Adult Dosing
Hypertension (used alone or in combination)
- Start 40 mg PO Daily if on monotherapy (use lower doses if on diuretics)
- Usual: 20-80 mg PO Daily
Heart failure (Non-FDA Approved)
- Note that similar dosing to that used for hypertension is typically used for this indication
CV event risk reduction
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
Hepatic Dose Adjustment
- Hepatic impairment: Use with caution; start at low doses and titrate cautiously in patients with biliary obstructive disorders or hepatic insufficiency
See Supplemental Patient Information
- When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as pregnancy is detected [US Black Box Warning]
- Symptomatic hypotension may occur after in intravascularly volume-depleted patients. Correct any volume or salt depletion before initiating therapy
- Hyperkalemia may occur, particularly in patients with advanced renal impairment, heart failure, on renal replacement therapy, or on potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes. Consider periodic determinations of serum electrolytes to detect possible electrolyte imbalances, particularly in patients at risk
- In patients with severe congestive heart failure or renal dysfunction, treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death
- In studies of ACE inhibitors in patients with unilateral or bilateral renal artery stenosis, increases in serum creatinine or blood urea nitrogen were observed; anticipate an effect similar to that seen with ACE inhibitors
- In recent ONTARGET study no additional benefit was found adding ramipril to temlmisartan, but experienced an increased incidence of renal dysfunction compared with groups receiving telmisartan alone or ramipril alone
- Concomitant use of telmisarten with ramipril not recommended
- Monitor carefully in patients with impaired hepatic or renal function
- Correct hypovolemia before starting therapy or monitor closely
- Maximal reduction of blood pressure is attained after 4 weeks. Consider lower initial dose in patients with intravascular volume depletion
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Biliary obstructive disorders
- Black patients
- Volume- or salt-depleted patients
- Women of childbearing potential
- Patients with primary renal disease or heart failure
Supplemental Patient Information
- Instruct patient to report pregnancies to their physicians as soon as possible
- Advise patients to inform their physician if they are taking any NSAIDs
Pregnancy Category:C (first trimester), D (second and third trimesters)
Breastfeeding: Safety unknown. An alternate drug might be preferred especially while nursing a new born infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 19 January 2011).
Pricing data from www.DrugStore.com in U.S.A.
- Micardis 80 MG TABS [Box] (BOEHRINGER INGELHEIM)
30 mg = $122.99
90 mg = $325.95 - Micardis 40 MG TABS [Box] (BOEHRINGER INGELHEIM)
30 mg = $123.99
90 mg = $355.97 - Micardis 20 MG TABS [Box] (BOEHRINGER INGELHEIM)
30 mg = $123.19
90 mg = $337.09
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.
