https://www.drugs.com/drug-interactions/candesartan-with-diclofenac-487-0-869-0.html

kindly follow the above mentioned link. This link may be beneficial for you.

Thanks

As the patient is taking candesartan since a long period the plasma levels are in steady state. There is no way to avoid interaction with diclofenac (as well as with ibuprofen, ketoprofen, naproxen).

You may try to manage occasional pain with paracetamol or with tramadol if pain is not controlled with paracetamol.

But Dr.Sardina, isn't this true? That there will be a rise in the blood concentration after ingesting the daily tablet of Candesartan, so although the interaction will occur, we can minimize the adverse effect as much as we can by taking the candesartan after 2 hours (Half life of diclofenac) because if both are administered together, candesartan along with diclofenac will be in their highest concentrations. Isn't this true, what I think?

Honestly I don't think so. Both peak and through plasma concentrations are able to block angiotensin receptors. Even there might be some, if any, less risks with the schedule you propose the risk cannot be eliminated. Then consider that the data sheet of candesartan does not report this kind of suggestion. So my point is: why take a risk when you have alternative, effective analgesics?

Yeah, agree Dr.Sardina I'm going to suggest the alternative but I'm asking just in case I have only Diclofenac. What is the best solution? To wait 2 hours (half life of Diclofenac) then administer Candesartan?

It is difficult to answer. Candesartan is at steady state that means through plasma levels are in the therapeutic range.

Considering the low dose of diclofenac you mention (25mg) and the impossibility to have an alternative (e.g. paracetamol) I would wait at least three hours and then monitor blood pressure in the following hours.

do not use diclofenac.

Thanks a lot Dr.Sardina! One last Q I have if it is obligatory for someone to take both Aspirin 81 mg one tablet daily and Candesartan 4 mg one tablet daily, how can I manage this interaction aside from monitoring? Is there dose spacing like in the case of Diclofenac, if so, Do I wait for half life of Aspirin or Candesartan to administer the second medication?

Why Dr.Daniel?

There are other options to use. the cronic use of non-steroidal anti-inflammatory drugs is not good even in casual use.

By the way I fully agree with Daniel

Mostafa Elsersy Aspiring is contrauindicated with candesartan as well. The problem cannot be solved as it is an irreversible inhibitor of COX. At steady state its activity is no longer related to plasma concentrations. i.e. even at 30mg/day it takes some days more to inhibith 100% COX vs higher doses but then the effect is complete.

Thanks a lot Dr.Sardina!

I will not repeat what was already said above but I thought I would just add couple things to the discussion. First, both diclofenac and candesartan are metabolized by the CYP2C9 so the interaction can get even more complex with what else the patient is also taking that may inhibit or induce CYP2C9. Second, ASA 81mg is not contraindicated with candesartan but we use it cautiously so we monitor closely for possible adverse effects such as hyperkalemia or worsening kidney function. In addition, ASA at the lower doses such as 81 or lower have little to no effect on COX but mainly platelet thromboxane to inhibit platelet aggregation. I hope this helps a little!

since diclofenac can be given any time when needed, it is less likely to tackle pharmacodynamic interaction between two drugs. if possible better to use alternative medication for pain management. Otherwise monitor toxicity.

Just have a look at candesartano drug-drug interactions at the link below

https://www.drugs.com/drug-interactions/candesartan.html

Thanks a lot Dr. Youssef!

I share the same opinion with Dr. Sardina; the answer he gave is thorough and complete. In this case, Diclofenac shoud as far as possible be avoided.