Lisinopril 5 mgLisinopril 5 mg tablets| 28 tabletP£ 7. 80 DT =
£ 0. 46
Lisinopril 10 mgLisinopril 10 mg tablets| 28 tabletP£ 11. 81 DT
=£ 0. 61
Lisinopril 20 mgLisinopril 20 mg tablets| 28 tabletP£ 10. 90 DT
=£ 0. 58
▶Zestril(AstraZeneca UK Ltd)
Lisinopril 5 mgZestril 5 mg tablets| 28 tabletP£ 9. 42 DT =
£ 0. 46
Lisinopril 10 mgZestril 10 mg tablets| 28 tabletP£ 14. 76 DT =
£ 0. 61
Lisinopril 20 mgZestril 20 mg tablets| 28 tabletP£ 13. 02 DT =
£ 0. 58DRUGS ACTING ON THE RENIN-ANGIOTENSIN
SYSTEM›ANGIOTENSIN II RECEPTOR
ANTAGONISTS
Angiotensin II receptor f
antagonists
lCAUTIONSAfro-Caribbean patients—particularly those
with left ventricular hypertrophy (may not benefit from an
angiotensin-II receptor antagonist).aortic or mitral valve
stenosis.hypertrophic cardiomyopathy.patients with a
history of angioedema.patients with primary
aldosteronism (may not benefit from an angiotensin-II
receptor antagonist).renal artery stenosis
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.asthenia.back
pain.cough.diarrhoea.dizziness.headache.
hyperkalaemia.hypotension.nausea.postural
hypotension (more common in patients with intravascular
volume depletion, e.g. those taking high-dose diuretics).
renal impairment.vertigo.vomiting
▶UncommonAngioedema.myalgia.skin reactions.
thrombocytopenia
▶Rare or very rareArthralgia.hepatic function abnormal
lPREGNANCYAngiotensin-II receptor antagonists should
be avoided in pregnancy unless essential. They may
adversely affect fetal and neonatal blood pressure control
and renal function; neonatal skull defects and
oligohydramnios have also been reported.
lBREAST FEEDINGInformation on the use of angiotensin-II
receptor antagonists in breast-feeding is limited. They are
not recommended in breast-feeding and alternative
treatment options, with better established safety
information during breast-feeding, are available.
lRENAL IMPAIRMENT
Dose adjustmentsUse with caution, starting with low dose,
and adjust according to response.
lMONITORING REQUIREMENTSMonitor plasma-potassium
concentration, particularly in children with renal
impairment.
eiiiiFaboveCandesartan cilexetil
lINDICATIONS AND DOSE
Hypertension
▶BY MOUTH
▶Child 6–17 years (under expert supervision) (body-weight up
to 50 kg):Initially 4 mg once daily, adjusted according
to response, lower dose may be used in intravascular
volume depletion; maximum 8 mg per day
▶Child 6–17 years (under expert supervision) (body-weight
50 kg and above):Initially 4 mg once daily, adjusted
according to response, lower dose may be used in
intravascular volume depletion; maximum 16 mg per
daylCONTRA-INDICATIONSCholestasis
lINTERACTIONS→Appendix 1 : angiotensin-II receptor
antagonists
lSIDE-EFFECTS
▶Common or very commonFever.increased risk of infection
.oropharyngeal pain.sinus arrhythmia
▶UncommonHyponatraemia
▶Rare or very rareAgranulocytosis.hepatitis.leucopenia.
neutropenia
lHEPATIC IMPAIRMENTAvoid in severe hepatic impairment.
Dose adjustmentsReduce initial dose in mild or moderate
impairment.
lRENAL IMPAIRMENTUse with caution if estimated
glomerularfiltration rate is less than
30 mL/minute/ 1. 73 m^2 —no information available.
Dose adjustmentsReduce initial dose.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
▶Candesartan cilexetil (Non-proprietary)
Candesartan cilexetil 2 mgCandesartan 2 mg tablets|
7 tabletP£ 2. 86 DT = £ 1. 90
Candesartan cilexetil 4 mgCandesartan 4 mg tablets|
7 tabletP£ 3. 88 DT = £ 0. 30 | 28 tabletP£ 0. 49 – £ 9. 78
Candesartan cilexetil 8 mgCandesartan 8 mg tablets|
28 tabletP£ 9. 89 DT = £ 0. 84
Candesartan cilexetil 16 mgCandesartan 16 mg tablets|
28 tabletP£ 12. 72 DT = £ 1. 14
Candesartan cilexetil 32 mgCandesartan 32 mg tablets|
28 tabletP£ 16. 13 DT = £ 1. 75
▶Amias(Takeda UK Ltd)
Candesartan cilexetil 2 mgAmias 2 mg tablets| 7 tabletP
£ 3. 58 DT = £ 1. 90
Candesartan cilexetil 4 mgAmias 4 mg tablets| 7 tabletP
£ 3. 88 DT = £ 0. 30 | 28 tabletP£ 9. 78
Candesartan cilexetil 8 mgAmias 8 mg tablets| 28 tabletP
£ 9. 89 DT = £ 0. 84
Candesartan cilexetil 16 mgAmias 16 mg tablets| 28 tabletP
£ 12. 72 DT = £ 1. 14
Candesartan cilexetil 32 mgAmias 32 mg tablets| 28 tabletP
£ 16. 13 DT = £ 1. 75eiiiiFaboveLosartan potassium
lINDICATIONS AND DOSE
Hypertension
▶BY MOUTH
▶Child 6–17 years (under expert supervision) (body-weight
20 – 49 kg):Initially 700 micrograms/kg once daily (max.
per dose 25 mg), adjusted according to response to
50 mg daily, lower initial dose may be used in
intravascular volume depletion; maximum 50 mg per
day
▶Child 6–17 years (under expert supervision) (body-weight
50 kg and above):Initially 50 mg once daily, adjusted
according to response to 1. 4 mg/kg once daily;
maximum 100 mg per day
Hypertension with intravascular volume depletion
▶BY MOUTH
▶Child 6–17 years (under expert supervision) (body-weight
50 kg and above):Initially 25 mg once daily; adjusted
according to response to 1. 4 mg/kg once daily;
maximum 100 mg per daylCAUTIONSSevere heart failure
lINTERACTIONS→Appendix 1 : angiotensin-II receptor
antagonists
lSIDE-EFFECTS
▶Common or very commonAnaemia.hypoglycaemia.
postural disordersBNFC 2018 – 2019 Hypertension 115
Cardiovascular system2