Fixed-dose combination: angiotensin II receptor blocker plus thiazide diuretic
ATC code: C09DA06 (Candesartan and diuretics)
Candesartan, hydrolyzed in the gut from the prodrug candesartan cilexetil, binds reversibly to AT1 receptors of angiotensin II with high affinity and slow dissociation. T½ 9 h, activity persists 24-36 h. Hydrochlorothiazide excretes sodium and water via distal tubules. Candesartan has proven benefit in heart failure with reduced EF (CHARM program).
Second line
Essential hypertension uncontrolled on candesartan monotherapy. Per ESH/ 2023 and SEH-LELHA 2023 – second-line. Dose: 8/12.5, 16/12.5, 32/12.5, 32/25 mg once daily. Full effect at 4 weeks. Candesartan reduces nocturnal BP more than most other ARBs, useful for the non-dipper profile on ABPM.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated from the 2nd trimester. ARBs and ACE inhibitors cause fetopathy: oligohydramnios, fetal renal failure, skull hypoplasia, limb contractures. In women of reproductive age planning pregnancy, switch in advance to methyldopa, labetalol, or slow-release nifedipine (ACOG 222 (2020), SEGO 2023).
Milk excretion data for the fixed combination are limited. For breastfeeding ESH 2023 and ACOG 2020 recommend switching to enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, or labetalol.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Candesartan + Hydrochlorothiazide is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Candesartan + Hydrochlorothiazide (≥ 1 in 100): Dizziness, Hypotension, Hyperkalemia, Hyponatremia, Hyperuricemia, Elevated creatinine. See the Safety section for uncommon and serious reactions.
FDA category D. Contraindicated from the 2nd trimester. ARBs and ACE inhibitors cause fetopathy: oligohydramnios, fetal renal failure, skull hypoplasia, limb contractures. In women of reproductive age planning pregnancy, switch in advance to methyldopa, labetalol, or slow-release nifedipine (ACOG 222 (2020), SEGO 2023).
Milk excretion data for the fixed combination are limited. For breastfeeding ESH 2023 and ACOG 2020 recommend switching to enalapril (RID 0.2%), captopril (RID 0.02%), methyldopa, or labetalol.
Candesartan + Hydrochlorothiazide is contraindicated in: Hypersensitivity to sartan, thiazides, or sulfonamides; Pregnancy (2nd-3rd trimester); Bilateral renal artery stenosis; Severe renal impairment (CrCl <30 for the thiazide component); Severe hepatic impairment, cholestasis. Full list in the Safety section.