page142
(e.g.
those taking high-dose diuretics).
Hyperkalaemia
occurs occasionally; angioedema has also been reported
with some angiotensin-II receptor antagonists.
CANDESARTAN CILEXETIL
Indications
hypertension;
heart failure with impaired
left ventricular systolic function in conjunction with
an ACE inhibitor,
or when ACE inhibitors are not
tolerated (see also section 2.5.5)
Cautions
see notes above
Contra-indications
cholestasis
Hepatic impairment
initially 4 mg once daily in mild
or moderate impairment; avoid in severe impairment
Renal impairment
initially 4 mg daily
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also vertigo,
headache;
very rarely
nausea,
hepatitis,
blood disorders,
hypo-
natraemia,
back pain,
arthralgia, myalgia,
rash,
urti-
caria,
pruritus
Dose
. Hypertension,
initially 8 mg (intravascular volume
depletion 4 mg) once daily,
increased if necessary at
intervals of 4 weeks to max. 32 mg once daily;
usual
maintenance dose 8 mg once daily
. Heart failure,
initially 4 mg once daily,
increased at
intervals of at least 2 weeks to ‘target’ dose of 32 mg
once daily or to max. tolerated dose
Amias
c
(Takeda) A
Tablets
,
candesartan cilexetil 2 mg (white),
net price
7-tab pack = £3.39; 4 mg (white, scored), 7-tab pack =
£3.68, 28-tab pack = £9.25; 8 mg (pink, scored), 28-tab
pack = £9.89;
16 mg (pink, scored),
28-tab pack =
£12.72;
32 mg (pink,
scored),
28-tab pack = £16.13
EPROSARTAN
Indications
hypertension (see also notes above)
Cautions
see notes above
Hepatic impairment
halve initial dose in mild or
moderate liver disease;
avoid if severe
Renal impairment
halve initial dose if eGFR less than
60 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also flatulence,
hyper-
triglyceridaemia, arthralgia,
rhinitis;
rarely
headache,
asthenia,
anaemia,
hypersensitivity reactions (includ-
ing rash,
pruritus,
urticaria);
very rarely
nausea
Dose
. 600 mg once daily (elderly over 75 years,
mild to
moderate hepatic impairment, renal impairment,
initially 300 mg once daily);
if necessary increased
after 2–3 weeks to 800 mg once daily
Teveten
c
(Solvay) A
Tablets
,
f/c,
eprosartan (as mesilate) 300 mg (white),
net price 28-tab pack = £7.31;
400 mg (pink), 56-tab
pack = £15.77; 600 mg (white), 28-tab pack = £14.31.
Label:
21
IRBESARTAN
Indications
hypertension;
renal disease in hyperten-
sive type 2 diabetes mellitus (see also notes above)
Cautions
see notes above
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also nausea,
vomiting;
fatigue;
musculoskeletal pain;
less commonly
diarr-
hoea,
dyspepsia,
flushing,
tachycardia, chest pain,
cough, and sexual dysfunction;
rarely
rash,
urticaria;
very rarely
headache,
myalgia,
arthralgia,
tinnitus,
taste disturbance,
hepatitis,
renal dysfunction,
and
cutaneous vasculitis
Dose
. Hypertension, initially 150 mg once daily, increased if
necessary to 300 mg once daily (in haemodialysis or
in
ELDERLY
over 75 years, initial dose of 75 mg once
daily may be used);
CHILD
not recommended
. Renal disease in hypertensive type 2 diabetes mellitus,
initially 150 mg once daily,
increased to 300 mg once
daily if tolerated (in haemodialysis or in
ELDERLY
over
75 years, consider initial dose of 75 mg once daily);
CHILD
not recommended
Aprovel
c
(Bristol-Myers Squibb,
Sanofi-Aventis) A
Tablets
, f/c, irbesartan 75 mg, net price 28-tab pack =
£9.69;
150 mg,
28-tab pack = £11.84;
300 mg,
28-tab
pack = £15.93
With diuretic
Note
For hypertension not adequately controlled with irbesar-
tan alone. For prescribing information on thiazides, see section
2.2.1
CoAprovel
c
(Bristol-Myers Squibb,
Sanofi-Aventis) A
Tablets
,
f/c,
irbesartan 150 mg,
hydrochlorothiazide
12.5 mg (peach),
net price 28-tab pack = £11.84;
irbesartan 300 mg,
hydrochlorothiazide 12.5 mg
(peach),
28-tab pack = £15.93;
irbesartan 300 mg,
hydrochlorothiazide 25 mg (pink), 28-tab pack =
£15.93
LOSARTAN POTASSIUM
Indications
hypertension (including reduction of
stroke risk in hypertension with left ventricular
hypertrophy);
chronic heart failure when ACE inhi-
bitors are unsuitable or contra-indicated;
diabetic
nephropathy in type 2 diabetes mellitus (see also
notes above)
Cautions
see notes above; severe heart failure
Hepatic impairment
consider dose reduction in mild
to moderate impairment; manufacturer advises avoid
in severe impairment—no information available
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
asthenia, fatigue,
vertigo;
less commonly
gastro-intestinal disturbances,
angina,
palpitation,
oedema, dyspnoea,
headache,
sleep disorders,
urticaria, pruritus,
rash;
rarely
hepatitis,
atrial fibrillation, cerebrovascular accident,
syncope,
paraesthesia;
also reported pancreatitis,
anaphylaxis,
cough, depression,
erectile dysfunction,
anaemia,
thrombocytopenia,
hyponatraemia,
arthr-
algia,
myalgia,
rhabdomyolysis,
tinnitus,
photosensit-
ivity,
and vasculitis (including Henoch-Scho
¨
nlein
purpura)
Dose
. Hypertension, diabetic nephropathy in type 2 diabetes
mellitus,
usually 50 mg once daily (intravascular
volume depletion,
initially 25 mg once daily);
if
122
2.5.5 Drugs affecting the renin-angiotensin system
BNF 61
2
Cardiovascular system