telmisartan

telmisartan /tel·mi·sar·tan/ (tel?mi-sahr´tan) an angiotensin II antagonist used as an antihypertensive.

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telmisartan

Micardis

Pharmacologic class: Angiotensin II receptor antagonist

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as pregnancy is detected.

Action

Inhibits vasoconstricting effects and blocks aldosterone-producing effects of angiotensin II at various receptor sites, including vascular smooth muscle and adrenal glands

Availability

Tablets: 20 mg, 40 mg, 80 mg

⊘Indications and dosages

➣ Hypertension

Adults: 40 mg P.O. daily, titrated up or down within range of 20 to 80 mg daily based on response and tolerance

Contraindications

• Hypersensitivity to drug or its components
• Pregnancy (second and third trimesters), breastfeeding

Precautions

Use cautiously in:
• heart failure, impaired renal function secondary to primary renal disease or renal stenosis, obstructive biliary disorders, hepatic impairment, volume or sodium depletion
• patients receiving high-dose diuretics
• pregnant patients in first trimester
• females of childbearing age
• children younger than age 18 (safety not established).

Administration

• Don't remove tablet from blister pack until just before giving.
• Know that drug may be used alone or with other antihypertensives.

Route	Onset	Peak	Duration
P.O.	Unknown	0.5-1 hr	24 hr

Adverse reactions

CNS: dizziness, headache, fatigue

CV: chest pain, peripheral edema, hypertension

EENT: sinusitis, pharyngitis

GI: nausea, vomiting, diarrhea, dyspepsia, abdominal pain

GU: urinary tract infection

Musculoskeletal: myalgia, back and leg pain

Respiratory: cough, upper respiratory infection

Other: pain, flu or flulike symptoms

Interactions

Drug-drug. Antihypertensives, diuretics: increased risk of hypotension

Digoxin: increased digoxin blood level

Warfarin: decreased warfarin blood level

Drug-diagnostic tests. Creatinine: slight elevation

Drug-food. Any food: slightly reduced drug bioavailability

Patient monitoring

• Watch for signs and symptoms of hypotension.
• Correct volume deficits as appropriate before therapy starts. Monitor fluid intake and output and creatinine level during therapy.

Patient teaching

• Tell patient to take 1 hour before or 2 hours after meals.
• Caution patient not to remove tablet from blister pack until just before taking.
• Advise patient to report swelling or chest pain.
• Teach patient to measure blood pressure regularly and report significant changes.
• Tell patient to report suspected pregnancy to prescriber. Caution her not to breastfeed.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.