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Note: reimbursed drug prices are in line with the regulations in force from July 1, 2018.
The preparation contains the substance:candesartan
The drug is available on prescription
The drug from the group of angiotensin II receptor antagonists, which, like all preparations in this group, limits the action of angiotensin II, a substance that causes vasoconstriction and aldosterone-stimulating release.
What does Atacand contain and how does it work?
The active substance in the preparation is candesartan belonging to a group of medicines called angiotensin II receptor antagonists or sartans. The common mechanism of action of drugs in this group is the blocking of angiotensin II receptors which prevents them from binding to angiotensin II and inhibits its action (drugs from this group are often indicated by the abbreviation ARB, which comes from the English nameAngiotensin II Receptor Blockers
). Agiotensin II plays an important role in the pathophysiology of hypertension. The effect of angiotensin II is vasoconstriction and the increase in the release of aldosterone, which leads to increased blood pressure. The action of candesartan, like other sartans, effectively counteracts the effects of angiotensin II and leads to a decrease in blood pressure. Unlike drugs from the angiotensin-converting enzyme inhibitors, sartans do not exacerbate the effects of bradykinin-dependent, for example, cough. Sartans are used as medicines to lower blood pressure and to treat and prevent diseases of the cardiovascular system. In patients with heart failure
, they reduce vascular resistance, which improves hemodynamic conditions, increases exercise capacity and improves the clinical condition.They have a protective effect on the kidneys, slow down the rate of development associated with high blood pressure and diabetes renal dysfunction.
Candesartan lowers blood pressure without affecting heart rate. Lowering blood pressure occurs within 2 hours after a single dose of candesartan and persists for more than 24 hours. The full development of antihypertensive effect usually requires 4 weeks of use and persists during long-term use.
When to use Atacand?
The preparation is indicated in adults:
· In the treatment of primary hypertension
· With heart failure and impaired left ventricular systolic function (left ventricular ejection fraction no greater than 40%) as adjunctive therapy in the treatment of angiotensin-converting enzyme (ACE inhibitors) or in case of intolerance.
When not to use this preparation?
Unfortunately, even if there are indications to use the preparation, it can not always be used. You can not use the preparation if you are allergic (you are hypersensitive) to any of the ingredients.
Contraindications are contraindicated in people with severe hepatic insufficiency and / or cholestasis
The preparation is contraindicated in the second and third trimester of pregnancy and during breastfeeding. It is not recommended during the first trimester of pregnancy.
When should you take special care with Atacand?
Certain diseases and other circumstances may constitute a contraindication to use or indication to change the dosage of the preparation. In some situations it may be necessary to carry out specific check-ups.
In patients at higher risk of renal dysfunction, in which renal function depends on the activity of the renin-angiotensin-aldosterone system (eg in patients with severe heart failure, bilateral renal artery stenosis or renal artery stenosis of the sole active kidney) use of drugs acting on the renin-angiotensin-aldosterone system may be associated with the risk of oliguria, increased urea and creatinine in the blood and acute renal failure
If the preparation is used in people with hypertension and concomitant renal insufficiency, regular monitoring of the parameters characterizing renal function (including creatinine and potassium in the blood) is recommended. There are insufficient clinical data on the use of the preparation in people with very severe or end-stage renal disease (creatinine clearance less than 15 ml / min); in each case, an individual doctor will determine the recommended dose.
Patients with heart failure, especially after 75. The kidneys (creatinine and potassium levels in the blood) are regularly monitored for renal function and for patients with renal impairment. Monitoring of renal function is also recommended during the dose escalation period.
In patients with heart failure, the concomitant use of the preparation and ACE inhibitors increases the risk of side effects, especially renal dysfunction and hyperkalemia. Exercise caution and be under strict medical supervision; regular assessment of renal function is necessary.
Caution should be exercised in patients undergoing hemodialysis. In this group of patients, there is an increased activity of the renin-angiotensin-aldosterone system and drugs that inhibit the activity of this system (including candesartan) may cause a sudden reduction in blood pressure. Your doctor will determine the recommended dose based on blood pressure measurements.
There are insufficient data on the safety and efficacy of the preparation in patients after recent kidney transplantation.
Caution should be exercised because symptomatic hypotension may occur, particularly in patients with heart failure, and in patients with circulating, dehydrated or sodium deficient circulating blood (eg, those who have previously received high doses of diuretics, who are on a low salt diet, diarrhea or vomiting). Before starting treatment, electrolyte deficits should be leveled and adequate hydration should be ensured.
Inform the doctor about the use of the preparation if you are planning a surgical procedure or other procedure requiring anesthesia. Rarely, the use of the preparation is associated with the risk of potentially severe hypotension during surgery and / or anesthesia.
Caution should be used if the preparation is used in patients with impaired left ventricular outflow (aortic or mitral stenosis), hypertrophic cardiomyopathy).
It is not recommended to use the preparation in patients with primary hyperaldosteronism, because the preparation is ineffective.
The use of the preparation may cause hyperkalaemia (increased potassium in the blood). Hyperkalaemia may cause serious arrhythmias. Your doctor will monitor the level of potassium in your blood, especially in those who are at increased risk for hyperkalaemia (with renal impairment, elderly, diabetic, dehydrated, heart failure or metabolic acidosis, taking medicines that increase the amount of potassium in the blood, including potassium salts, potassium-sparing diuretics or Heparin
). Parallel use of potassium-sparing and diuretics or ACE inhibitors is not recommended.
