Geocand Plus 16/12.5 mg 21 tablets

Description:

Geocand Plus is a fixed-dose combination of an angiotensin II receptor blocker (candesartan cilexetil) and a thiazide diuretic (hydrochlorothiazide). It is indicated for the treatment of essential hypertension in patients whose blood pressure is not adequately controlled on monotherapy.

Indications for Use:

Treatment of essential hypertension where monotherapy with either component is insufficient.

Dosage and Administration:

Recommended dose: 1 tablet once daily
May be taken with or without food
Candesartan dose should be titrated before switching to Geocand Plus
Most of the antihypertensive effect is seen within 4 weeks.

Elderly patients: dose titration of candesartan is recommended.
Renal impairment: not for use if creatinine clearance <30 ml/min/1.73 m²
Hepatic impairment: not for use in severe liver impairment or cholestasis.
Pediatric use: not established.

Contraindications:

Hypersensitivity to active substances or excipients
Sulfonamide allergy (hydrochlorothiazide-related)
Pregnancy and breastfeeding
Severe renal impairment (CrCl <30 ml/min/1.73 m²)
Severe hepatic impairment and/or cholestasis
Gout
Refractory hypokalaemia and hypercalcaemia
Co-administration with aliskiren in patients with diabetes or impaired renal function (GFR <60 ml/min/1.73 m²).

Precautions:

Lactose intolerance (galactose intolerance, Lapp deficiency).
Dual RAAS blockade (ACEIs, ARBs, aliskiren) not recommended.
Monitor potassium, creatinine, uric acid.
Volume depletion may lead to hypotension.
Anaesthesia may cause hypotension requiring IV fluids.
Use caution in aortic/mitral stenosis, hypertrophic cardiomyopathy.
Not effective in primary hyperaldosteronism.
Electrolyte imbalance (especially potassium, magnesium, sodium, calcium).
May worsen glucose tolerance, raise lipids.
May precipitate gout.
Risk of hypersensitivity, lupus exacerbation.

Side Effects:

Common (>1/100): dizziness/vertigo, hyperglycaemia, hyperuricaemia, electrolyte imbalance, glycosuria, hyperlipidaemia, fatigue
Uncommon to Rare:
Blood: leucopenia, thrombocytopenia, agranulocytosis
Immune: anaphylaxis
CNS: insomnia, depression, paraesthesia
Cardiac: arrhythmias, postural hypotension
GI: anorexia, nausea, diarrhoea, constipation, pancreatitis
Hepatic: jaundice, hepatitis
Skin: rash, urticaria, photosensitivity, TEN, lupus-like reactions
Renal: renal failure, interstitial nephritis
General: weakness, fever
Labs: ↑ cholesterol, uric acid, glucose, BUN, creatinine, ALAT.

Pregnancy and Breastfeeding:

Pregnancy: contraindicated during 2nd and 3rd trimesters — may cause fetal or neonatal injury or death.
Breastfeeding: not recommended — hydrochlorothiazide is excreted in breast milk; candesartan unknown.

Storage Conditions:

Store in a dry place below 30 °C
Keep out of reach of children
Do not use after the expiry date.

Packaging:

Carton box with 3 strips of 7 tablets each, and an inner leaflet included.