Candesartan
1. About candesartan
Candesartan is a medicine widely used to treat high blood pressure (hypertension) and heart failure.
Candesartan helps to prevent future strokes, heart attacks and kidney problems. It also improves your survival if you're taking it for heart failure.
This medicine is only available on prescription. It comes as tablets.
2. Key facts
- Candesartan lowers your blood pressure and makes it easier for your heart to pump blood around your body.
- It's often used as a second-choice treatment if you had to stop taking your first because it gave you a dry, irritating cough.
- The main side effects of candesartan are dizziness, headache and cold or flu-like symptoms - but they're usually mild and short-lived.
- If you get severe diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to stop taking candesartan for a while until you feel better.
- Drinking alcohol can increase the blood pressure-lowering effect of candesartan, which can make you feel dizzy or lightheaded.
- Candesartan is also called by the brand name Amias.
3. Who can and can't take candesartan
Candesartan can be taken by adults aged 18 and over.
It can also be taken by children aged 6 years and over, but only to treat high blood pressure.
Candesartan is meant for people who have tried taking blood pressure-lowering medicines called ACE inhibitors (such as ramipril and lisinopril) in the past, but had to stop taking them because of side effects such as a dry cough.
Candesartan isn't suitable for some people.
To make sure candesartan is safe for you, tell your doctor if you have:
- diarrhoea (or if you've recently had it) or you're being sick (vomiting)
- been on a low salt diet
- recently had a kidney transplant
- if you have had an allergic reaction to candesartan or any other medicines in the past
- severe liver disease or a problem with the drainage of the bile from your gall bladder (biliary obstruction)
- diabetes
- heart, liver or kidney problems
- low blood pressure (hypotension)
- are trying to get pregnant, are already pregnant or you're breastfeeding
4. How and when to take it
It's usual to take candesartan tablets once a day. You can take your candesartan tablet at any time of day, but try to be consistent and take it at the same time every day.
You can take candesartan tablets with or without food. Swallow the tablets whole with a drink of water.
How much to take
The dose of candesartan you take depends on why you need the medicine. Take it as instructed by your doctor.
As a general rule in adults, the dose to treat:
- high blood pressure is 8mg to 32mg once a day
- heart failure is 4mg to 32mg once a day
In people with liver or kidney problems, the dose may be lower.
As a general rule in children (aged 6 years and over), the dose to treat high blood pressure is:
- for children weighing less than 50kg, the dose is 4mg to 8mg once a day
- for children weighing 50kg and more, the dose is 4mg to 16mg once daily
Will my dose go up or down?
You will start on a low dose of candesartan. After a few weeks your doctor will check your blood pressure and ask you if you're getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood. Your doctor will then decide whether to change your dose of candesartan.
If candesartan doesn't get your blood pressure down, your doctor may want to increase the dose. If your blood pressure gets too low or you get side effects, your doctor may want to lower your candesartan dose.
Important
Take candesartan even if you feel well, as you will still be getting the benefits of the medicine.
What if I get sick while I'm taking it?
If you get severe diarrhoea or vomiting for any reason, contact your doctor or a pharmacist. They’ll be able to advise you about what to do.
They may recommend that you stop taking candesartan until you’re better, and you’re able to eat and drink normally again.
What if I forget to take it?
If you miss a dose of candesartan, take it as soon as you remember. Do not take a double dose to make up for a forgotten one.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways that are suitable for you and your medicines.
What if I take too much?
If you take too many candesartan tablets by accident, contact your doctor or nearest hospital straight away. An overdose of candesartan can cause low blood pressure and dizziness.
The amount of candesartan that can lead to an overdose varies from person to person.
Call your doctor or go to A&E straight away if you take too much candesartan
If you need to go to a hospital accident and emergency (A&E) department, do not drive yourself - get someone else to drive you or call for an ambulance.
Take the candesartan packet, or the leaflet inside it, plus any remaining medicine with you.
