Atacand Plus: Uses, Side Effects and Dosage

What is ATACAND PLUS used for?

ATACAND PLUS is used in adults to lower high blood pressure.

How does ATACAND PLUS work?

ATACAND PLUS is a combination of 2 drugs, candesartan cilexetil and hydrochlorothiazide:

• Candesartan is an angiotensin receptor blocker (ARB). It lowers blood pressure.
• Hydrochlorothiazide is a diuretic or “water pill” that increases urination. This also helps to lower blood pressure.

This medicine does not cure high blood pressure. It helps to control it. Therefore, it is important to continue taking ATACAND PLUS regularly even if you feel fine.

What are the ingredients in ATACAND PLUS?

Medicinal ingredients: candesartan cilexetil and hydrochlorothiazide.

Non-medicinal ingredients: calcium carboxymethylcellulose, hydroxypropyl cellulose, iron oxide red, iron oxide yellow, lactose, magnesium stearate, maize starch, and polyethylene glycol.

ATACAND PLUS comes in the following dosage forms:

Tablets: 16 mg / 12.5 mg, 32 mg / 12.5 mg and 32 mg / 25 mg of candesartan cilexetil / hydrochlorothiazide.

Do not use ATACAND PLUS if:

• You are allergic to candesartan cilexetil, hydrochlorothiazide or to any non-medicinal ingredient in the formulation.
• You have severe liver disease.
• You have severe kidney disease.
• You are allergic to any sulfonamide-derived drugs (sulfa drugs); most of them have a medicinal ingredient that ends in “-MIDE”.
• You have diabetes or kidney disease and are already taking a blood pressure-lowering medicine that contains aliskiren.
• You have experienced an allergic reaction (angioedema) with swelling of the hands, feet, or ankles, face, lips, tongue, throat or sudden difficulty breathing or swallowing to any ARB (any drug in the same class as candesartan cilexetil). Be sure to tell your healthcare professional

Serious Warnings and Precautions

ATACAND PLUS should not be used during pregnancy. Taking ATACAND PLUS during pregnancy can cause injury or even death to your baby. If you discover that you are pregnant while taking ATACAND PLUS, stop the medication and contact your healthcare professional as soon as possible.

• You have difficulty urinating or produce no urine.
• You are pregnant or intend to become pregnant. Taking ATACAND PLUS during pregnancy can cause injury and even death to your baby.
• You are breastfeeding. ATACAND PLUS passes into breast milk.
• You have gout.
• You have one of the following rare hereditary diseases, because ATACAND PLUS contains lactose:
• Galactose intolerance,
• Lapp lactase deficiency,
• Glucose-galactose malabsorption.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take ATACAND PLUS. Talk about any health conditions or problems you may have, including if you:

• Are allergic to any drug used to lower blood pressure, including angiotensin converting enzyme (ACE) inhibitors, or penicillin.
• Have a liver or kidney disorder.
• Are taking an ACE inhibitor. You can recognize ACE inhibitors because their medicinal ingredient ends in ‘-PRIL’.
• Have narrowing of an artery or a heart valve.
• Have heart failure.
• Have diabetes, liver, heart or kidney disease.
• Have lupus.
• Are on dialysis.
• Are dehydrated or suffer from excessive vomiting, diarrhea or sweating.
• Are taking a salt substitute that contains potassium, potassium supplements, a potassium-sparing diuretic (a specific kind of “water pill”) or other drugs that may increase potassium levels such as heparin, co-trimoxazole.
• Are on a low-salt diet.
• Have had a heart attack or stroke.
• Have had breathing or lung problems (including inflammation or fluid in the lungs) after taking hydrochlorothiazide in the past. If you develop any severe shortness of breath or difficulty breathing after taking ATACAND PLUS, stop the medication and seek medical attention immediately.
• Have had skin cancer or have a family history of skin cancer.
• Have a greater chance of developing skin cancer because you have light-coloured skin, get sunburned easily, or are taking drugs to suppress your immune system.

