Pharmacology · Angiotensin II receptor blockers (ARBs)
Candesartan !
An ARB given as the prodrug candesartan cilexetil. Used for high blood pressure and for heart failure.
Updated 2026-11-01
The figure shows olmesartan, another ARB, in the same binding pocket of the human AT1 receptor; no structure with candesartan bound is available.
Mechanism of action
Candesartan cilexetil is hydrolysed in the gut wall during absorption to candesartan, which binds the AT1 receptor tightly and dissociates slowly. Angiotensin II can no longer constrict arterioles or release aldosterone, so blood pressure falls and sodium retention lessens, without raising bradykinin.
- Candesartan cilexetil is turned into candesartan during absorption
- Candesartan binds the AT1 receptor tightly
- Arterioles dilate, aldosterone falls and blood pressure drops
Pharmacokinetics
- Absorption
- Prodrug converted during absorption; low bioavailability, not changed by food
- Elimination
- Urine and bile, mostly unchanged
- Half-life
- About 9 hours
Indications
- High blood pressure, also in children Arterial hypertension →
- Heart failure with reduced ejection fraction Heart failure →
Adverse effects
Common
- Dizziness and hypotension
- Hyperkalaemia
- Rise in creatinine
- Back pain
Contraindications
- Pregnancy
- Hypersensitivity to the drug
- Use with aliskiren in people with diabetes
Key interactions
- Potassium-sparing diuretics, potassium supplements or salt substitutes
- Hyperkalaemia
- NSAIDs, including COX-2 inhibitors
- Weaker effect and risk of kidney injury
- Lithium
- Higher lithium levels and toxicity
What is monitored
- Blood pressure
- Potassium and creatinine, closely in heart failure
Administration and safety
- Given by mouth, with or without food
- Several «-sartan» names look alike: the name is checked on every order
Nursing care
- Check blood pressure, potassium and creatinine when starting and after changes
- Watch for dizziness, especially in patients on diuretics
- Ask women of childbearing age about pregnancy plans
- Teach the patient to avoid potassium salt substitutes unless prescribed
Pregnancy and breastfeeding
Contraindicated: drugs acting on the renin-angiotensin system can injure and kill the developing fetus; it is stopped as soon as pregnancy is detected.
Test yourself
Think of the answer, then tap the question to see it.
Is candesartan cilexetil active as given?
No. It is a prodrug hydrolysed to candesartan during absorption from the gut.
Which lab values are followed closely when candesartan is used in heart failure?
Potassium and creatinine, because hyperkalaemia and worse kidney function are more frequent.
Why is candesartan stopped when pregnancy is detected?
Drugs acting on the renin-angiotensin system can injure and kill the developing fetus.
Related drugs
Related conditions
← Back to the class: Angiotensin II receptor blockers (ARBs)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - CANDESARTAN CILEXETIL tablet (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.