Uses of Giran-H: - Hypertension (high blood pressure) Hypertension, Congestive heart failure Hypersensitivity.

Combined antihypertensive preparations

Candesartan Cilexetil-Hydrochlorothiazide combines an angiotensin II receptor blocker, Candesartan Cilexetil and a diuretic, Hydrochlorothiazide. Candesartan Cilexetil is an ester prodrug that is hydrolysed in the body to the active form Candesartan during absorption from the gastrointestinal tract. Candesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues (eg, vascular smooth muscle, adrenal gland).Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly by increasing sodium excreation. Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume with consequent increase in plasma renin activity, aldosterone secretion, urinary potassium loss, and decrease in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of Candesartan tends to reverse the potassium loss associated with Hydrochlorothiazide.

How to use Candesartan Cilexetil + Hydrochlorothiazide: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Candesartan Cilexetil + Hydrochlorothiazide may be taken with or without food, but it is better to take it at a fixed time. Administration: May be taken with or without food. Adult Dose: Hypertension 16-32 mg candesartan/12.5-25 mg HCTZ PO: 1 tablet once daily. Elderly: No dosage adjustment is necessary in elderly patients. Impaired Hepatic Function: Patients with Hepatic Impairment: Dose titration is recommended in patients with mild to moderate chronic liver disease. This should not be used in patients with severe hepatic impairment and/or cholestasis. Child Dose: The safety and efficacy have not been established in children. Renal Dose: Impaired Renal Function: In patients with mild to moderate renal impairment (ie, creatinine clearance between 30-80 mL/min/1.73m2 BSA), a dose titration is recommended. This should not be used in patients with severe renal impairment (creatinine clearance <30 mL/min/1.73 m2 BSA).

NSAIDs may reduce antihypertensive effect and result in deterioration of renal function including possible acute renal failure. May increase serum lithium concentration. K-sparing diuretics, K supplements or salt substitutes containing K may increase risk of hyperkalaemia. Potentially Fatal: Coadministration w/ aliskiren in diabetic patients may increase risk of renal impairment, hypotension and hyperkalaemia.

Hypersensitivity.

Common - Nausea - Taste change - Stomach pain - Diarrhea - Weakness - Dizziness - Headache - Decreased blood pressure - Increased blood uric acid - Electrolyte imbalance - Glucose intolerance - Increased blood lipid level 1-10% Headache (3%),Dizziness (3%),Upper respiratory tract infection (4%),Back pain (3%),Flu-like syndrome (2%) Frequency Not Defined Candesartan Dizziness, headache, vertigo, back pain, upper resp tract infections, pharyngitis, rhinitis, hypotension, hyperkalaemia, increased serum creatinine. Hydrochlorothiazide Anorexia,Epigastric distress,Hypotension,Orthostatic hypotension,Photosensitivity,Anaphylaxis,Anemia,Confusion,Erythema multiforme,Stevens-Johnson syndrome,Exfoliative dermatitis including toxic epidermal necrolysis,Dizziness,Headache,Hyperuricemia,Hypokalemia and/or hypomagnesemia

Use in pregnancy & lactation is not recommended.

Precaution: Volume or sodium depletion, preexisting renal insufficiency; aortic or mitral valve stenosis, hypertrophic obstructive cardiomyopathy, renal artery stenosis, primary hyperaldosteronism. Patients with a history of angioedema, urticaria. Monitor serum potassium levels especially in elderly and renally impaired patients. Hypotension may occur during major surgery and anaesthesia due to suppression of the renin-angiotensin system. Lactation: enters breast milk/contraindicated

Combined antihypertensive preparations

Candesartan inhibits the binding of angiotensin II to AT1 receptors in many tissues (e.g. vascular smooth muscles, adrenal gland) which leads to vasoconstriction blockade and aldosterone release. Hydrochlorothiazide inhibits the reabsorption of Na and chloride in the distal tubules causing increased excretion of Na and water K and hydrogen ions.

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimesters) Lactation: enters breast milk/contraindicated