Maximum Dose for Candesartan in Hypertension
The maximum recommended dose for candesartan in adults with hypertension is 32 mg once daily. 1
Dosing Guidelines for Candesartan
Starting and Maximum Doses
- Initial recommended starting dose: 16 mg once daily for patients who are not volume depleted 1
- Dose range: 8 mg to 32 mg total daily dose 1
- Administration: Can be given once or twice daily 1
- Maximum dose: 32 mg daily (doses larger than 32 mg do not appear to provide additional blood pressure lowering effect) 1
Dose Titration
- Patients requiring further blood pressure reduction should be titrated up to the maximum dose of 32 mg 1
- The maximal antihypertensive effect of any dose can be expected within 4 weeks of initiating that dose 1
- Candesartan can be administered with or without food 1
Special Population Considerations
Renal Impairment
- Dosing recommendations cannot be provided for patients with creatinine clearance <30 mL/min 1
- For patients with mild to moderate renal impairment, no dose adjustment is necessary 2
Hepatic Impairment
- Candesartan is not recommended for initiation in patients with moderate to severe hepatic impairment 1
- Hepatic impairment does not significantly change pharmacokinetics at doses up to 12 mg/day 2
Clinical Efficacy
Dose-Response Relationship
- The 32 mg dose has demonstrated greater antihypertensive efficacy compared to lower doses 3
- In patients with isolated systolic hypertension, increasing from 16 mg to 32 mg provides additional blood pressure reduction (8.9/3.8 mmHg further reduction) 4
- The dose-response relationship is consistent across age, sex, and race 4
Comparative Efficacy
- Candesartan 16 mg once daily produces significantly greater blood pressure reduction than losartan 50 mg once daily 5
- Candesartan has a trough-to-peak ratio of approximately 1.0, indicating consistent 24-hour blood pressure control 5
Safety and Tolerability
- Tolerability profile similar to placebo 2
- Most common adverse events: headache, upper respiratory tract infection, back pain, and dizziness 2
- Adverse events are usually mild to moderate in severity and not dose-related 3
- The incidence of adverse events in long-term trials is not different from short-term trials 2
Important Clinical Considerations
- When using candesartan for heart failure, the target dose is also 32 mg once daily 6
- For hypertension management, candesartan can be used as monotherapy or in combination with other antihypertensive agents 1
- The American College of Cardiology/American Heart Association guidelines emphasize the importance of titrating to target doses (or maximally tolerated doses) to achieve maximal benefits 6
Remember that the full antihypertensive effect may take up to 4 weeks to develop after a dose change, so allow adequate time before further dose adjustments.