telmisartan

Absorption: 42–58% absorbed following oral administration (bioavailability ↑ in hepatic impairment).

Distribution: Widely distributed to tissues.

Protein Binding: 99.5%.

Metabolism/Excretion: Excreted mostly unchanged in feces via biliary excretion.

Half-Life: 24 hr.

Time/Action Profile ⬆ ⬇

(antihypertensive effect)

ROUTE	ONSET	PEAK	DURATION
PO	within 3 hr*	4 wk‡	24 hr‡

*After single dose.

‡Chronic dosing.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Bilateral renal artery stenosis;
Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr <60 mL/min);
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Volume- or salt-depleted patients or patients receiving large doses of diuretics (correct deficits before initiating therapy);
Black patients (may not be as effective);
Renal impairment caused by primary renal disease or heart failure (may worsen renal function);
Obstructive biliary disorders or hepatic impairment;
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

EENT: sinusitis

F and E: hyperkalemia

GI: abdominal pain, diarrhea, dyspepsia

GU: renal impairment

MS: back pain, myalgia

Neuro: dizziness, fatigue, headache

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

Additive hypotensive effects with other antihypertensives.
Excessive hypotension may occur with concurrent use of diuretics.
↑risk of hyperkalemia with concurrent use of potassium supplements, potassium-containing salt substitutes, or potassium-sparing diuretics.
↑risk of hyperkalemia, renal impairment, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min; avoid concurrent use with ACE inhibitors.
May ↑ levels and risk of toxicity of digoxin.
NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal impairment.
↑risk of renal impairment when used with ramipril; concurrent use not recommended.

Route/Dosage ⬆ ⬇

Hypertension

PO (Adults ): 40 mg once daily (volume-depleted patients should start with 20 mg); may be titrated up to 80 mg/day.

Cardiovascular Risk Reduction

PO (Adults ): 80 mg once daily.

Availability ⬆ ⬇

(Generic available)

Tablets: 20 mg; 40 mg; 80 mg
In combination with: hydrochlorothiazide (Micardis HCT); amlodipine; see Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess BP (lying, sitting, standing) and HR frequently during initial dose adjustment and periodically during therapy.
Assess for signs of angioedema (dyspnea, facial swelling).

Lab Test Considerations:

Monitor renal function. May ↑ BUN and serum creatinine.
- May cause hyperkalemia.

Implementation ⬆ ⬇

Volume depletion should be corrected, if possible, before initiation of therapy.
PO: May be administered without regard to food.

Patient/Family Teaching ⬆ ⬇

Emphasize importance of taking as directed, even if feeling well. Take missed doses as soon as remembered if not almost time for next dose; do not double doses. Take at the same time each day. Warn patient not to discontinue therapy unless directed by health care professional. Advise patient to read Patient Information prior to starting therapy and with each refill in case of changes.
Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See Food Sources for Specific Nutrients.
Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, stress management). Medication controls but does not cure hypertension.
Instruct patient and family on proper technique for monitoring BP. Advise to check BP at least weekly and to report significant changes. The effect of telmisartan is apparent within 2 wk and has maximal effect around 4 wk.
Caution patient to avoid sudden changes in position to ↓ orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may ↑ orthostatic hypotension.
May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs and cough, cold, or allergy remedies.
Instruct patient to notify health care professional of medication regimen before treatment or surgery.
Instruct patient to notify health care professional if swelling of face, eyes, lips, or tongue or difficulty swallowing or breathing occur.
Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
Rep: May cause fetal harm. Advise women of reproductive potential to use contraception and notify health care professional if pregnancy is planned or suspected or if breastfeeding. If pregnancy is detected, discontinue medication as soon as possible.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