telmisartan
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telmisartan
[tel″mĭ-sahr´tan]telmisartan
Pharmacologic class: Angiotensin II receptor antagonist
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
FDA Box Warning
Drugs that act directly on the renin-angiotensin system can cause injury to or death of a developing fetus. Discontinue drug as soon as possible when 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
➣ Cardiovascular risk reduction
Adults: 80 mg P.O. daily in patients unable to take angiotensin-converting enzyme (ACE) inhibitors
Contraindications
• Hypersensitivity to drug or its components
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
• concomitant use of ACE inhibitors and angiotensin receptor blockers (avoid use)
• pregnant or breastfeeding patients
• 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.
Adverse reactions
CNS: dizziness, headache, fatigue
CV: chest pain, peripheral edema, hypertension, intermittent claudication
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
Skin: ulcer
Other: pain, flu or flulike symptoms, hypersensitivity
Interactions
Drug-drug. Antihypertensives, diuretics: increased risk of hypotension
Ace inhibitors (ramipril): increased ramipril steady-state Cmax and area under the curve (AUC), decreased telmisartan Cmax and AUC
Digoxin: increased digoxin blood level
Lithium: increased serum lithium concentration and toxicity
Nonsteroidal anti-inflammatory drugs, including selective cyclooxygenase-2 inhibitors): deterioration of renal function, including possible acute renal failure in elderly patients, volume-depleted patients (including those on diuretic therapy), or with compromised renal function; attenuated telmisartan antihypertensive effect
Drug-diagnostic tests. Creatinine: slight elevation
Drug-food. Any food: slightly reduced drug bioavailability
Patient monitoring
• Monitor blood pressure frequently and watch for signs and symptoms of hypotension.
• Closely monitor patient with impaired hepatic or renal function. 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.