Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Drug reference
Candesartan
Angiotensin II receptor blocker (ARB; prodrug candesartan cilexetil) · Antihypertensive, Heart failure management, Diabetic nephropathy management
Also known as Candesartan cilexetil
START
HTN 8–16 mg once daily (4 mg if volume-depleted); HFrEF 4 mg titrate to 32 mg/day
TYPICAL MAX
32 mg/day
STOP IF
Pregnancy, angioedema, K+ >6.0, AKI (creatinine rise >30%)
WATCH
BP, K+ and creatinine 1–2 weeks after start/titration, pregnancy status
CDSCO approvedSchedule HATC C09CA06
KDIGO 2024 + manufacturer label
- ONSET
- 2h · BP onset
- PEAK
- 3.5h · Cmax
- t½
- 9h · plasma t½
- DURATION
- 1d · once-daily
EXCRETION
~67% biliary/faecal, ~33% renal; minimal metabolism
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated 2nd/3rd trimester — fetal renal/skull injury, death; discontinue if pregnancy detected
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AliskirenContraindicatedDatabaseKimi deep-research + Cla · p603
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
- BenazeprilSevereTextbookG&G 14e
Available in India
18 branded formulations and 1 fixed-dose combination. Look up specific brands in the Drugs workspace.
Mechanism
Prodrug hydrolysed during absorption to candesartan, a tight-binding insurmountable AT1-receptor antagonist → blocks angiotensin II vasoconstriction/aldosterone, lowering BP and providing cardiac/renal protection.
Indications
HypertensionHeart failure (reduced ejection fraction; ACE-intolerant)Diabetic nephropathy/proteinuria (renoprotection)Migraine prophylaxis (off-label)
Dosing
- Adult
- Hypertension: 8–16 mg PO once daily (start 4 mg if volume-depleted), max 32 mg/day. Heart failure: 4 mg daily titrated (double ~2-weekly) to 32 mg/day.
- Pediatric
- 1–<6 y: 0.2 mg/kg/day; ≥6 y weight-based per label.
- Renal adjustment
- No initial adjustment; monitor K+/creatinine (consider lower start in severe impairment).
- Hepatic adjustment
- Mild–moderate: consider lower start. Severe/cholestasis: contraindicated/avoid.
- Geriatric
- No specific adjustment; consider lower start.
- Max dose
- 32 mg/day
Pharmacokinetics
Onset
~2 h (BP); full effect ~4 weeks
Peak effect
Cmax 3–4 h
Duration
>24 h (tight receptor binding)
Half-life
~9 h
Bioavailability
~15% (cilexetil prodrug; food-independent)
Protein binding
>99%
Metabolism
Minimal (mostly excreted unchanged; minor CYP2C9)
Excretion
Biliary/faecal (~67%) and renal (~33%)
Contraindications
- Pregnancy (2nd/3rd trimester)
- Bilateral renal artery stenosis
- Concomitant aliskiren in diabetes
- Severe hepatic impairment/cholestasis
- Hypersensitivity/angioedema with ARB
Side effects
Common
DizzinessHyperkalaemiaHypotensionHeadacheFatigue
Serious
- Angioedema
- Acute kidney injury (RAS/volume depletion)
- Severe hyperkalaemia
- Fetal toxicity (2nd/3rd trimester)
Pregnancy & lactation
Pregnancy
Contraindicated 2nd/3rd trimester — fetal renal/skull injury, death; discontinue if pregnancy detected
Lactation
Avoid — alternatives preferred (limited data)
Drug interactions
Aliskiren
Contraindicated
Database
Dual RAAS blockade → hyperkalaemia/AKI/hypotension
Do not combine in diabetes/eGFR <60
Source: Kimi deep-research + Cla · p603
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Benazepril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Captopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalapril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Fosinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Lisinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Moexipril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Perindopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Ask House about Candesartan
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19