candesartan, amlodipine and indapamide

C09DX09

Forms & Strengths

Single-pill combination: Candesartan cilexetil / Amlodipine besylate / Indapamide (various fixed-dose combinations e.g., 8mg/5mg/1.5mg, 16mg/10mg/2.5mg)
Oral tablets

Adult Dosing

Hypertension: 1 tablet daily, titrated based on individual component response and blood pressure goals
Max recommended dose: typically 32mg candesartan / 10mg amlodipine / 2.5mg indapamide equivalent per day depending on regional regulatory approval

Pediatric Dosing

Safety and efficacy in pediatric patients have not been established; use is not recommended

Indications

Treatment of essential hypertension in patients whose blood pressure is not adequately controlled by dual therapy with the respective mono- or combination components

Mechanism of Action

Candesartan: Angiotensin II receptor blocker (ARB) that selectively blocks AT1 receptors, causing vasodilation and decreased aldosterone secretion
Amlodipine: Dihydropyridine calcium channel blocker (CCB) that inhibits transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, causing peripheral vasodilation
Indapamide: Thiazide-like diuretic that inhibits sodium reabsorption in the distal renal tubules, reducing fluid retention and peripheral vascular resistance

Contraindications

Hypersensitivity to candesartan, amlodipine, indapamide, other sulfonamide derivatives, or any component of the formulation
Pregnancy (second and third trimesters): causes fetal injury and death
Anuria or severe renal impairment (CrCl <30 mL/min)
Severe hepatic impairment or hepatic encephalopathy
Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment
Severe hypotension or shock (including cardiogenic shock)

Adverse Reactions

Dizziness, headache, and fatigue
Peripheral edema (attributed to amlodipine)
Hypotension, orthostatic hypotension
Electrolyte disturbances (hypokalemia, hyponatremia, hypercalcemia, hypomagnesemia due to indapamide)
Hyperuricemia, gout exacerbation
Renal function impairment, hyperkalemia (attributed to candesartan)
Palpitations, flushing

Drug Interactions

Lithium: decreased renal clearance, increasing risk of lithium toxicity
Potassium-sparing diuretics, potassium supplements, or ACE inhibitors/ARBs: increased risk of hyperkalemia
NSAIDs: potential attenuation of antihypertensive effect and increased risk of worsening renal function
CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) and inducers: may alter amlodipine exposure
Drugs associated with QT prolongation or torsades de pointes (due to indapamide-induced hypokalemia)

Curated Content: Needs Vetting Before Put to Clinical Use