Common uses

The combination of candesartan and hydrochlorothiazide is used alone or with other medications to treat high blood pressure. Candesartan is in a class of medications called angiotensin II antagonists. It makes blood flow more smoothly by blocking the action of certain natural chemicals that tighten the blood vessels. Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). It works by causing the the kidneys to get rid of unneeded water and salt from the body into the urine.

Before using

Some medical conditions may interact with Atacand . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
• if you are planning to become pregnant or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have liver or kidney problems
• if you have low blood volume or salt (sodium) levels
Some MEDICINES MAY INTERACT with Atacand . Tell your health care provider if you are taking any other medicines, especially any of the following:
• Diuretics (eg, furosemide, hydrochlorothiazide) or lithium because the risk of their side effects may be increased by Atacand
• Angiotensin-converting enzyme (ACE) inhibitors (eg, captopril) or potassium-sparing diuretics (eg, spironolactone) because the risk of high blood potassium levels may be increased
This may not be a complete list of all interactions that may occur. Ask your health care provider if Atacand may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Directions
Use Atacand as directed by your doctor. Check the label on the medicine for exact dosing instructions.
• Take Atacand by mouth with or without food.
• Continue to take Atacand even if you feel well. Do not miss any doses.
• If you miss a dose of Atacand , take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Atacand .

Cautions

The use of drugs that act directly on the renin-angiotensin system during the second and third trimesters of pregnancy has been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased fetal renal function; oligohydramnios in this setting has been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development. Prematurity, intrauterine growth retardation, and patent ductus arteriosus have also been reported, although it is not clear whether these occurrences were due to exposure to the drug.

Possible side effects

Candesartan may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
• dizziness
• back pain
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
• lightheadedness
• fainting
• dry mouth
• thirst
• weakness
• lack of energy
• drowsiness
• restlessness
• confusion
• seizures
• muscle pain or cramps
• infrequent urination
• rapid or pounding heartbeat
• upset stomach
• vomiting
Candesartan and hydrochlorothiazide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you take too much
The most likely manifestation of overdosage with ATACAND would be hypotension, dizziness, and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation. If symptomatic hypotension should occur, supportive treatment should be instituted.
Candesartan cannot be removed by hemodialysis.

Additional information

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to candesartan and hydrochlorothiazide.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Drug interactions

No significant drug interactions have been reported in studies of candesartan cilexetil given with other drugs such as glyburide, nifedipine, digoxin, warfarin, hydrochlorothiazide, and oral contraceptives in healthy volunteers, or given with enalapril to patients with heart failure (NYHA class II and III). Because candesartan is not significantly metabolized by the cytochrome P450 system and at therapeutic concentrations has no effects on P450 enzymes, interactions with drugs that inhibit or are metabolized by those enzymes would not be expected.
Lithium— Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors, and with some angiotensin II receptor antagonists. An increase in serum lithium concentration has been reported during concomitant administration of lithium with ATACAND, so careful monitoring of serum lithium levels is recommended during concomitant use.