Candesartan cilexetil

Sensory systems

Taste disorders have been reported with ACE inhibitors and now also with an angiotensin receptor antagonist [ ].

• A renal transplant patient developed stomatitis and dysgeusia while taking candesartan cilexetil for hypertension. Although the patient was taking many concomitant medications, the chronology of the adverse effect suggested a causal relation with candesartan.

The potential for taste disturbances with candesartan has been investigated in a randomized, double-blind, placebo-controlled, crossover trial in 8 healthy subjects, measuring taste sensation by a paper disc method and also by electrogustometry [ ]. In view of the suggestion that taste disturbance is associated with low serum zinc concentrations, in that drugs may chelate or complex with zinc, serial serum and salivary zinc measurements were also made. The data suggested that candesartan subclinically reduces taste sensitivity after repeated dosage in healthy subjects but serum and salivary zinc concentrations were not affected, suggesting a zinc-independent effect.

Electrolyte balance

As angiotensin II receptor antagonists are often used for similar indications or substituted for ACE inhibitor therapy, the combination of an angiotensin II receptor antagonist with spironolactone will become more commonly used in treating cardiovascular and renal disease. Severe hyperkalemia, due to a combination of candesartan and spironolactone, has been described in a patient with hypertensive nephrosclerosis and only mild renal impairment [ ]. The authors reasonably advised that close monitoring of serum potassium should be mandatory during combination therapy, in order to prevent hyperkalemia. They also suggested that the transtubular potassium gradient and fractional excretion of potassium should be assessed before starting therapy to identify high-risk patients, and that a thiazide or loop diuretic be co-administered in order to reduce the risk of hyperkalemia; however, neither of these strategies has clear evidence to support it.

Liver

Jaundice and ductopenic hepatitis, similar to that described above under enalapril, has been attributed to candesartan [ ]. Hepatotoxicity has been reported with losartan, but this appears to be the first case associated with candesartan.