Telmisartan
Brand Name: Micardis
Generic Available
Common Dosage Forms:
Tablets: 20 mg, 40 mg, 80 mg
FDA Indications/Dosages:
For the treatment of hypertension: Recommended initial dose is 40 mg once daily. The average dosage range is between 20-80/day. Telmisartan may be used alone or in combination with other antihypertensive agents. No dosage adjustments are necessary in elderly patients, or in patients with hepatic impairment or mild to severe renal impairment. Telmisartan may be administered with or without food.
To reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years of age or older at high-risk and who are unable to take ACE inhibitors: 80 mg once daily.
Monitor: CrCl, BP, K
Pharmacology/Pharmacokinetics: Angiotensin II is a potent vasoconstrictor, the primary vasoactive hormone of the renin-angiotensin system, and an important component in the pathophysiology of hypertension. It also stimulates aldosterone secretion by the adrenal cortex. Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking of angiotensin II to the AT1 receptor found in many tissues. Telmisartan does not inhibit ACE or bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation. After an oral dose, telmisartan is rapidly absorbed with an average dose-dependent absolute bioavailability of 42-58%. Peak plasma levels are reached in 0.5-1 hour. Terminal elimination half-life averages 24 hours. Metabolism occurs via glucuronide conjugation. Telmisartan is >99% bound to serum proteins.
Drug Interactions: Telmisartan may increase plasma levels of digoxin and slightly decrease levels of warfarin.
Contraindications/Precautions: Drugs that act directly on the renin-angiotensin system can cause fatal and neonatal morbidity and death when administered to pregnant women. In patients who are intravascularly volume-depleted, symptomatic hypotension may occur after initiation of therapy. Use with caution in patients with impaired renal function. Pregnancy Category C (first trimester) and Pregnancy Category D (second and third trimesters).
Adverse Effects: The most common adverse effects are upper respiratory infection, back pain, sinusitis, diarrhea, and pharyngitis. Rare cases of rhabdomyolysis have been reported in patients receiving angiotensin II receptor blockers.
Patient Consultation:
May be administered with or without food.
Do not remove tablets from the individual blister until immediately prior to administration.
When pregnancy is detected, discontinue use as soon as possible.
Store in a cool, dry place away from sunlight and children.
Contact a physician if the above side effects are severe or persistent.
