Candesartan/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Atacand HCT

• ARB/HCTZ Combos

Angiotensin II antagonist and thiazide diuretic used together for management of HTN; additive efficacy; less potassium loss compared to diuretic monotherapy.

Indicated for the treatment of hypertension in patients who do not respond to monotherapy.

Hypersensitivity to candesartan, hydrochlorothiazide, or sulfonamides

Pregnancy (2nd and 3rd trimesters): Significant risk of fetal/neonatal morbidity and mortality

Gout

Refractory hypercalcemia

Refractory hypokalemia

Severe hepatic impairment and/or cholestasis

Do not coadminister with aliskiren in patients with diabetes mellitus

As initial therapy

Adverse reactions with combination products and individual agents

Headache (3%)

Dizziness (3%)

Upper respiratory tract infection (4%)

Back pain (3%)

Flu-like syndrome (2%)

Candesartan

• Peripheral edema
• Dizziness
• Fatigue
• Abdominal pain
• Diarrhea
• Nausea
• Arthralgia
• Back pain
• Chest pain
• Albuminuria
• Bronchitis
• Coughing
• Pharyngitis
• Rhinitis
• URI

Hydrochlorothiazide

• Anorexia
• Epigastric distress
• Hypotension
• Orthostatic hypotension
• Photosensitivity
• Anaphylaxis
• Anemia
• Confusion
• Erythema multiforme
• Stevens-Johnson syndrome
• Exfoliative dermatitis including toxic epidermal necrolysis
• Dizziness
• Headache
• Hyperuricemia
• Hypokalemia and/or hypomagnesemia

Hypersensitivity reactions to hydrochlorothiazide may occur in patients with or without history of allergy or bronchial asthma, but are more likely in patients with such a history

Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

Photosensitivity may occur; instruct patients taking hydrochlorothiazide to protect skin from sun and undergo regular skin cancer screening

Monitor serum electrolytes periodically; drugs that inhibit the renin-angiotensin system can cause hyperkalemia; hydrochlorothiazide can cause hypokalemia and hyponatremia; hypomagnesema can result in hypokalemia which appears difficult to treat despite potassium repletion

Thiazides decrease urinary calcium excretion and may cause mild elevation of serum calcium; avoid therapy in patients with hypercalcemia

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy

Caution in aortic mitral stenosis, hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, bilateral renal artery stenosis or anuria

Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides

Thiazides may decrease urinary calcium excretion

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimesters)

Lactation: enters breast milk/contraindicated