Angiotensin receptor blockers · Cardiovascular
Candesartan
candesartan cilexetil · Atacand®(brand names vary by market)
The tightest-binding ARB, and the one with a migraine side-line.
Mechanism
Insurmountable angiotensin II receptor antagonism: it binds slowly and leaves slowly, giving a flatter 24-hour effect than its plasma half-life suggests.
Open the interactive pathwayIndications
- Hypertension
- Heart failure with reduced ejection fraction
- Migraine prophylaxis (off-label in many markets)
Formulations
Dosing concepts
Once daily
The slow receptor dissociation is what makes true 24-hour cover realistic, so trough blood pressure is the number that matters when judging it.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~15% (prodrug, activated during absorption)
- Half-life
- ~9 h, effect longer
- Elimination
- mixed: Biliary and renal
- Protein binding
- >99%
Adverse effects
- Hyperkalemiacommon & serious
- Dizzinesscommon
- Acute kidney injury when volume-depleteserious
Contraindications & precautions
Contraindications
- Pregnancy
- Bilateral renal artery stenosis
Precautions
- Renal impairment
- Volume depletion
- Hepatic impairment
Interactions
- ACE inhibitors / ARBs + Potassium-sparing diuretics, K supplements, salt substitutescautionAdditive hyperkalemia, worst with renal impairment layered on top.
- ACE inhibitor / ARB + diuretic + NSAID (the 'triple whammy')avoidAcute kidney injury, classically in a dehydrated older adult who bought ibuprofen for a sore knee.
Monitoring
Potassium and creatinine
Class effect · After each dose change
Blood pressure at trough
Where a once-daily claim is actually tested
Counselling points
- Once daily.
- Avoid potassium salt substitutes.
- Not to be used in pregnancy.
Clinical pearls
- It has the best evidence of the ARBs for migraine prevention, which occasionally makes it the obvious choice for a hypertensive migraineur, two problems and one tablet.
References & review
- Candesartan product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.