Telmisartan

Class
Antihypertensives
Subclass
Angiotensin receptor blockers
Substance name
Telmisartan
Brand names
Micardis®
Common formulations
Tablet
Contained in
Telmisartan / amlodipine (Twynsta®)
Dosage and administration
Adults patients
Treatment
Hypertension
•
Start at: 40 mg PO daily
•
Maintenance: 20-80 mg PO daily
Taken with or without food.
Secondary prevention
Secondary prevention of AF in patients with hypertension • Off-label
•
Maintenance: 80 mg PO daily
•
Maximum: 160 mg per day
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
•
Prevention of cardiovascular events (in patients ≥ 55 years) with high cardiovascular risk, if ACEis are ineffective or contraindicated
Off-label indications
Adults
•
Secondary prevention of AF in patients with hypertension
Safety risks
Boxed warnings
Fetal toxicity
•
Do not use in pregnant patients. Discontinue telmisartan as soon as possible when pregnancy is detected.
Contraindications
Hypersensitivity to telmisartan orits components
Concomitant use of aliskiren in patients with diabetes
•
Avoid using aliskiren with telmisartan in patients with renal impairment.
Concomitant use of other RAAS inhibitors
Warnings and precautions
Hypotension
•
Use caution in patients volume or salt depletion and/or receiving high doses of diuretics.
Increased serum creatinine, increased BUN
•
Use caution in patients with unilateral or bilateral renal artery stenosis.
Increased serum digoxin levels
•
Use caution in patients taking digoxin. Monitor digoxin levels when initiating, adjusting, and discontinuing telmisartan.
Increased serum lithium levels
•
Use caution in patients taking lithium. Monitor lithium levels.
Increased serum potassium
•
Use caution in patients with advanced renal impairment, HF, on RRT, or taking potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes, or other drugs that increase potassium levels.
Increased serum telmisartan levels
•
Use caution in patients with hepatic insufficiency or biliary obstructive disorders. Start telmisartan at low doses and titrate slowly.
Oliguria, renal failure
•
Use caution in patients with renal dysfunction or severe congestive HF.
Renal dysfunction
•
Use caution in patients taking nonsteroidal anti-inflammatory agents, including selective cyclooxygenase-2 inhibitors, especially in patients with renal impairment, volume depletion, or in the elderly.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for hyperkalemia.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for hyperkalemia.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for hyperkalemia.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for hyperkalemia.
Hepatic impairment
Any severity
•
Reduce starting dose. Titrate slowly.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Do not use. Evidence of fetal harm in humans. Monitor neonates for hypotension and oliguria. Monitor for neonatal hyperkalemia. Discontinue telmisartan when pregnancy is detected.
•
Use of RAAS inhibitors during the second and third trimesters can cause reduced fetal renal function leading to anuria and renal failure, oligohydramnios, fetal lung hypoplasia, and skeletal deformations, including skull hypoplasia, hypotension, and death.
Breastfeeding
Do not use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Pharyngitis, back pain, cough, diarrhea, flu-like symptoms, myalgia, dyspepsia, abdominal pain, headache, dizziness, fatigue, hypertension, chest pain, nausea, peripheral edema, intermittent claudication, sinusitis, skin ulceration, urinary tract infections, upper respiratory tract infections
Uncommon < 1%
•
Migraine, gout, diabetes mellitus, hemorrhoids, gastroenteritis, bronchitis, asthma, acute otitis media, stroke, skin flushing, sweating, fever, erectile dysfunction, leg pain, malaise, palpitations, angina pectoris, tachycardia, insomnia, somnolence, vertigo, paresthesia, hypoesthesia, flatulence, dry mouth, constipation, vomiting, gastroesophageal reflux, dental pain, ↑ serum cholesterol, arthralgia, leg cramps, anxiety, muscle cramps, depression, nervousness, rhinitis, dyspnea, nosebleed, skin rash, pruritus, visual disturbances, urinary frequency, ear pain, conjunctivitis, tinnitus
Unknown frequency
•
↑ serum potassium, orthostatic hypotension, rhabdomyolysis, angioedema, anemia, ↑ blood eosinophil count, ↓ platelet count, asthenia, weakness, facial edema, ↑ serum uric acid, ↑ serum CK, ↓ blood glucose, ↓ serum sodium, urticaria, syncope, ↑ liver enzymes, skin erythema, renal failure, anaphylaxis
Interactions
Drug(s)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource