Candesartan Hydrochlorothiazide

Candesartan Hydrochlorothiazide Brand Name– Atacand HCT

What is Candesartan Hydrochlorothiazide

Candesartan and hydrochlorothiazide (HCTZ) are combined in a once daily oral preparation to manage hypertension.

HCTZ is a thiazide diuretic. Similar to the prototype losartan, candesartan is a specific and selective angiotensin II antagonist.

The half-life of candesartan is shorter than irbesartan and telmisartan; however, all three agents can be effectively dosed once daily for hypertension.

Compared to losartan, candesartan does not require dosage adjustment for hepatic insufficiency, is not metabolized to an active metabolite, and lacks uricosuric effects.

Because AT₁ receptors are nearly saturated at the starting doses for most angiotensin II antagonists, the antihypertensive dose-response curve for these drugs is nonlinear, with proportionally small decreases in blood pressure attained with increased dosage.

Greater antihypertensive efficacy is generally achieved by adding a small dose of HCTZ to the angiotensin II antagonist.

Candesartan tends to reverse the potassium loss associated with HCTZ. Because candesartan does not inhibit angiotensin converting enzyme (ACE), it does not result in bradykinin accumulation which is theorized to cause the cough and angioedema associated with ACE inhibitors.

However, angioedema has been rarely associated with candesartan or other angiotensin II antagonists.

The antihypertensive response rate for the combination product is similar in black and non-black patients.

Atacand® HCT was approved by the FDA on September 5, 2000.

Indications

• hypertension

For the treatment of hypertension in patients who do not respond to monotherapy

Side Effects

1. agranulocytosis
2. alopecia
3. anaphylactoid reactions
4. angioedema
5. aplastic anemia
6. azotemia
7. back pain
8. blurred vision
9. cough
10. diaphoresis
11. dizziness
12. elevated hepatic enzymes
13. exfoliative dermatitis
14. gout
15. headache
16. hemolytic anemia
17. hepatitis
18. hyperbilirubinemia
19. hypercalcemia
20. hypercholesterolemia
21. hyperglycemia
22. hyperkalemia
23. hypertriglyceridemia
24. hyperuricemia
25. hypochloremia
26. hypokalemia
27. hypomagnesemia
28. hyponatremia
29. hypotension
30. hypovolemia
31. impotence (erectile dysfunction)
32. infection
33. influenza
34. interstitial nephritis
35. jaundice
36. leukopenia
37. muscle cramps
38. myopia
39. nephrolithiasis
40. neutropenia
41. ocular hypertension
42. oliguria
43. orthostatic hypotension
44. pancreatitis
45. pancytopenia
46. photosensitivity
47. pruritus
48. rash
49. renal failure (unspecified)
50. rhabdomyolysis
51. sialadenitis
52. Stevens-Johnson syndrome
53. syncope
54. teratogenesis
55. thrombocytopenia
56. toxic epidermal necrolysis
57. urticaria
58. xanthopsia

Monitoring Parameters

• blood glucose
• blood pressure
• LFTs
• serum bilirubin (total and direct)
• serum creatinine/BUN
• serum electrolytes
• serum uric acid

Contraindications

• ACE-inhibitor induced angioedema
• angioedema
• anuria
• asthma
• breast-feeding
• children
• diabetes mellitus
• electrolyte imbalance
• geriatric
• gout
• heart failure
• hepatic disease
• hypercalcemia
• hyperglycemia
• hyperkalemia
• hyperuricemia
• hypokalemia
• hypomagnesemia
• hyponatremia
• hypotension
• hypovolemia
• orthostatic hypotension
• pancreatitis
• penicillin hypersensitivity
• pregnancy
• renal artery stenosis
• renal disease
• renal impairment
• sulfonamide hypersensitivity
• sunlight (UV) exposure
• surgery
• sympathectomy
• syncope
• systemic lupus erythematosus (SLE)
• thiazide diuretic hypersensitivity

