Candesartan

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Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient candesartan is a commonly used drug against high blood pressure and can also be administered for chronic heart failure. It belongs to the active ingredient group of sartans, which are generally classified as having few side effects. Candesartan is taken in tablet form once a day. Here you can read everything you need to know about the effects of candesartan, side effects and use.

This is how candesartan works

Like all sartans, the active ingredient candesartan intervenes in the so-called renin-angiotensin-aldosterone system (RAAS) of the human body. This regulates the fluid and electrolyte balance and thus also the blood pressure. To see how the sartans work, it is sufficient to look at a small section of this hormonal system.

Sartans (also called angiotensin II receptor antagonists) block the docking point (receptor) of the hormone angiotensin II so that it can no longer develop its effect. The hormone normally causes blood vessels to constrict, decreased blood flow to the kidneys and increased reuptake of sodium ions and thus water in the kidneys. Overall, this leads to an increase in blood pressure.

The name "angiotensin II" suggests that there is also an angiotensin I. This hormone is made from angiotensinogen - a step that can also be blocked with medication to lower blood pressure. The preparations used for this are called ACE inhibitors.

The decisive advantage of the sartans (like candesartan) is that they intervene in the hormone control loop later than the ACE inhibitors. Since hormone control loops are quite complex and interconnected, the following applies: the earlier medication is used, the stronger this can affect other control loops. This explains the better side effect profile of the sartans compared to the ACE inhibitors.

Candesartan cilexetil

In practice, the precursor candesartan-cilexetil is used instead of candesartan. This is absorbed much better in the intestine and then quickly and completely converted into the actual active ingredient candesartan in the body (already in the intestinal wall). After taking a tablet, the highest level of active ingredient in the blood is reached after about three to four hours.

Candesartan is barely metabolized in the body. About nine hours after ingestion, half of the active ingredient is excreted unchanged in the urine (about a third) and in the bile with the stool (about two thirds).

When is candesartan used?

Candesartan is primarily used to treat high blood pressure (hypertension) and chronic heart failure (chronic heart failure), especially when ACE inhibitors cannot be tolerated.

Candesartan is used over the long term in order to achieve a safe and stable lowering of blood pressure.

This is how candesartan is used

The active ingredient candesartan is taken in the form of tablets. Therapy is usually started with a low dose (four or eight milligrams). On medical advice, the dose can be increased slowly over a few weeks, if necessary, until the blood pressure is adequately regulated. The tablets are taken once a day and offered in different dosages. The maximum daily dose is 32 milligrams.

The combination of candesartan and other drugs that regulate blood pressure (such as the dehydrating agent hydrochlorothiazide - HCT) can result in a mutual reinforcement of effects (synergistic effect), which is particularly desirable in the case of strongly increased blood pressure. Corresponding combination products are also available on the German market.

What are the side effects of candesartan?

Studies have shown that patients who received candesartan had hardly more side effects than subjects who were treated with a dummy drug (placebo). Side effects such as respiratory infections, dizziness, headache, low blood pressure, impaired kidney function and high blood potassium levels were common (affects one in ten to one hundred people).

The suspicion that candesartan could possibly cause cancer has now been carefully checked and refuted several times in larger studies and meta-analyzes (joint evaluation of several studies).

The "first-dose hypotension" that occurs with other blood pressure medication - a sharp drop in blood pressure after taking the medication for the first time - does not occur with candesartan. The same applies to the “rebound effect”. This is understood to mean an intensification of the original symptoms (in this case high blood pressure) after stopping the drug.

What should be considered when taking candesartan?

Since the potassium level in the blood can increase during treatment with candesartan, additional potassium intake should be avoided. If the mood stabilizer lithium is used at the same time (for psychoses), its blood levels should be monitored.

During treatment with candesartan, non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid or ibuprofen should not be taken without consulting a doctor. Otherwise, kidney function may deteriorate and the antihypertensive effect of the drug may be weakened. Paracetamol is an alternative pain reliever.

Candesartan is contraindicated in severe liver disease and biliary congestion. In the case of kidney disease, kidney function and blood potassium levels should be monitored regularly.

pregnancy and breast feeding period

Candesartan must not be taken during pregnancy because it has teratogenic properties. Better tested blood pressure medication is to be given preference during breastfeeding.

Children and adolescents

Doctors can also use candesartan in children and adolescents six years and older to treat high blood pressure. In younger people, however, safety and effectiveness have not yet been adequately proven. In addition, there are (as yet) no data on children and adolescents with cardiac insufficiency. Candesartan is contraindicated in children under one year of age.

How to get candesartan medication

The active ingredient candesartan is prescription-only in Germany, Austria and Switzerland in every dosage and can be obtained from the pharmacy upon presentation of a prescription.

How long has candesartan been known?

In 1982 scientists discovered some inhibitors of the blood pressure-increasing effect of angiotensin II. In the years that followed, their structure was continuously improved by means of computer calculations, laboratory tests and animal experiments. As a result, the first representative of the new group of sartans was created in 1986 with the active ingredient losartan.

It was launched in 1995 in the USA and also in Germany. Other sartans with a longer retention time and lower metabolism in the body were later developed. One of them was candesartan. It was approved in Germany in 1997.

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