Adult: As monotherapy or in combination with other antihypertensive agents: Initially, 8 mg once daily. Dose may be increased according to response. Usual maintenance dose: 8 mg once daily. Max: 32 mg once daily. In patients with intravascular volume depletion: Initially, 4 mg once daily. Child: 1-<6 years Initially, 0.2 mg/kg daily, may adjust dose according to response to 0.05-0.4 mg/kg daily; 6-<17 years weighing <50 kg: Initially, 4-8 mg daily, may adjust according to response to 2-16 mg daily; ≥50 kg: Initially, 8-16 mg daily, may adjust according to response to 4-32 mg daily. All doses are given as a single daily dose or in 2 divided doses. Dosage recommendations and age range of use may vary among countries and between individual products (refer to specific product guidelines).
Oral Heart failure with reduced ejection fraction
Adult: In patients with LVEF ≤40% who cannot tolerate ACE inhibitors or as add-on treatment to ACE inhibitors: Initially, 4 mg once daily. Titrate to the target dose of 32 mg once daily or the Max tolerated dose at intervals of at least 2 weeks.
What are the brands available for Candesartan in Malaysia?
Hypertension:
Including patients on haemodialysis: Initially, 4 mg once daily. Titrate dose according to response. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Hepatic Impairment
Hypertension:
Mild to moderate: Initially, 4 mg once daily. Titrate dose according to response. Severe: Contraindicated. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Administration
Candesartan May be taken with or without food.
Contraindications
Severe hepatic impairment and/or cholestasis. Children <1 year. Pregnancy. Concomitant use with aliskiren-containing agents in patients with diabetes mellitus or renal impairment (eGFR <60 mL/min/1.73 m2).
Special Precautions
Patient with unstented unilateral/bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, history of angioedema, haemodynamically relevant aortic or mitral valve stenosis, obstructive hypertrophic cardiomyopathy, primary hyperaldosteronism, diabetes mellitus, volume depletion. Black patients. Patients undergoing surgery. Renal impairment (including patients on haemodialysis) and mild to moderate hepatic impairment. Children ≥1 year. Lactation.
Adverse Reactions
Significant: Symptomatic hypotension (particularly in salt- or volume-depleted patients); hyperkalaemia; deterioration of kidney function (may result in oliguria, acute kidney failure and progressive azotaemia), increased serum creatinine; intestinal angioedema. Blood and lymphatic system disorders: Very rarely, agranulocytosis, leucopenia, neutropenia. Ear and labyrinth disorders: Vertigo. Gastrointestinal disorders: Diarrhoea. Very rarely, nausea. Investigations: Very rarely, increased liver enzymes, abnormal hepatic function, hepatitis. Metabolism and nutrition disorders: Very rarely, hyponatraemia. Musculoskeletal and connective tissue disorders: Very rarely, back pain, arthralgia, myalgia. Nervous system disorders: Headache, dizziness. Respiratory, thoracic and mediastinal disorders: Respiratory infection, pharyngitis, rhinitis. Very rarely, cough. Skin and subcutaneous tissue disorders: Very rarely, angioedema, rash, pruritus, urticaria.
PO: Z (Angiotensin II receptor blockers are generally contraindicated or not recommended, particularly during 2nd and 3rd trimesters, due to adverse effects on the foetal renin-angiotensin system.)
Monitoring Parameters
Monitor renal function (e.g. serum creatinine, BUN), serum potassium, and blood pressure. Assess for signs or symptoms of hypotension and angioedema.
Overdosage
Symptoms: Dizziness, symptomatic hypotension, tachycardia, bradycardia. Management: Symptomatic and supportive treatment. Monitor vital signs. For symptomatic hypotension, place the patient in supine position with legs elevated. If insufficient, plasma volume must be increased by infusion of isotonic saline solution. Administer sympathomimetic agents if previous measures are still insufficient.
Drug Interactions
Increased risk of adverse reactions, particularly hyperkalaemia, hypotension and reduced renal function (including acute renal failure), with ACE inhibitors or aliskiren. Increased risk of hyperkalaemia with potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes or other drugs that increase potassium levels (e.g. heparin, trimethoprim/sulfamethoxazole). May increase the serum concentration and toxicity of lithium. Reduced antihypertensive effect, increased risk of worsening renal function and increased serum potassium with NSAIDs (e.g. selective COX-2 inhibitors, aspirin).
Lab Interference
May result in false-negative aldosterone/renin ratio (ARR).
Action
Description: Mechanism of Action: Candesartan is an angiotensin II receptor blocker. It selectively binds to angiotensin II type 1 (AT1) receptor found in numerous tissues (e.g. vascular smooth muscle, adrenal gland), preventing angiotensin II from binding and thereby blocking its vasoconstrictive and aldosterone-secreting effects. Onset: 2-3 hours; within 2 weeks (antihypertensive effect). Duration: >24 hours. Pharmacokinetics: Absorption: Rapidly and completely absorbed after conversion from candesartan cilexetil (prodrug). Time to peak plasma concentration: Approx 3-4 hours. Distribution: Enters breast milk. Volume of distribution: 0.13 L/kg. Plasma protein binding: >99%. Metabolism: Rapidly converted from candesartan cilexetil to active candesartan via ester hydrolysis during absorption from the gastrointestinal tract; metabolised in the liver (minor) via O-deethylation into inactive metabolite. Excretion: Via faeces (67%); urine (33%; 26% as unchanged drug). Elimination half-life: 5-9 hours (dose dependent).
Chemical Structure
Candesartan Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2541, Candesartan. https://pubchem.ncbi.nlm.nih.gov/compound/Candesartan. Accessed July 28, 2025.
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