassium loss, and decrease in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of Candesartan tends to reverse the potassium loss associated with Hydrochlorothiazide.

The usual dose is one tablet once daily.

No significant drug interactions have been reported for Candesartan Cilexetil with other drugs such as glyburide, nifedifine, digoxin, warfarin, hydrochlorothiazide and oral contraceptives. Alcohol, barbiturates, or narcotics- Potentiation of orthostatic hypotension may occur. Antidiabetic drugs (oral agents and insulin)- Dosage adjustment of the antidiabetic drug may be required. Other antihypertensive drugs- Additive effect or potentiation. Skeletal muscle relaxants, tubocurarine- Possible increased responsiveness to the muscle relaxant. NSAID can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics.

Candesartan Cilexetil & Hydrochlorothiazide is contraindicated in patients who are hypersensitive to any component of this product. Because of the hydrochlorothiazide component, this product is contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Mild and transient in nature. The overall incidence of adverse events is comparable to placebo. Side effects are headache, upper respiratory tract infection, back pain, influenza-like symptoms.

Use in pregnancy & lactation is not recommended.

No patient receiving this combination was discontinued due to increases or decreases in serum potassium. Overall, the combination of candesartan cilexetil and hydrochlorothiazide had no clinically significant effect on serum potassium.

Use in pediatric patient: Safety and effectiveness in pediatric patients have not been established.