Atacand Plus

Brand Names: Atacand Plus

Common Name: candesartan - hydrochlorothiazide

What is this drug used for?

Candesartan belongs to a family of medications known as angiotensin II receptor blockers. Hydrochlorothiazide belongs to a family of medications known as diuretics (or "water pills"). This combination medication is used to lower high blood pressure. Candesartan works by relaxing blood vessels. Angiotensin II is a chemical that the body releases to cause the constriction (tightening up) of blood vessels. Candesartan blocks the action of angiotensin II, resulting in the relaxation of the blood vessels. This relaxation causes the blood pressure to decrease. Hydrochlorothiazide works by causing the body to get rid of excess salt and water. Treatment is started with each of the ingredients separately (i.e., candesartan and hydrochlorothiazide). Once the best dose of each individual ingredient is found, the combination medication may then be used at the appropriate dose.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Is there any reason not to take this drug?

This medication should not be taken by anyone who:

• is allergic to candesartan, hydrochlorothiazide, or any of the ingredients of the product
• is allergic to sulfonamide-containing medications
• has severe kidney disease and cannot pass urine
• is pregnant

What about possible side effects?

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medication. Check with your doctor if the following side effects continue or become bothersome.

Less common:

• back pain
• chills
• diarrhea
• headache
• joint pain
• loss of appetite
• muscle aches and pains
• nausea
• runny nose
• sneezing
• sweating
• trouble sleeping
• unusual tiredness
• vomiting

Call your doctor as soon as possible if any of the following side effects occur:

Less common:

• cough
• dizziness
• dryness of mouth
• fever
• increased thirst
• irregular heartbeat
• lightheadedness
• muscle cramps
• nausea
• sore throat
• unusual tiredness
• vomiting
• weak pulse
• weakness
• skin rash

  Rare:

• arm pain
• chest pain
• chest tightness
• fast or irregular heartbeat
• large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• shortness of breath

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

The following agents may affect how this medication works, be affected by the medication, or increase the occurrence of side effects:

alcohol allopurinol amantadine anticholinergic medications (e.g., atropine, biperiden) barbiturates (e.g., secobarbital, phenobarbital) calcium supplements cholestyramine corticosteroids cyclophosphamide cyclosporin diazoxide digoxin diuretics (also called "water pills") insulin

potassium supplements or medications which increase potassium in the blood lithium methyldopa methotrexate narcotics (e.g., morphine, codeine) norepinephrine NSAIDs (nonsteroidal anti-inflammatory drugs; e.g., naproxen, ibuprofen) tubocurarine vitamin D warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Cholesterol: Cholesterol levels may increase when taking hydrochlorothiazide.

Diabetes: Hydrochlorothiazide may make it more difficult for people with diabetes to control their blood sugar. People who have diabetes should be cautious and monitor their blood sugar carefully while taking this medication. Dose adjustment of antidiabetic medications, including insulin, may be needed.

Fluid and electrolyte balance: Levels of electrolytes such as potassium, sodium, magnesium, and chloride can be reduced by the use of hydrochlorothiazide. Your doctor will periodically check to see if your electrolytes remain in balance. Warning signs or symptoms of fluid and electrolyte imbalance include:

• dryness of mouth
• thirst
• weakness
• lethargy
• drowsiness
• restlessness
• seizures
• confusion
• muscle pains or cramps
• muscular fatigue
• low blood pressure
• racing heart beat
• nausea
• vomiting

Gout: Hydrochlorothiazide may bring on an attack of gout for people prone to this condition.

Kidney problems: Candesartan may affect the function of the kidneys, especially for those who already have kidney problems. Make sure to tell your doctor if you have kidney problems so that he or she can closely monitor your kidney function.

Liver problems: The ability of the body to break down candesartan may be affected in people with below normal liver function. Be sure to tell your doctor if you have liver problems.

Low blood pressure: Occasionally, a larger-than-expected decrease in blood pressure occurs after taking candesartan. In some cases, this happens after the first dose. This is more likely to occur if you take diuretics (water pills), have a reduced salt intake, are on dialysis, or are experiencing diarrhea or vomiting. Blood pressure should be monitored more often in these situations. Those with low blood pressure or those just starting to take this medication should move slowly from a reclining to an upright position to reduce the risk of dizziness.

Lupus: Hydrochlorothiazide may worsen the symptoms of this condition.

Pregnancy: Candesartan should not be taken by pregnant women. If you discover you are pregnant while taking this medication, stop taking it and tell your doctor at once.

Breast-feeding: It is not known if candesartan passes into breast milk. Breast-feeding is not recommended while taking candesartan because of the possibility of serious side effects to the child. Discuss this situation with your doctor.

Children: The safety and effectiveness of using this medication have not been established for children.

Special Instructions:

The usual adult dose is one tablet to be taken once daily at approximately the same time each day, with or without food. Do not remove this medication from the blister package until just before you take it.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

If you forget to take a dose, but remember within 12 hours, take it as soon as possible and then go back to your regular dose. If more than 12 hours have passed since your usual dose, skip that dose and carry on as usual with your next dose. Never double-up on doses.

To ensure you receive the maximum benefit from the medication, it is important to take this medication regularly and to follow your doctor's instructions regarding blood pressure monitoring.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

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