Cardosia-Plus
Generic Name
Candesartan Cilexetil and Hydrochlorothiazide
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cardosia plus 5 mg tablet | ৳ 4.52 | N/A |
Description
Overview of the medicine
Cardosia-Plus 5 mg Tablet is a combination medicine used to treat essential hypertension (high blood pressure). It helps to control blood pressure by relaxing blood vessels and removing excess water and salt from the body.
Uses & Indications
Dosage
Adults
Usually one tablet once daily. Dosage may be adjusted based on blood pressure response.
Elderly
No initial dosage adjustment is usually needed unless there is significant renal impairment. Monitor renal function.
Renal_impairment
Use with caution in mild to moderate renal impairment. Contraindicated in severe renal impairment (creatinine clearance <30 mL/min) or anuria.
How to Take
Take the tablet orally once daily, with or without food, at approximately the same time each day. Swallow the tablet whole with water; do not crush, chew, or break it.
Mechanism of Action
Candesartan Cilexetil is an Angiotensin II Receptor Blocker (ARB) that works by blocking the action of a natural substance in the body called angiotensin II, which narrows blood vessels. This allows blood vessels to relax, lowering blood pressure. Hydrochlorothiazide is a thiazide diuretic that works by increasing the excretion of sodium and water from the body through the kidneys, which reduces blood volume and consequently blood pressure.
Pharmacokinetics
Onset
Antihypertensive effect begins within 2 hours; maximal reduction usually observed within 4-6 weeks.
Excretion
Candesartan: Primarily excreted unchanged in urine and bile. Hydrochlorothiazide: Primarily excreted unchanged in urine.
Half life
Candesartan: approximately 9-15 hours. Hydrochlorothiazide: approximately 6-15 hours.
Absorption
Candesartan Cilexetil is rapidly absorbed and completely hydrolyzed to candesartan during absorption from the gastrointestinal tract. Hydrochlorothiazide is also well absorbed orally. Bioavailability of candesartan is approximately 15%, and hydrochlorothiazide is 65-75%.
Metabolism
Candesartan: Minimal hepatic metabolism. Hydrochlorothiazide: Not metabolized; excreted unchanged.
Side Effects
Contraindications
- Hypersensitivity to candesartan, hydrochlorothiazide, or any sulfonylamide-derived drugs.
- Anuria or severe renal impairment (creatinine clearance <30 mL/min).
- Severe hepatic impairment, biliary cirrhosis, and cholestasis.
- Pregnancy (especially second and third trimesters).
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m²).
Drug Interactions
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
ACE Inhibitors
Dual blockade of the renin-angiotensin-aldosterone system (RAAS) with ARBs and ACE inhibitors is not recommended due to increased risk of hypotension, hyperkalemia, and renal impairment.
Other Antihypertensives
Additive hypotensive effect.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
May reduce the diuretic and antihypertensive effects; can also increase risk of renal impairment.
Potassium-sparing diuretics & Potassium supplements
May lead to hyperkalemia.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include hypotension (low blood pressure), dizziness, tachycardia, and electrolyte disturbances (e.g., hypokalemia, hyponatremia). Treatment is symptomatic and supportive, including correction of fluid and electrolyte imbalances. Hemodialysis is not effective for removing candesartan or hydrochlorothiazide.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to risk of fetal injury and death. Use during lactation is not recommended as both components are excreted in human milk.
Side Effects
Contraindications
- Hypersensitivity to candesartan, hydrochlorothiazide, or any sulfonylamide-derived drugs.
- Anuria or severe renal impairment (creatinine clearance <30 mL/min).
- Severe hepatic impairment, biliary cirrhosis, and cholestasis.
- Pregnancy (especially second and third trimesters).
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m²).
Drug Interactions
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
ACE Inhibitors
Dual blockade of the renin-angiotensin-aldosterone system (RAAS) with ARBs and ACE inhibitors is not recommended due to increased risk of hypotension, hyperkalemia, and renal impairment.
Other Antihypertensives
Additive hypotensive effect.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
May reduce the diuretic and antihypertensive effects; can also increase risk of renal impairment.
Potassium-sparing diuretics & Potassium supplements
May lead to hyperkalemia.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include hypotension (low blood pressure), dizziness, tachycardia, and electrolyte disturbances (e.g., hypokalemia, hyponatremia). Treatment is symptomatic and supportive, including correction of fluid and electrolyte imbalances. Hemodialysis is not effective for removing candesartan or hydrochlorothiazide.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to risk of fetal injury and death. Use during lactation is not recommended as both components are excreted in human milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years from manufacturing date.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by DGDA (Bangladesh) and FDA (USA)
Patent Status
Off-patent (Generic available)
WHO Essential Medicine
YesClinical Trials
Clinical trials have demonstrated the efficacy and safety of candesartan/hydrochlorothiazide combination therapy in reducing blood pressure in patients with essential hypertension, with a favorable tolerability profile.
Lab Monitoring
- Monitor serum electrolytes (especially potassium, sodium, magnesium) regularly.
- Monitor renal function (serum creatinine, blood urea nitrogen, GFR) periodically.
- Monitor liver function tests.
- Periodic monitoring of uric acid and blood glucose levels, especially in patients with pre-existing conditions.
Doctor Notes
- Emphasize the importance of consistent daily intake for optimal blood pressure control.
- Regular monitoring of renal function and serum electrolytes is crucial, especially in elderly patients or those with pre-existing renal impairment.
- Counsel patients on potential symptoms of hypotension and advise them on appropriate actions.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine suddenly without consulting your doctor.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Maintain a low-sodium diet and healthy lifestyle as advised by your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
This medicine may cause dizziness or lightheadedness, especially at the start of treatment or when changing doses. Avoid driving or operating heavy machinery until you know how the medicine affects you.
Lifestyle Advice
- Adopt a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as approved by your doctor.
- Limit alcohol consumption.
- Quit smoking.
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