Telmisartan

Indications

Telmisartan is used for: Hypertension, Diabetic nephropathy

Adult Dose

Oral Hypertension Adult: Initially, 40 mg once daily, may be adjusted to 20-80 mg once daily if needed. Elderly: 20 mg/day PO initially; Cardiovascular risk reduction Adult: 80 mg once daily. Hepatic impairment: Mild to moderate: Max: 40 mg once daily. Severe: Contraindicated.

Child Dose

<18 years old: Safety and efficacy not established

Renal Dose

Renal impairment: Severe impairment or on haemodialysis: Initially, 20 mg once daily.

Administration

May be taken with or without food.

Contra Indications

Severe hepatic impairment, biliary obstructive disorders. Pregnancy. Lactation.

Precautions

Hepatic insufficiency, biliary obstruction, renal impairment, renaly artery stenosis. Correct volume depletion before initiating treatment. Monitor serum potassium levels regularly, especially in elderly and renally-impaired patients.

Pregnancy-Lactation

Pregnancy category: 1st trimester, C; 2nd and 3rd trimesters, D

Interactions

May increase plasma levels of digoxin. May increase serum lithium levels and toxicity. May reduce plasma levels of warfarin. Increased risk of hyperkalaemia w/ K-sparing diuretics, K supplements or K-containing salt substitutes. May antagonise hypotensive effect and increase risk of renal impairment w/ NSAIDs. Potentially Fatal: May increase nephrotoxic, hyperkalaemic and hypotensive effect w/ aliskiren in patients w/ diabetes and renal impairment (GFR <60 mL/min).

Adverse Effects

Side effects of Telmisartan : 1-10% Upper respiratory tract infection (URTI) (7%),Back pain (3%),Diarrhea (3%),Myalgia (3%),Sinusitis (3%),Chest pain (1%),Hypertension (1%),Headache (1%),Dizziness (1%),Pharyngitis (1%) <1% Abnormal ECG,Anemia,Angina,Angioedema,Bradycardia,Eczema,Epistaxis,Gout,Hypercholesterolemia,Hyperkalemia,Hypoglycemia,Otitis media Potentially Fatal: Rarely angioedema, rash, pruritus and urticaria.

Mechanism of Action

Telmisartan is a nonpeptide AT1 angiotensin II receptor antagonist. It exerts antihypertensive activity by preventing angiotensin II from binding to AT1 receptors thus inhibiting the vasoconstricting and aldosterone-secreting effects of angiotensin II.