In people whose vascular tone and renal function depends on the activity of the renin-angiotensin-aldosterone system (eg in patients with severe congestive heart failure or renal artery stenosis), the use of the preparation may be associated with the risk of a rapid fall in blood pressure. In people with ischemic heart disease or cerebrovascular disease (people with coronary artery stenosis or narrowing of the cerebral vessels) a significant reduction in blood pressure may result in a heart attack or stroke.
In black people, the preparation may be less effective in lowering blood pressure and it may be necessary to increase the dose.
Additional information about the other ingredients of the preparation:
· The product contains lactose; people with galactose intolerance, lactase deficiency or malabsorption of Glucose
-galactose should not use this preparation.
Does this preparation affect the ability to drive vehicles?
The effect of the preparation on the ability to drive vehicles and operate machinery / machines has not been studied; the effect of the preparation on the above activities is considered unlikely. However, it should be taken into account that the preparation may cause dizziness, fatigue or other symptoms in some people, which may impair psychophysical fitness and ability to drive vehicles and operate machinery and equipment.
Dosage of Atacand
The preparation is in the form of tablets. It is intended for oral use. The tablets can be taken with or without food. Do not exceed the recommended doses because it will not increase the effectiveness of the drug and may harm your health and life. If you have any doubts regarding the use of the preparation, consult a physician.
Hypertension: the starting dose is 8 mg once a day; if necessary, your doctor may increase the dose to 16 mg once daily and up to a maximum of 32 mg once daily. Full antihypertensive effect is achieved within 4 weeks of treatment.
To enhance the antihypertensive effect, your doctor may prescribe the use of thiazide diuretics (hydrochlorothiazide) in parallel.
In elderly patients, there is no need to adjust the initial dose.
If you have an increased risk of hypotension (eg if your circulating blood volume is low), your doctor may recommend an initial dose of 4 mg 1 once a day.
In patients with renal insufficiency and in patients undergoing hemodialysis, the doctor will recommend a reduction of the initial dose to 4 mg 1 once a day and then individually adjust the maintenance dose. There are no adequate clinical data on the use of the preparation in subjects with very severe or end-stage renal disease (creatinine clearance less than 15 ml / min).
In patients with mild to moderate hepatic impairment, the recommended starting dose is 4 mg once daily; then the doctor will individually set the maintenance dose. The use of the preparation is contraindicated in the presence of severe hepatic dysfunction or disturbances of the outflow of bile (cholestasis).
Heart failure: the starting dose is 4 mg 1 once a day; then the doctor, at intervals of at least two weeks, will double the dose up to the highest dose tolerated by the patient, no more than 32 mg once a day.
There is no need to adjust the starting dose in elderly patients with reduced circulating volume, renal insufficiency or mild to moderate hepatic impairment.
It can be used in combination with medicines used to treat heart failure (as prescribed by your doctor).
There are no data on the safety and efficacy of the preparation in children and adolescents up to 18 years of age.
Can Atacand be used during pregnancy and breastfeeding?
During pregnancy, do not use any medicine without consulting your doctor!
It is very important that before using any medicine during pregnancy or breastfeeding, consult a physician and explain beyond any doubt the potential risks and benefits associated with the use of the drug. If you are pregnant or plan to become pregnant, please inform the doctor prescribing the prescription for this medicine.
The preparation should not be used during the first trimester of pregnancy. The use of the preparation in the second and third trimester of pregnancy is contraindicated. If a woman plans to become pregnant she should consult a doctor because it is recommended to change the way of antihypertensive treatment. If you suspect or confirm pregnancy during the period of taking the preparation, you should consult a doctor as soon as possible because immediate discontinuation of the preparation is required. Your doctor will prescribe other antihypertensive agents.
Do not use the product during breast-feeding.
Can I use other preparations in parallel?
Tell your doctor about all medicines you have recently taken, including those that are over the counter.
There were no clinically relevant interactions when the product was used in parallel with the following drugs: hydrochlorothiazide, Digoxin
, oral contraceptives, gibenklamide, Nifedipine
Parallel use of drugs that affect the level of potassium in the blood (potassium salts, potassium-sparing diuretics, such as spironolactone, potassium supplements, heparin) and potassium-containing salt substitutes may lead to increased levels of potassium in the blood (hyperkalemia). The amount of potassium in the blood should be monitored.
The preparation, like angiotensin-converting enzyme (ACE inhibitors), may increase the toxic effects of lithium salts. The simultaneous use of lithium is not recommended, and if necessary, combination therapy should be used with caution and control of the concentration of lithium in the blood.
Non-steroidal anti-inflammatory drugs (eg Acetylsalicylic acid
, indomethacin) may reduce the antihypertensive effect of the preparation and cause renal dysfunction and increase in potassium in the blood. Adequate hydration and regular renal function should be ensured. Caution should be exercised, especially in elderly patients.
What side effects can occur?
Like all medicines, including Atacand, it can cause side effects, although they will not occur in all patients who use this product. Remember that the expected benefits of using the drug are usually greater than the damage resulting from the occurrence of side effects.
Common side effects include: dizziness and headaches, respiratory infections, hypotension, renal dysfunction, increased potassium (hyperkalemia). Very rare: leukopenia / agranulocytosis (decrease in the number of white blood cells and / or significant decrease in the number of granulocytes), neutropenia (decrease in neutrophil count), decrease in sodium, decrease in hemoglobin, cough, nausea, increased liver enzymes, liver dysfunction, inflammation liver, joint pain, muscle pain, kidney problems, kidney failure in susceptible individuals.
Other preparations on the Polish market containing candesartan
Candesartan Genoptim (tablets)