Candez Plus Drug Interactions

Candesartan: Concomitant use of candesartan with lithium may cause an increase in serum lithium concentrations. Monitor serum lithium levels during concomitant use.
Candesartan administration to patients under diuretic therapy may enhance antihypertensive effect. Start candesartan at a lower dose.
Candesartan's antihypertensive effect may be enhanced by other antihypertensives.
The antihypertensive effect of angiotensin II receptor antagonists may be reduced when coadministered with non-steroidal anti-inflammatory drugs (NSAIDs) such as selective COX-2 inhibitors, aspirin (>3g/day), and nonselective NSAIDs.
Concurrent administration of angiotensin II receptor antagonists and NSAIDs may result in an increased risk of worsening of renal function (including possible acute renal failure) and an increase in serum potassium, particularly in patients with poor pre-existing renal function. The combination should be administered with caution, especially in the elderly. Regularly monitor renal function after initiation of concomitant therapy and adequately hydrate patients.
In studies, coadministration of candesartan with other drugs such as glibenclamide, nifedipine, digoxin, warfarin, HCTZ, and oral contraceptives showed no significant drug interactions. Since candesartan is not significantly metabolized by the cytochrome P450 system and at therapeutic concentrations has no effects on P450 enzymes, interactions with drugs that inhibit or are metabolized by those enzymes would not be expected.
Hydrochlorothiazide: Administration of the following drugs may interact with thiazide diuretics: Alcohol, barbiturates, or narcotics: Potentiation of orthostatic hypotension may be observed.
Amantadine: Increased risk of adverse effects.
Anticholinergic agents (e.g., atropine, biperidine): May increase availability of thiazide diuretics by decreasing gastrointestinal motility and stomach emptying rate.
Antidiabetic medicines (oral agents and insulin): Dosage adjustment of the antidiabetic drug may be necessary.
Other antihypertensive drugs: Additive effect.
Cholestyramine and colestipol resins: HCTZ absorption is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind HCTZ and reduce its absorption from the gastrointestinal tract by up to 85% and 43%, respectively.
Corticosteroids, ACTH: Intensified electrolyte depletion, particularly hypokalemia.
Cytotoxic agents: Decreased renal excretion; increased myelosuppresive effects.
Pressor amines (e.g. adrenaline): Possible decreased response to pressor amines but not sufficient to prevent their use.
Skeletal muscle relaxants, nondepolarising (e.g. tubocurarine): Possible increased responsiveness to the muscle relaxant.
Lithium: Volume depletion increases lithium absorption and may cause lithium toxicity, unless levels are closely monitored and dosage reduced accordingly. Conversely, sudden stopping of diuretic treatment may result in a sub-therapeutic level of circulating lithium.
Non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 Inhibitors: The administration of NSAIDs including selective COX-2 inhibitors can reduce the diuretic, natriuretic and antihypertensive effects of diuretics in some patients.