Common Side Effects of Candesartan
The most common side effects of candesartan are hypotension, hyperkalemia, worsening renal function, headache, dizziness, and upper respiratory tract infections, with the overall tolerability profile similar to placebo. 1, 2
Cardiovascular and Hemodynamic Effects
Hypotension is a key side effect, particularly in volume-depleted patients or those on concurrent diuretics, requiring blood pressure monitoring within 1-2 weeks of initiation 1, 2
Symptomatic hypotension occurs most frequently in patients with prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea, or vomiting 2
In heart failure patients, candesartan may cause excessive hypotension leading to oliguria, azotemia, and rarely acute renal failure 2
Electrolyte Disturbances
Hyperkalemia is as likely with candesartan as with ACE inhibitors due to suppression of aldosterone, reducing potassium excretion in the distal tubule 1
In clinical trials, hyperkalemia (serum potassium >5.7 mEq/L) occurred in 0.4% of patients on candesartan versus 1.0% on placebo 2
Risk increases substantially in patients with chronic kidney disease, diabetes mellitus, heart failure, or those taking potassium supplements, potassium-sparing diuretics, or NSAIDs 1, 2
Monitor serum potassium and renal function at baseline and within 1-2 weeks after initiation or dose changes 1
Renal Effects
Worsening renal function including acute renal failure can occur, particularly in patients whose renal function depends on the renin-angiotensin system 2
Patients at highest risk include those with renal artery stenosis, chronic kidney disease, severe heart failure, or volume depletion 2
Renal function should be monitored periodically, with consideration to withhold or discontinue therapy if clinically significant decline occurs 2
Common Non-Serious Adverse Events
Headache is the most frequently reported adverse event across clinical trials 3, 4, 5
Dizziness, nausea, diarrhea, back pain, and upper respiratory tract infections occur at rates similar to placebo 3, 4, 5
Transient elevations in liver transaminases may occur but are generally mild 3
Cough incidence is similar to placebo, making candesartan an excellent alternative for patients intolerant to ACE inhibitors due to cough 3, 4, 5
Important Clinical Distinctions
All adverse events are usually mild to moderate in severity and not dose-related 4, 5
The tolerability profile does not differ significantly from placebo in pooled analyses 4, 5
Long-term tolerability is not different from short-term trials, with no increase in adverse events over time 4
Rare but Serious Reactions
Angioedema is much less frequent with candesartan than ACE inhibitors, though rare cases have occurred in patients who previously developed angioedema to ACE inhibitors 1
Fetal toxicity including oligohydramnios, hypotension, renal failure, and death can occur with second and third trimester exposure; discontinue immediately when pregnancy is detected 2