What is the maximum recommended dose of candesartan (Angiotensin II receptor antagonist) for adults?

Maximum Dose of Candesartan

The maximum recommended dose of candesartan is 32 mg once daily for adults. 1

FDA-Approved Dosing

• The FDA label explicitly states that candesartan can be administered once or twice daily with total daily doses ranging from 8 mg to 32 mg 1
• Doses larger than 32 mg do not appear to have a greater blood pressure-lowering effect 1
• Patients requiring further blood pressure reduction beyond initial dosing should be titrated to 32 mg 1

Target Dosing in Heart Failure

• For heart failure with reduced ejection fraction, the target dose is 32 mg once daily, as established in major clinical trials 2
• The European Society of Cardiology guidelines recommend starting at 4-8 mg once daily and titrating to the evidence-based target dose of 32 mg once daily 2
• Dose up-titration should be considered after 2-4 weeks, with renal function and electrolytes rechecked 1 and 4 weeks after each dose increase 2

Hypertension Dosing

• The ACC/AHA hypertension guidelines list candesartan's usual dose range as 8-32 mg once daily 2
• The starting dose for hypertension is typically 16 mg once daily when used as monotherapy in patients who are not volume depleted 1
• Clinically effective dosages range between 8 and 32 mg/day 3

Special Population Considerations

• Renal impairment: For patients with severe renal dysfunction (creatinine clearance <30 mL/min), dosing recommendations cannot be provided, and caution is warranted 1
• Hepatic impairment: In moderate to severe hepatic impairment, candesartan should not be initiated because the appropriate starting dose of 8 mg cannot be given with combination products 1
• No dose adjustment is necessary in patients with mild or moderate renal impairment 4

Common Pitfalls to Avoid

• Do not exceed 32 mg daily as higher doses provide no additional blood pressure-lowering benefit 1
• If blood pressure remains uncontrolled on 32 mg daily, add a thiazide diuretic or another antihypertensive agent from a different class rather than increasing candesartan further 1
• Monitor renal function and serum potassium within 1 week of starting treatment and after each dose increase, especially when combining with other agents affecting the renin-angiotensin system 2
• Avoid combining candesartan with ACE inhibitors and aldosterone antagonists due to increased risk of hyperkalemia and renal dysfunction 2