Torcand-8

Essential HTN. Adult patients w/ heart failure & impaired left ventricular systolic function (left ventricular ejection fraction of 40%) as add-on therapy to ACE inhibitors or when ACE inhibitors are not tolerated.

HTN Initially 8 mg once daily, can be increased to 16 mg once daily & to max 32 mg once daily. Heart failure Initially 4 mg once daily. Up-titration to max dose 32 mg once daily or highest tolerated dose by doubling dose at intervals of at least 2 wk. Patient w/ intravascular vol depletion, renal impairment including on haemodialysis & mild to moderate hepatic impairment Initially 4 mg.

May be taken with or without food.

Hypersensitivity. Patients w/ severe hepatic impairment &/or cholestasis. Pregnancy & lactation.

Periodic monitoring of serum K & creatinine levels (hypertensive patients w/ renal impairment); assessment of renal function, especially in elderly ≥75 yr & w/ impaired renal function (patients w/ heart failure). Monitor BP thoroughly in patients on hemodialysis. May increase blood urea & serum creatinine in patients w/ bilateral renal artery stenosis or stenosis of artery to a solitary kidney. Patients w/ kidney transplantation. Caution when initiating therapy & correction of hypovolemia should be attempted in heart failure & hypertensive patients w/ intravascular vol depletion (eg, those receiving high dose diuretics). Hypotension during anesth & surgery. Special caution in patients suffering from haemodynamically relevant aortic or mitral valve stenosis, or obstructive hypertrophic cardiomyopathy. Not recommended in patients w/ primary hyperaldosteronism. Not recommended in combination w/ ACE inhibitors. Hyperkalemia may occur (heart failure patients); not recommended in combination w/ K-sparing diuretics (eg, spironolactone). Excessive BP decrease in patients w/ ischemic cardiopathy & ischemic cerebrovascular disease could result in MI or stroke. Not to be taken by patients w/ rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Dizziness or weariness may occur occasionally during treatment. Immediately stop treatment when pregnancy is diagnosed. Perform ultrasound check of renal function & skull when exposed to treatment during 2nd trimester of pregnancy. Not recommended during breast-feeding, especially while nursing a newborn or preterm infant. Safety & efficacy in childn between birth & 18 yr have not been established.

Dizziness/vertigo, headache, & resp infections. Decrease in Na & Hb, increased creatinine urea & K; hyperkalemia; renal impairment; hypotension.

May increase K levels w/ K-sparing diuretics, K supplements, salt substitute containing K, or other medicinal products (eg, heparin). Reversible increases in lithium serum conc & toxicity. Attenuation of antihypertensive effect w/ NSAIDs [ie, selective COX-2 inhibitors, ASA (>3 g/day) & non-selective NSAIDs]. Increased risk of worsening of renal function, including possible acute renal failure & increase in serum K, especially in patients w/ poor preexisting renal function w/ NSAIDs.

Angiotensin II Antagonists

C09CA06 - candesartan ; Belongs to the class of angiotensin II receptor blockers (ARBs). Used in the treatment of cardiovascular disease.

Rx