Candesartan and Hydrochlorothiazide

Candesartan and hydrochlorothiazide is a prescription medication used to treat high blood pressure. It is a single product containing 2 medications: candesartan and hydrochlorothiazide. Candesartan is in a class of medications called angiotensin II receptor antagonists. It works by blocking the action of certain natural substances that tighten the blood vessels, allowing the blood to flow more smoothly and the heart to pump more efficiently. Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

This medication comes in tablet form and is taken once or twice daily, with or without food.

Common side effects of candesartan and hydrochlorothiazide include nausea, a condition of excess uric acid in the blood (hyperuricemia), and upper respiratory tract infection.  

Candesartan and hydrochlorothiazide can also cause dizziness.  Do not drive or operate heavy machinery until you know how candesartan and hydrochlorothiazide affects you.

Candesartan and hydrochlorothiazide is a prescription medication used to treat high blood pressure.  

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight 
• your height
• your age
• your gender

The usual recommended starting dose is candesartan and hydrochlorothiazide 16/12.5mg once daily. Candesartan and hydrochlorothiazide can be administered once or twice daily with total daily doses ranging from 8mg to 32mg of candesartan; hydrochlorothiazide is effective in doses of 12.5mg to 50mg once daily.

Warning: Fetal Toxicity

• When pregnancy is detected, discontinue candesartan and hydrochlorothiazide as soon as possible.
• Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Serious side effects have been reported with candesartan and hydrochlorothiazide including the following:

• harm to an unborn baby causing injury and even death.
• low blood pressure (hypotension). Low blood pressure is most likely to happen if you:
  • take water pills
  • are on a low salt diet
  • get dialysis treatments
  • have heart problems
  • get sick with vomiting or diarrhea
  • drink alcohol
• allergic reactions. People with and without allergy problems or asthma who take candesartan and hydrochlorothiazide may get allergic reactions.
• worsening of lupus. Hydrochlorothiazide, one of the medicines in candesartan and hydrochlorothiazide, may cause lupus to become active or worse.
• fluid and electrolyte (salt) problems. Tell your doctor about any of the following signs and symptoms of fluid and electrolyte problems:
  • dry mouth
  • thirst
  • lack of energy (lethargy)
  • weakness
  • drowsiness
  • restlessness
  • confusion
  • seizures
  • muscle pain or cramps
  • muscle fatigue
  • very low urine output
  • fast heartbeat
  • nausea and vomiting
• kidney problems. Kidney problems may become worse in people that already have kidney disease. Some people will have changes on blood tests for kidney function and may need a lower dose of candesartan and hydrochlorothiazide. Call your doctor if you get swelling in your feet, ankles, or hands, or unexplained weight gain. If you have heart failure, your doctor should check your kidney function before prescribing candesartan and hydrochlorothiazide.
• skin rash. Call your doctor right away if you have an unusual skin rash.
• eye problems. One of the medicines in candesartan and hydrochlorothiazide can cause eye problems that may lead to vision loss. Symptoms of eye problems can happen within hours to weeks of starting candesartan and hydrochlorothiazide. Tell your doctor right away if you have:
  • decrease in vision
  • eye pain

Do not take candesartan and hydrochlorothiazide if you:

• are allergic to candesartan and hydrochlorothiazide or to any of its ingredients, or medicines that contain sulfonamides
• make less urine due to kidney problems
• are a diabetic patient taking aliskiren

Serious side effects have been reported with candesartan and hydrochlorothiazide. See the "Candesartan and hydrochlorothiazide Precautions" section.

Common side effects of candesartan and hydrochlorothiazide include the following:

• nausea
• a condition of excess uric acid in the blood (hyperuricemia)
• dizziness
• an infection that affects the nose, throat, and airways (upper respiratory tract infection)

This is not a complete list of candesartan and hydrochlorothiazide side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.  Especially tell your doctor if you take:

• other medicines for high blood pressure or a heart problem
• water pills (diuretics)
• potassium supplements. Your doctor may check the amount of potassium in your blood periodically. 
• a salt substitute. Your doctor may check the amount of potassium in your blood periodically. 
• antidiabetic medicines including insulin
• narcotic pain medicines
• sleeping pills
• lithium, a medicine used in some types of depression (Eskalith, Lithobid, Lithium Carbonate, Lithium Citrate)
• aspirin or other medicines called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), like ibuprofen or naproxen 
• digoxin or other digitalis glycosides (a heart medicine)
• muscle relaxants (medicines used during operations)
• certain cancer medicines, like cyclophosphamide or methotrexate 
• certain antibiotics (rifamycin group), a drug used to protect against transplant rejection (cyclosporin) or an antiretroviral drug used to treat HIV/AIDS infection (ritonavir). These drugs may increase the effect of candesartan.

This is not a complete list of candesartan and hydrochlorothiazide drug interactions. Ask your doctor or pharmacist for more information.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy.  Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Candesartan and hydrochlorothiazide falls into category D. It has been shown that use of candesartan and hydrochlorothiazide in pregnant women caused some babies to be born with problems. However, in some situations, the benefit of using this medication may be greater than the risk of harm to the baby.

Tell your doctor if you are breastfeeding or plan to breastfeed.  

It is not known whether candesartan is excreted in human milk. Hydrochlorothiazide is excreted in human breast milk. Because many drugs are excreted into human milk and because of the potential for adverse reactions in nursing infants from candesartan and hydrochlorothiazide, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.