Candesartan Hydrochlorothiazide

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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
  • Albuterol; Ipratropium
  • 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
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Amyl Nitrite
  • Angiotensin II
  • Angiotensin-converting enzyme inhibitors
  • Anticholinergics
  • Apomorphine
  • Apraclonidine
  • Aprepitant, Fosaprepitant
  • Arformoterol
  • Aripiprazole
  • Arsenic Trioxide
  • Articaine; Epinephrine
  • Asenapine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • 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
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Benztropine
  • Beta-agonists
  • Bortezomib
  • Bosentan
  • Brexpiprazole
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Cabergoline
  • Calcium
  • Calcium Phosphate, Supersaturated
  • Calcium; Vitamin D
  • Canagliflozin
  • Canagliflozin; Metformin
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cardiac glycosides
  • Cariprazine
  • Celecoxib
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chlordiazepoxide; Clidinium
  • Chloroprocaine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpropamide
  • Cholestyramine
  • Cidofovir
  • Cisapride
  • Cisatracurium
  • Citalopram
  • Clindamycin; Tretinoin
  • Clozapine
  • Co-Enzyme Q10, Ubiquinone
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Colchicine; Probenecid
  • Colestipol
  • Conivaptan
  • Corticosteroids
  • Cosyntropin
  • Cyclophosphamide
  • Cyclosporine
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Desloratadine; Pseudoephedrine
  • Desvenlafaxine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexlansoprazole
  • Dexmethylphenidate
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Quinidine
  • Diazoxide
  • Dichlorphenamide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Dicyclomine
  • Diethylpropion
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Diphenhydramine; Phenylephrine
  • Dobutamine
  • Dofetilide
  • Dolasetron
  • Donepezil; Memantine
  • Dopamine
  • Doxacurium
  • Droperidol
  • Drospirenone
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Dulaglutide
  • Duloxetine
  • Elexacaftor; tezacaftor; ivacaftor
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enflurane
  • Ephedrine
  • Epinephrine
  • Eplerenone
  • Epoprostenol
  • Ergocalciferol, Vitamin D2
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Escitalopram
  • Esomeprazole
  • Esomeprazole; Naproxen
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Ethanol
  • Etodolac
  • 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
  • Insulin Glargine; Lixisenatide
  • 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
  • Lumacaftor; Ivacaftor
  • Lurasidone
  • Magnesium Salts
  • Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
  • Mannitol
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meglitinides
  • Meloxicam
  • Memantine
  • Mepenzolate
  • Meperidine
  • Meperidine; Promethazine
  • Mequinol; Tretinoin
  • Mestranol; Norethindrone
  • 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
  • Nefazodone
  • Nesiritide, BNP
  • Neuromuscular blockers
  • Niacin, Niacinamide
  • Niacin; Simvastatin
  • Nitrates
  • Nitroglycerin
  • Nitroprusside
  • 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
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  • Risperidone
  • Rocuronium
  • Rofecoxib
  • Rosiglitazone
  • Salicylates
  • Salmeterol
  • Saxagliptin
  • Scopolamine
  • Selegiline
  • Semaglutide
  • Serotonin norepinephrine reuptake inhibitors
  • Sertraline
  • Sevoflurane
  • SGLT2 Inhibitors
  • Silodosin
  • Simvastatin; Sitagliptin
  • Sitagliptin
  • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Solifenacin
  • Spironolactone
  • Streptozocin
  • Succinylcholine
  • Sufentanil
  • Sulfacetamide
  • Sulfacetamide; Sulfur
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Sulfinpyrazone
  • Sulfonylureas
  • Sulindac
  • Tapentadol
  • Tazarotene
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  • Tetrabenazine
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  • Tezacaftor; Ivacaftor
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  • Tolbutamide
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  • Trandolapril
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  • Tranylcypromine
  • Trazodone
  • Treprostinil
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  • Triamterene
  • Trihexyphenidyl
  • Trimethoprim
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  • Umeclidinium; Vilanterol
  • Valdecoxib
  • Vecuronium
  • Venlafaxine
  • Verteporfin
  • Vilazodone
  • Vitamin D
  • Vitamin D analogs
  • Vorinostat
  • Vortioxetine
  • Yohimbine
  • Ziconotide
  • Ziprasidone

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