Interactions

• Acarbose
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Acetazolamide
• Acetohexamide
• Aclidinium; Formoterol
• Acrivastine; Pseudoephedrine
• Albiglutide
• Albuterol
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• Aldesleukin, IL-2
• Alemtuzumab
• Alendronate; Cholecalciferol
• Alfentanil
• Aliskiren
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Allopurinol
• Alogliptin
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Alpha-glucosidase Inhibitors
• Alprostadil
• Amifostine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminolevulinic Acid
• Amiodarone
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amobarbital
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamine; Dextroamphetamine Salts
• Amphotericin B
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• Amphotericin B liposomal (LAmB)
• Amyl Nitrite
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• Asenapine
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• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Atracurium
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Baclofen
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• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril
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• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
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• Cabergoline
• Calcium
• Calcium Phosphate, Supersaturated
• Calcium; Vitamin D
• Canagliflozin
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• Captopril
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• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
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• Codeine; Promethazine
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• Diazoxide
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• Elexacaftor; tezacaftor; ivacaftor
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enalapril, Enalaprilat
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• Enalapril; Hydrochlorothiazide, HCTZ
• Enflurane
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• Ethanol
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• Etomidate
• Exenatide
• Famotidine; Ibuprofen
• Fenofibric Acid
• Fenoprofen
• Fentanyl
• Fexofenadine; Pseudoephedrine
• Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
• Flavoxate
• Fluconazole
• Fluocinolone; Hydroquinone; Tretinoin
• Fluoxetine
• Fluoxetine; Olanzapine
• Flurbiprofen
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• Formoterol
• Formoterol; Mometasone
• Fosinopril
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fospropofol
• Gallium Ga 68 Dotatate
• General anesthetics
• Glimepiride
• Glimepiride; Pioglitazone
• Glimepiride; Rosiglitazone
• Glipizide
• Glipizide; Metformin
• Glyburide
• Glyburide; Metformin
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guaifenesin; Pseudoephedrine
• Halobetasol; Tazarotene
• Halofantrine
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen
• Ibuprofen lysine
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Icosapent ethyl
• Iloperidone
• Iloprost
• Inamrinone
• Incretin Mimetics
• Indacaterol
• Indacaterol; Glycopyrrolate
• Indapamide
• Indomethacin
• Inotersen
• Insulin Degludec; Liraglutide
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• Insulins
• Intravenous Lipid Emulsions
• Isocarboxazid
• Isoflurane
• Isoproterenol
• Isosorbide Dinitrate, ISDN
• Isosorbide Mononitrate
• Ivacaftor
• Ketamine
• Ketoprofen
• Ketorolac
• Lansoprazole
• Lansoprazole; Naproxen
• Lesinurad; Allopurinol
• Levalbuterol
• Levodopa
• Levomethadyl
• Levomilnacipran
• Levorphanol
• Linagliptin
• Linagliptin; Metformin
• Liraglutide
• Lisdexamfetamine
• Lisinopril
• Lithium
• Lixisenatide
• Loop diuretics
• Loratadine; Pseudoephedrine
• Lovastatin; Niacin
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• Magnesium Salts
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• Mannitol
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• Mefenamic Acid
• Meglitinides
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• Memantine
• Mepenzolate
• Meperidine
• Meperidine; Promethazine
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• Metaproterenol
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methadone
• Methamphetamine
• Methazolamide
• Methenamine
• Methenamine; Sodium Acid Phosphate
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methohexital
• Methotrexate
• Methoxsalen
• Methscopolamine
• Methylphenidate
• Metoclopramide
• Midodrine
• Miglitol
• Milnacipran
• Milrinone
• Mirtazapine
• Mivacurium
• Moexipril
• Morphine
• Morphine; Naltrexone
• Nabumetone
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nateglinide
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• Nesiritide, BNP
• Neuromuscular blockers
• Niacin, Niacinamide
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• Nitrates
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• Nonsteroidal antiinflammatory drugs
• Norepinephrine
• Octreotide
• Olanzapine
• Olodaterol
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Ondansetron
• Oprelvekin, rh-IL-11
• Oritavancin
• Oxaprozin
• Oxybutynin
• Oxycodone
• Oxymetazoline
• Oxymorphone
• Paliperidone
• Pancuronium
• Pantoprazole
• Paroxetine
• Pasireotide
• Pentamidine
• Pentazocine
• Pentazocine; Naloxone
• Pentoxifylline
• Perindopril
• Perindopril; Amlodipine
• Phendimetrazine
• Phenelzine
• Phenothiazines
• Phentermine
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Photosensitizing agents (topical)
• Pimozide
• Pioglitazone
• Pirbuterol
• Piroxicam
• Polycarbophil
• Polyethylene Glycol; Electrolytes
• Polyethylene Glycol; Electrolytes; Ascorbic Acid
• Porfimer
• Potassium
• Pramlintide
• Prazosin
• Prilocaine; Epinephrine
• Probenecid
• Procainamide
• Procaine
• Propantheline
• Propofol
• Pseudoephedrine
• Quetiapine
• Quinapril
• Quinidine
• Rabeprazole
• Ramipril
• Rapacuronium
• Rasagiline
• Remifentanil
• Repaglinide
• Risperidone
• Rocuronium
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• Rosiglitazone
• Salicylates
• Salmeterol
• Saxagliptin
• Scopolamine
• Selegiline
• Semaglutide
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• Silodosin
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• Sitagliptin
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• Solifenacin
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