Posology : מינונים

4.2     Posology and method of administration
Dosage in Hypertension

The recommended initial dose and usual maintenance dose is 8 mg once daily.
Most of the antihypertensive effect is attained within 4 weeks. In some patients whose blood pressure is not adequately controlled, the dose can be increased to a maximum of 16 mg once daily.


Therapy should be adjusted according to blood pressure response.

Atacand may also be administered with other antihypertensive agents (see sections 4.3, 4.4, 4.5 and 5.1). Addition of hydrochlorothiazide has been shown to have an additive antihypertensive effect with various doses of Atacand.


Use in the elderly
No initial dosage adjustment is necessary in elderly patients.

Use in patients with intravascular volume depletion
An initial dose of 4 mg may be considered in patients at risk for hypotension, such as patients with possible volume depletion (see also 4.4 Special warnings and special precautions for use).


Use in impaired renal function
The starting dose is 4 mg in patients with renal impairment, including patients on haemodialysis. The dose should be titrated according to response. There is limited experience in patients with very severe or end-stage renal impairment (Clcreatinine < 15 ml/min). See section 4.4 Special warnings and special precautions for use.



Use in impaired hepatic function
Patients with hepatic impairment: An initial dose of 2 mg once daily is recommended in patients with mild to moderate hepatic impairment. The dose may be adjusted according to response.
Atacand is contraindicated in patients with severe hepatic impairment and/or cholestasis (see section 4.3).


Black patients
The antihypertensive effect of candesartan is less pronounced in black patients than in non-black patients. Consequently, uptitration of Atacand and concomitant 

therapy may be more frequently needed for blood pressure control in black patients than in non-black patients (see section 5.1).


Dosage in Heart Failure
The usual recommended initial dose of Atacand is 4 mg once daily. Up-titration to the target dose of 32 mg once daily (maximum dose) or the highest tolerated dose is done by doubling the dose at intervals of at least 2 weeks (see section 4.4 Special warnings and special precautions for use). Evaluation of patients with heart failure should always comprise assessment of renal function including monitoring of serum creatinine and potassium. Atacand can be administered with other heart failure treatment, including ACE-inhibitors, beta-blockers, diuretics and digitalis or a combination of these medicinal products. Atacand may be co-administered with an ACE-inhibitor in patients with symptomatic heart failure despite optimal standard heart failure therapy when mineralocorticoid receptor antagonists are not tolerated. The combination of an ACE-inhibitor, a potassium-sparing diuretic and Atacand is not recommended and should be considered only after careful evaluation of the potential benefits and risks (see sections 4.4, 4.8 and 5.1).


Special patient populations
No initial dose adjustment is necessary for elderly patients or in patients with intravascular volume depletionrenal or renal impairment or mild to moderate hepatic impairment.


Paediatric Population
The safety and efficacy of Atacand in children aged between birth and 18 years have not been established in the treatment of heart failure. No data are available.


Method of administration
Oral use.
Atacand should be taken once daily with or without food.
The bioavailability of candesartan is not affected by food.