Other warnings you should know about:

Use of anesthesia: If you are about to have a surgery or dental procedure with anesthesia, be sure to tell your healthcare professional that you are taking ATACAND PLUS.

Risk of skin cancer: ATACAND PLUS contains hydrochlorothiazide. Treatment with hydrochlorothiazide may increase the risk of developing non-melanoma skin cancer. The risk is higher if you have been taking ATACAND PLUS for many years (more than 3) or at a high dose. While taking ATACAND PLUS:

• Make sure to regularly check your skin for any new lesions. Check areas that are most exposed to the sun, such as the face, ears, hands, shoulders, upper chest and back.
• Limit your exposure to the sun and to indoor tanning. Always use sunscreen (SPF-30 or higher) and wear protective clothing when going outside.
• Talk to your healthcare professional immediately if you get more sensitive to the sun or UV light or if you develop an unexpected skin lesion (such as a lump, bump, sore, or patch) during the treatment.

Sudden eye disorders: Treatment with hydrochlorothiazide in ATACAND PLUS can cause sudden eye problems such as:

• Myopia: sudden nearsightedness or blurred vision.
• Glaucoma: an increased pressure in your eyes, eye pain. Untreated, it may lead to permanent vision loss.
• Choroidal effusion: an abnormal building of liquid in your eye that may result in vision changes.

These eye disorders are related and can develop within hours to weeks of starting ATACAND PLUS. If you earlier have had a penicillin or sulfonamide allergy, you can be at higher risk of developing this. If you experience the above symptoms, stop taking ATACAND PLUS and seek immediate medical help.

Monitoring: During your treatment with ATACAND PLUS, your healthcare professional may monitor:

• Your kidney function.
• Your blood pressure.
• The amount of electrolytes in your blood (such as potassium).

Driving and using machines: Before you perform tasks which may require special attention, wait until you know how you respond to ATACAND PLUS. Dizziness, lightheadedness, or fainting can occur, especially after the first dose and when the dose is increased.

Blood tests: ATACAND PLUS can cause abnormal blood test results. Your healthcare professional will decide when to perform blood tests and will interpret the results.

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

The following may interact with ATACAND PLUS:

• Adrenocorticotropic hormone (ACTH), which may be used to treat diseases such as nephrotic syndrome or collagen diseases and in diagnostic tests.
• Alcohol, barbiturates (sleeping pills), or narcotics (strong pain medications). They may cause low blood pressure and dizziness when you go from lying or sitting to standing up.
• Amantadine used to treat the flu and reduce symptoms of Parkinson’s Disease.
• Amphotericin B, an antifungal drug.
• Drugs used to treat cancer such as cyclophosphamide and methotrexate.

• Antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs) such as citalopram, escitalopram and sertraline.
• Drugs used to treat diabetes such as insulin and oral medicines.
• Bile acid resins used to lower cholesterol such as cholestyramine.

• Other blood pressure lowering drugs such as:

  • Diuretics (“water pills”).
  • Guanethidine.
  • Diazoxide.
  • Methyldopa.
  • Beta-blockers, such as atenolol, metoprolol, propranolol.
  • Vasodilators.
  • Calcium channel blockers, such as felodipine and amlodipine.
  • Angiotensin converting enzyme inhibitors (ACEIs).
  • Angiotensin receptor blockers (ARBs), such as valsartan and losartan.
  • Direct renin inhibitors.
• Calcium or vitamin D supplements.
• Corticosteroids used to treat joint pain and swelling.
• Cyclosporine used to treat autoimmune diseases.
• Digoxin, a heart medication.
• Drugs that slow down or speed up bowel function such as atropine, biperiden, domperidone and metoclopramide.
• Drugs used to treat epilepsy such as carbamazepine and topiramate.
• Gout medications such as allopurinol, probenecid, uricosurics and xanthine oxidase inhibitors.
• Lithium used to treat bipolar disease.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), used to reduce pain and swelling such as ibuprofen, naproxen, acetylsalicylic acid and celecoxib.
• Drugs that can increase blood potassium levels such as heparin, co-trimoxazole, potassium supplements or potassium-containing salt substitutes.
• Pressor amines such as norepinephrine.
• Skeletal muscle relaxants used to relieve muscle spasms such as tubocurarine.