5. Side effects
Like all medicines, candesartan can cause side effects although not everyone gets them. Side effects often improve as your body gets used to the medicine.
Common side effects
These common side effects happen in more than 1 in 100 people. Talk to your doctor or pharmacist if these side effects bother you or don't go away:
- feeling dizzy or having a spinning sensation (vertigo)
- feeling sick (nausea)
- headaches
- being sick (vomiting) or diarrhoea
- pain in your joints or muscles
Serious side effects
It happens rarely, but some people have serious side effects after taking candesartan. Call a doctor straight away if you have:
- yellow skin or the whites of your eyes turn yellow - this can be a sign of liver problems
- pale skin, feeling tired, faint or dizzy, purple spots, any sign of bleeding, sore throat and fever - these can be signs of blood or bone marrow disorder
- weakness, an irregular heartbeat, pins and needles and muscle cramps - these can be signs of changes in the sodium and potassium levels in your blood
Serious allergic reaction
In rare cases, candesartan may cause a serious allergic reaction (anaphylaxis).
Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of candesartan. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
6. How to cope with side effects
What to do about:
- feeling dizzy - if candesartan makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Do not drive or use tools or machines if you feel dizzy, have muscle cramps or muscle pain, or if you just feel a bit shaky.
- feeling sick (nausea) - try taking your tablets with or after a meal or snack. It may also help if you don't eat rich or spicy food.
- headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking candesartan. Talk to your doctor if they last longer than a week or are severe.
- being sick (vomiting) or diarrhoea - drink plenty of water to prevent dehydration. If you're being sick try small, frequent sips. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. If you get severe vomiting or diarrhoea from a stomach bug or illness, tell your doctor. You may need to stop taking candesartan for a while until you feel better.
- pain in your joints or muscles - if you get unusual muscle pain, weakness or tiredness which isn't from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it.
7. Pregnancy and breastfeeding
Candesartan is not normally recommended in pregnancy or when breastfeeding. However, your doctor may prescribe it for you if they think the benefits of the medicine outweigh the risks.
If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking candesartan. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.
For more information about how candesartan can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.
Candesartan and breastfeeding
Small amounts of candesartan may get into breast milk. This can cause low blood pressure in the baby. Talk to your doctor, as other medicines might be better while you are breastfeeding.
Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
8. Cautions with other medicines
Some medicines interfere with the way candesartan works.
Tell your doctor if you're taking:
- other medicines to help lower your blood pressure, including aliskiren, enalapril, captopril, lisinopril or ramipril
- painkillers such as ibuprofen, naproxen, diclofenac, celecoxib or etoricoxib
- aspirin (if you're taking more than 3g a day)
- potassium supplements or salt substitutes containing potassium
- heparin (a medicine for thinning the blood)
- water tablets (diuretics)
- lithium (a medicine for mental health problems)
- spironolactone (a medicine to treat heart failure)
Mixing candesartan with herbal remedies or supplements
There's very little information about taking herbal remedies and supplements with candesartan.
Important
For safety, tell your doctor and pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
9. Common questions
How does candesartan work?
Candesartan is a type of blood pressure-lowering medicine called an angiotensin receptor blocker.
Like other angiotensin receptor blockers, candesartan relaxes and widens your blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.
How long does it take to work?
Candesartan starts to work after about 2 hours to reduce high blood pressure but it may take up to 4 weeks for full effect.
If you're taking candesartan for heart failure, it may take weeks, even months, before you feel better.
If you have high blood pressure, you may not have any symptoms. In this case, you may not feel any different when you take candesartan. This doesn't mean that the medicine isn't working and it's important to keep taking it.
How long will I take it for?
Usually, treatment with candesartan is long term, even for the rest of your life.
Is candesartan safe to take for a long time?
Candesartan is generally safe to take for a long time. In fact, it works best when you take it for a long time.
Taking candesartan for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.
What will happen if I stop taking it?
Even if your blood pressure is successfully lowered by candesartan, it's best to carry on taking it. If you stop taking candesartan, your blood pressure could rise back up again.
