- Treatment of hypertension
Note: Not indicated for the initial therapy
Renal Dose Adjustment (Based on CrCl)
- Mild to moderate impairment (30-80 mL/min): No dose adjustments
- Severe renal impairment: Not recommended
- Monitor patients on dialysis for orthostatic hypotension
Hepatic Dose Adjustment
- Mild to moderate impairment: Use with caution; start at low doses and titrate cautiously
- Severe hepatic impairment: Not recommended
See Supplemental Patient Information
- Discontinue the therapy as soon as possible when pregnancy is detected. Drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus when used during the second and third trimesters [US Black Box Warning]
- Oligohydramnios associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development have occurred
- In certain cases, if no alternate to angiotensin II receptor antagonist is found, apprise the mothers about the potential hazards to their fetuses, and perform serial ultrasound examinations to assess the intra-amniotic environment; discontinue therapy on detection of oligohydramnios
- Thiazides cross the placental barrier and appear in cord blood. Risk of fetal or neonatal jaundice, thrombocytopenia, and other adverse events that have occurred in adults may be seen
- Reports of symptomatic hypotension after initiation of therapy, especially in volume- or salt-depleted patients. If hypotension occurs, place the patient in supine position and give IV normal saline; closely monitor the patient during the therapy
- Hypersensitivity reactions have occurred in patients receiving hydrochlorothiazide with or without a history of allergy or bronchial asthma
- Increase in serum creatinine or blood urea nitrogen (BUN) have been reported in patients with unilateral or bilateral renal artery stenosis
- Exacerbation or activation of systemic lupus erythematosus may occur with the use of thiazides
- Hypokalemia can occur with use of this drug. Patients receiving thiazides should be observed for clinical signs of fluid or electrolyte imbalance
- Hypokalemia may develop, especially with brisk diuresis, in case of severe cirrhosis or prolonged therapy
- Interference with adequate oral electrolyte intake will contribute to hypokalemia. Hypokalemia can sensitize or exaggerate the response of the heart to the toxic effects of digitalis and may cause cardiac arrhythmias
- Dilutional hyponatremia may occur in edematous patients in hot weather, appropriate therapy must be used in such patients
- Hyperuricemia may occur or frank gout may be precipitated by thiazide therapy
- Dose adjustments of insulin or oral hypoglycemic agents may be required in diabetic patients; hyperglycemia may occur with thiazide diuretics
- Post-sympathectomy may enhance antihypertensive effects of the drug
- Discontinue or withhold diuretic therapy in case progressive renal impairment becomes evident
- Thiazide may cause decrease in urinary calcium excretion which may lead to increase in serum calcium level. Marked hypercalcemia may be evidence of hidden hyperparathyroidism; discontinue thiazides before carrying out tests for parathyroid function
- During thiazide therapy, increase in cholesterol and triglyceride levels may occur
- Changes in renal function (including acute renal failure) have been reported when an ACE inhibitor is added to an angiotensin II receptor antagonist
Cautions: Use cautiously in
- Hepatic impairment and progressive hepatic diseases
- Severe renal impairment
- Hyponatremia
- Biliary obstructive disorders
- Black patients
- Congestive heart failure
- Diabetes mellitus
- Women of childbearing potential
- Major surgery
- Elderly patients
Supplemental Patient Information
- Inform childbearing women about the consequences of second- and third-trimester exposure to drugs that act on the renin-angiotensin system and also tell them that these consequences do not result from intrauterine drug exposure limited to the first trimester. Advise these patients to immediately report their pregnancies to their physicians
- Advise the patients that lightheadedness may occur, especially during initiation of therapy; advise patients to discontinue therapy and consult their physicians if syncope occurs
- Caution patients that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting may lead to an excessive fall in blood pressure resulting in lightheadedness or syncope
- Do not use potassium supplements or salt substitutes without seeking physician advice
Pregnancy Category:C (first trimester), D (second and third trimesters)
Breastfeeding: Safety unknown. Because there is no information on the use of telmisartan during breastfeeding, an alternate drug might be preferred especially while nursing a newborn or a preterm infant. During lactation, hydrochlorothiazide at a dose of 50 mg daily or less is acceptable. Intense diuresis with large doses may decrease breastmilk production. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 February 2011). As per the manufacturer's data, potential adverse effects on nursing infants exist. Manufacturer recommends discontinuing nursing or postponing treatment, taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
telmisartan/hydrochlorothiazide (generic)
- TABS:
- 40 mg/12.5 mg
- 80 mg/12.5 mg
- 80 mg/25 mg
Micardis HCT (telmisartan/hydrochlorothiazide)
- TABS:
- 40 mg/12.5 mg
- 80 mg/12.5 mg
- 80 mg/25 mg
Canadian Trade Name(s)
Canadian Availability
Micardis Plus (telmisartan/hydrochlorothiazide)
UK Trade Name(s)
UK Availability
MicardisPlus (telmisartan/hydrochlorothiazide)
- TABS:
- 40 mg/12.5 mg
- 80 mg/12.5 mg
- 80 mg/25 mg
Australian Trade Name(s)
Australian Availability
Micardis Plus (telmisartan/hydrochlorothiazide)
- TABS:
- 40 mg/12.5 mg
- 80 mg/12.5 mg
- 80 mg/25 mg
Pricing data from www.DrugStore.com in U.S.A.
- Micardis HCT 40-12.5 MG TABS [Box] (BOEHRINGER INGELHEIM)
30 mg = $123.99
90 mg = $339.96 - Micardis HCT 80-12.5 MG TABS [Box] (BOEHRINGER INGELHEIM)
30 mg = $122
90 mg = $335.97 - Micardis HCT 80-25 MG TABS [Box] (BOEHRINGER INGELHEIM)
30 mg = $123.99
90 mg = $349.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.