How to take ATACAND PLUS:

• ATACAND PLUS is not for initial therapy. You must first be stabilized on the individual components of ATACAND PLUS (i.e., candesartan cilexetil and hydrochlorothiazide).
• Take ATACAND PLUS exactly as your healthcare professional has told you.
• It is recommended to take your dose at about the same time everyday.

• ATACAND PLUS can be taken with or without food, but it should be taken the same way each day. If ATACAND PLUS causes upset stomach, take it with food or milk.

• Swallow ATACAND PLUS with a glass of water.
• If you take diuretics (i.e., “water pills”), your healthcare professional may ask you to temporarily stop taking them 2 or 3 days before you start your treatment with ATACAND PLUS. They may also reduce their dose during your treatment. Furthermore, your healthcare professional may also prescribe you other medications depending on your condition. Follow their instructions carefully.
• Remember to get a new prescription from your doctor or a refill from your pharmacy a few days before all your tablets are taken.

Usual dose:

Your healthcare professional will decide the best dose of ATACAND PLUS for you and how long you will take it. Your healthcare professional will monitor your health throughout your treatment and may increase or decrease your dose as needed.

The recommended dose is 1 tablet of ATACAND PLUS once daily.

Overdose:

Missed Dose:

If you miss a dose of ATACAND PLUS and remember within 12 hours, you should take your usual dose as soon as possible. Then go back to your regular schedule. But if it is more than 12 hours when you remember, do not take the missed dose. Just take the next dose on time. Do not take a double dose.

What are possible side effects from using ATACAND PLUS?

These are not all the possible side effects you may have when taking ATACAND PLUS. If you experience any side effects not listed here, tell your healthcare professional.

Side effects may include:

• back or leg pain, muscle cramps, spasms and pain, weakness, restlessness.
• cold or flu-like symptoms.
• dizziness, pins and needles in your fingers, headache.
• urinary tract infections.
• constipation, diarrhea, nausea, vomiting, decreased appetite, upset stomach, enlargement of the glands in your mouth.
• cough.
• bleeding under skin, rash, red patches on the skin, itching.
• drowsiness, insomnia.
• low sex drive.
• nose bleeds.

Serious side effects and what to do about them

Serious side effects and what to do about them

Serious side effects and what to do about them

Serious side effects and what to do about them

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, tell your healthcare professional.

Reporting Side Effects

Storage:

• When you first open the package, if you find any damage to the plastic seal or foil which exposes the tablet, ask your pharmacist to check the package.
• Do not transfer ATACAND PLUS to other pill containers. Keep in the original package at room temperature (15°C to 30°C) and in a dry place. Do not keep ATACAND PLUS in the bathroom.
• Do not keep or use ATACAND PLUS after the expiry date indicated on the package. Return any unused medicines, which you know you will no longer need, to your pharmacy for disposal.

Keep out of reach and sight of children.

If you want more information about ATACAND PLUS:

• Talk to your healthcare professional.
• Find the full product monograph that is prepared for healthcare professionals and includes this Patient Medication Information by visiting the Health Canada website: https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html; the Xediton’s website https://xediton.com/, or by calling 1-888-XEDITON (933-4866).
• This Patient Medication Information is current at the time of printing. The most up-to-date version can be found at https://xediton.com/.

Importer / Distributor

Xediton Pharmaceuticals Inc.

2020 Winston Park Drive, Suite 402

Oakville, Ontario L6H 6X7

Last revised: JUL 11, 2024