If you need blood pressure-lowering medicines, you'll probably need to take them for the rest of your life.
Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.
Can I come off candesartan now my blood pressure is lower?
Even if your blood pressure is successfully lowered by candesartan, it's best to carry on taking it. If you stop taking candesartan, your blood pressure could rise back up again.
If you need blood pressure-lowering medicines, you'll probably need to take them for the rest of your life.
Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.
Can I drink alcohol with it?
Drinking alcohol can increase the blood pressure-lowering effect of candesartan, which can make you feel dizzy or lightheaded.
During the first few days of taking candesartan or after a dose increase, it is best to stop drinking alcohol until you see how the medicine affects you.
If you find candesartan makes you feel dizzy it's best to stop drinking alcohol.
Is there any food or drink I need to avoid?
Do not use salt substitutes such as Lo-Salt. This is because they are high in potassium. When mixed with candesartan they may make the level of potassium in your blood too high.
Other than alcohol, there's nothing else you need to avoid while taking candesartan. Eating a healthy, balanced diet can help if you have high blood pressure or heart failure.
Are there similar medicines to candesartan?
There are several other angiotensin receptor blocker medicines that work in the same way as candesartan. They include irbesartan, losartan and valsartan.
There are also other types of blood pressure-lowering medicines such as:
- ACE inhibitors - for example ramipril
- calcium-channel blockers - for example amlodipine
- beta blockers - for example bisoprolol
- diuretics (water tablets) - for example bendroflumethiazide
The blood pressure-lowering medicine you're prescribed depends on your age and ethnicity:
- if you're under 55 - you'll usually be offered an ACE inhibitor or an angiotensin receptor blocker
- if you're 55 or older, or you're any age and of African Caribbean or black African origin - you'll usually be offered a calcium channel blocker
Many people need to take a combination of different blood pressure-lowering medicines.
How does candesartan differ from other angiotensin receptor blockers?
Candesartan works as well as other angiotensin receptor blockers when it's used to lower blood pressure. Its side effects are also similar.
Can I take candesartan before surgery?
If you are going to be put to sleep for an operation, tell your doctor that you're taking candesartan.
Candesartan can reduce your blood pressure when it's used with general anaesthetics (that put you to sleep).
Your doctor will advise you to stop taking candesartan 24 hours before surgery.
Can I take candesartan for migraines?
There's some evidence that candesartan might help prevent migraines.
However, candesartan is not officially approved for migraine. Your doctor would probably advise you to try other medicines first.
Can I take candesartan to protect myself against Alzheimer's disease?
There have been some studies that have looked at whether blood pressure medicines could help protect people against Alzheimer's. However, at the moment, there is not enough evidence to recommend taking candesartan or other similar medicines for Alzheimer's.
There are steps you can take that may reduce your risk of Alzheimer's. If you are worried about getting Alzheimer's disease in the future, or have a family history of this condition, speak to your doctor.
Is candesartan addictive?
No, there's no evidence that candesartan is addictive.
Will it affect my sex life?
Candesartan won't affect your sex life.
Will it affect my fertility?
There's no firm evidence to suggest that taking candesartan will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.
Will it affect my contraception?
Candesartan won't affect any type of contraception.
However, some types of hormonal methods of contraception, such as the combined pill and contraceptive patch, aren't usually recommended for women with high blood pressure.
Talk to your doctor if you're taking a combined hormonal contraceptive.
Can I drive or ride a bike?
Candesartan can make some people feel dizzy - especially when you first start taking it or after taking a bigger dose. If this happens to you, do not drive a car, ride a bike, or use tools or machinery.
Can lifestyle changes help?
You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.
- Quit smoking - smoking increases your heart rate and blood pressure. Stopping smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke too.
- Cut down on alcohol - drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
- Exercise - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day is enough.
- Eat well - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt too. Eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
- Deal with stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
- Vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination (also called the pneumococcal vaccine) every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.