Candesartan cilexetil: An angiotensin II-receptor blocker

The mechanism of action, pharmacokinetics, pharmacodynamics, clinical effic acy, and adverse effects of candesartan cilexetil are reviewed. Candesartan is an angiotensin II-receptor blocker (ARB). It is administered as a pro-drug that undergoes activation during gastrointestinal absorption . The agent is excreted mostly unchanged and has a terminal half-life of ab out nine hours (slightly longer in the elderly). Candesartan differs from o ther agents in its class in that it is tightly bound to angiotensin II type 1 receptors, allowing prolonged activity. In clinical trials, candesartan cilexetil has produced a dose-dependent effect when given in dosages of 2-3 2 mg/day. Observed trough-to-peak blood pressure ratios support a once-dail y dosage regimen. The anti-hypertensive effect of candesartan cilexetil 4-1 6 mg/day was as great as that of enalapril 10-20 mg/day and amiodipine 5 mg /day and larger than that of Iosartan potassium 50 mg/day. Adding candesart an cilexetil to hydrochlorothiazide 12.5-25 mg/day and amlodipine 5 mg/day led to enhanced blood-pressure reductions and was well tolerated. It appear s that candesartan can decrease renal perfusion without adversely affecting renal blood flow and may mediate a decrease in albuminuria in hypertensive patients with type 2 diabetes. No clinically important drug interactions h ave been reported, adverse effects include headache, dizziness, nausea, dia rrhea, and transient elevations in liver transaminases. The frequency of co ugh is similar to that seen with placebo. Candesartan cilexetil is an effective antihypertensive agent that can be us ed alone or in combination with other antihypertensive drugs. It is general ly well tolerated and may be an option for patients who cannot tolerate ang iotensin-converting-enzyme inhibitors because of cough.