What it's for (Indications)
- Telmisartan is indicated for the treatment of hypertension (increased blood pressure).
- It is also used for cardiovascular risk reduction in patients with established atherosclerotic cardiovascular disease or with type 2 diabetes with end-organ damage.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | Telmisartan may be administered with or without food. For Hypertension: The usual starting dose is 40 mg once daily, with a dose range of 40 to 80 mg once daily. Dosage must be individualized. Most of the antihypertensive effect is apparent within 2 weeks, with maximal reduction generally attained after 4 weeks. No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis; however, patients on dialysis should be closely monitored for orthostatic hypotension. For Cardiovascular Risk Reduction: The recommended dose is 80 mg once daily. Blood pressure monitoring is recommended, and if appropriate, adjustment of medications that lower blood pressure may be necessary. |
Safety & Warnings
Common Side Effects
- Patients may experience upper respiratory tract infections, back pain, sinusitis, and diarrhea.
- Serious adverse events reported in cardiovascular risk reduction trials include intermittent claudication and skin ulcer.
- Renal dysfunction may occur upon concomitant use with ramipril.
Serious Warnings
- Black Box Warning: WARNING: FETAL TOXICITY. When pregnancy is detected, discontinue telmisartan as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
- Telmisartan should not be used in pregnancy and must be discontinued as soon as possible if pregnancy is detected due to the risk of fetal injury and death.
- It should also not be used by lactating mothers; consult a doctor if no alternative medicine exists.
- Use with extreme caution in patients with impaired hepatic function, bilateral renal artery stenosis, renovascular hypertension, and mild to moderate renal impairment.
- While no initial dosage adjustment is typically needed for elderly patients or patients with renal impairment (including those on hemodialysis), patients on dialysis may develop orthostatic hypotension and require close monitoring.
- This medication may impair glucose tolerance.
- Patients should avoid driving as it may affect their ability to drive, and alcohol consumption should be avoided while taking this medicine.
- For cardiovascular risk reduction, monitoring of blood pressure is recommended, and adjustment of other blood pressure-lowering medications may be necessary.
How it Works (Mechanism of Action)
Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). Angiotensin II is the principal pressor agent of the renin-angiotensin system, with effects that include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation, and renal reabsorption of sodium. Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. Its action is therefore independent of the pathways for angiotensin II synthesis. Telmisartan has much greater affinity (>3,000 fold) for the AT1 receptor than for the AT2 receptor, which is not known to be associated with cardiovascular homeostasis.