What is the recommended dosage of Atacand (Candesartan) 16 MG Oral Tablet for adults with hypertension?

Atacand (Candesartan) 16 MG Dosing for Hypertension

For adults with hypertension, start Atacand (candesartan cilexetil) at 16 mg once daily as monotherapy in patients who are not volume depleted, and titrate to 32 mg once daily if blood pressure remains uncontrolled after 2-4 weeks. 1

Initial Dosing Strategy

• Starting dose: 16 mg once daily is the usual recommended initial dose for monotherapy 1
• For patients with stage 2 hypertension (BP ≥140/90 mmHg and more than 20/10 mmHg above target), consider initiating combination therapy with candesartan plus a thiazide diuretic or calcium channel blocker rather than monotherapy 2
• Candesartan can be administered once or twice daily with total daily doses ranging from 8-32 mg 1

Dose Titration Protocol

• Assess response after 2-4 weeks of initial 16 mg dose 1
• Titrate to 32 mg once daily if systolic BP remains ≥140 mmHg 1, 3
• The maximal antihypertensive effect of any dose can be expected within 4 weeks of initiating that dose 1
• Doses larger than 32 mg do not provide greater blood pressure lowering effect 1
• Monitor blood pressure monthly after initiation or dose changes until target is achieved 4

Blood Pressure Targets

• Target BP <130/80 mmHg for patients with known cardiovascular disease or 10-year ASCVD risk ≥10% 4
• Target BP <140/90 mmHg for patients without comorbidities 4
• Target BP <130/80 mmHg for high-risk patients (diabetes, chronic kidney disease, high cardiovascular risk) 4

Combination Therapy Approach

• If BP remains uncontrolled on candesartan 32 mg once daily, add a second agent from a different class 2
• Preferred add-on agents: thiazide or thiazide-like diuretics, or long-acting dihydropyridine calcium channel blockers 4, 2
• Combination with hydrochlorothiazide (12.5-25 mg) produces additive antihypertensive effects 1, 5
• Never combine candesartan with another ACE inhibitor or ARB due to increased adverse effects without additional benefit 6

Special Populations and Contraindications

• Moderate to severe hepatic impairment: Do not initiate with 16 mg tablet; start with 8 mg dose (requires different formulation) 1
• Severe renal impairment (creatinine clearance <30 mL/min): Dosing recommendations cannot be provided 1
• Absolutely contraindicated in pregnancy; women of childbearing age must use reliable contraception 6

Monitoring Requirements

• Check renal function and serum electrolytes at baseline, 1 week after starting, and after each dose increase 4
• Monitor for hyperkalemia, especially if used with other potassium-sparing agents 4
• Recheck renal function and electrolytes at 1,3, and 6 months after achieving maintenance dose, then every 6 months 4
• Follow up every 3-5 months once BP is controlled 4

Clinical Efficacy Evidence

• Candesartan 16 mg once daily demonstrates greater antihypertensive efficacy than losartan 50 mg once daily 7
• Response rate (DBP ≤90 mmHg or reduction >10 mmHg) is 57% with candesartan 16 mg 7
• Trough-to-peak ratio is approximately 1.0, indicating consistent 24-hour BP control 7
• In isolated systolic hypertension, candesartan 16 mg reduces BP by approximately 19.7/5.5 mmHg with 62% control rate 3

Tolerability Profile

• Adverse event profile similar to placebo 1, 5, 8
• Most common adverse events: headache (6%), dizziness (7%), upper respiratory infection (5%) 3
• Does not cause cough (unlike ACE inhibitors), making it better tolerated than enalapril 5, 8
• Adverse events are not dose-related and are generally mild to moderate in severity 5, 8
• Only 8% of patients withdraw due to adverse events 3

Administration Details

• May be administered with or without food 1
• Once-daily dosing promotes adherence 6
• Duration of action maintained up to 36 hours after drug intake 9