Candesartan
An angiotensin receptor blocker, given as a prodrug ester, used for high blood pressure and heart failure.
Also called candesartan cilexetil (the prodrug ester in tablets).
Drug card
- How it works
- Blocking angiotensin II's AT1 receptor, so vessels relax
- Used for
- High blood pressure
- Heart failure, to cut deaths and hospital admissions
- Known for
- High potassium (hyperkalemia)
- Harm to the unborn baby (fetal toxicity)
- Its name
- -sartan means an angiotensin II receptor blocker (ARB)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does candesartan work?
Tablets contain candesartan cilexetil, an ester prodrug that is completely hydrolyzed to candesartan while it is absorbed from the gut. Candesartan favors the AT1 receptor over AT2 by more than 10,000-fold and leaves mostly unchanged in urine and bile, with a half-life of about 9 hours.
Like other angiotensin receptor blockers: They block the AT1 receptor, so angiotensin II can no longer narrow arterioles or drive aldosterone release: vessels relax, the kidneys keep less sodium, and potassium can rise. They act at the receptor rather than on ACE, so bradykinin does not build up and cough is far rarer than with ACE inhibitors, though angioedema can still occur.
Uses
What is candesartan used for?
- High blood pressure
- Heart failure, to cut deaths and hospital admissions
Side effects
Side effects of candesartan
- High potassium (hyperkalemia)Known forSerious
- Harm to the unborn baby (fetal toxicity)Known forSerious
- Low blood pressure, common in heart failure
- Worsening kidney functionSerious
- Dizziness
- Headache
- Back pain
- Angioedema (very rare)Serious
- Hepatitis (very rare)Serious
- Neutropenia and agranulocytosis (very rare)Serious
- Low sodium (hyponatremia)
- Muscle breakdown (rhabdomyolysis), rareSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Heart failure: low blood pressure, worsening kidney function and hyperkalemia are common, so they are checked.
- It raises lithium levels and can cause lithium toxicity.
Good to know: The NHS notes that doctors sometimes use it, outside its licence, to prevent migraine.
Remember it
A way to remember it
Block the lock, not the key-maker.
ACE inhibitors stop the enzyme that makes angiotensin II (the key); ARBs leave that enzyme alone and block the AT1 receptor (the lock). Bradykinin is not built up, so the ACE inhibitor cough is rare, and ARBs are the usual swap when that cough stops an ACE inhibitor.
Written for biofideX
Its name
-sartan means angiotensin II receptor blocker (ARB)
Sartans block the AT1 receptor for angiotensin II. Valsartan is also half of sacubitril/valsartan, which adds a neprilysin inhibitor.
- Every drug name stem
Its class
Angiotensin receptor blockers
Other angiotensin receptor blockers with a card:
Easily mixed up with ACE inhibitors and angiotensin receptor-neprilysin inhibitors.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood pressure
Candesartan is one of 27 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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