Impaired renal function
Against the background of therapy with Atacand®, as with other agents that affect or act on the renin-angiotensin-aldosterone system, some patients may have impaired renal function.
At application of preparation Atakand® at patients with an arterial hypertensia and a serious renal insufficiency (creatinine clearance less than 30 ml / min) it is recommended to periodically monitor the potassium content and serum creatinine concentration. The clinical experience of using the drug in patients with severe renal dysfunction or terminal stage of renal failure is limited (creatinine clearance less than 15 ml / min). Thus, patients should be cautioned titrate dose of Atacand® under careful control of blood pressure.
Patients with chronic heart failure need periodic monitoring of kidney function, especially in patients aged 75 years and older, as well as in patients with impaired renal function. With increasing doses Atacand® It is also recommended to monitor the potassium content and the concentration of creatinine.
In clinical trials Atacand® in patients with chronic heart failure, patients with a concentration of more than 265 μmol / L (> 3 mg / dL) were not included.
Co-administration with ACE inhibitors in chronic heart failure
When applying candesartan in combination with ACE inhibitors, the risk of side effects may increase, especially kidney and hyperkalemia (see "Side effect" section). In these cases, careful monitoring and monitoring of laboratory indicators is necessary.
Stenosis of the renal artery
In patients with bilateral renal artery stenosis or stenosis of the single kidney artery, drugs that affect the renin-angiotensin-aldosterone system, in particular ACE inhibitors, can cause an increase in the concentration of urea and creatinine in the serum. Similar effects can be expected with the appointment of angiotensin II receptor antagonists.
Kidney transplantation
Clinical experience of the drug Atakand® in patients who have undergone a kidney transplant, is limited.
Arterial hypotension
In patients with chronic heart failure against the background of therapy with Atacand®, hypotension may develop. As with the use of other drugs that affect the renin-angiotensin-aldosterone system, the cause of the development of arterial hypotension in patients with arterial hypertension can be a decrease in the volume of circulating blood, as observed in patients receiving high doses of diuretics.Therefore, at the beginning of therapy, care should be taken and, if necessary, correct hypovolemia.
Double blockade of the renin-angiotensin-aldosterone system when applied preparations containing aliskiren
The double blockade of the renin-angiotensin-aldosterone system is not recommended by combining candesartan cilexetil and aliskiren, in view of the increased risk of arterial hypotension, hyperkalemia, and renal function changes.
The use of candesartan cilexetil in combination with aliskiren contraindicated in patients with diabetes mellitus (type 1 or type 2) or with moderate or severe renal failure (GFR <60 mL / min / 1.73 m2) (see the section "Contraindications").
General anesthesia and surgery
In patients receiving angiotensin II antagonists, during general anesthesia and during surgical interventions, arterial hypotension may result from blockade of the renin-angiotensin-aldosterone system. Very rarely, cases of severe arterial hypotension, requiring intravenous introduction of plasma-substituting solutions and / or vasopressors.
Stenosis of the aortic and mitral valve or hypertrophic obstructive cardiomyopathy
At appointment of preparation Atakand®, as well as other vasodilators, to patients with hypertrophic obstructive Caution should be exercised in cardiomyopathy or hemodynamically significant stenosis of the aortic or mitral valve.
Primary hyperaldosteronism
Patients with primary hyperaldosteronism usually are resistant to therapy with antihypertensive drugs that affect the renin-angiotensin-aldosterone system. In this regard, Atacand® is not recommended for such patients.
Hyperkalemia
The clinical experience of using other drugs that affect the renin-angiotensin-aldosterone system shows that simultaneous administration of Atacand® with potassium-sparing diuretics, potassium preparations or salt substitutes containing potassium, or other drugs that can increase the potassium content in the blood (for example, heparin), can lead to the development of hyperkalemia in patients with arterial hypertension.
In patients with chronic heart failure against the background of therapy with Atacand®, hyperkalemia can develop.When administering Atakand® to patients with chronic heart failure, regular monitoring of potassium in the blood is recommended, especially when co-administered with ACE inhibitors and potassium-sparing diuretics.
Are common
Patients in whom vascular tone and kidney function predominantly depend on the activity of renin-angiotensin-aldosterone system (for example, patients with severe chronic heart failure or kidney disease, including renal artery stenosis) are particularly sensitive to drugs acting on the renin-angiotensin-aldosterone system. The appointment of such agents is accompanied in these patients sharp arterial hypotension, azotemia, oliguria and, more rarely, acute renal failure. The possibility of developing these effects can not be ruled out when angiotensin II receptor antagonists are used. A sharp decrease in blood pressure in patients with coronary heart disease or cerebrovascular diseases of atherosclerotic origin the use of any antihypertensive drugs can lead to the development of myocardial infarction or stroke.