telmisartan

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telmisartan

 [tel″mĭ-sahr´tan]
an angiotensin II antagonist used as an antihypertensive, administered orally.

telmisartan

Micardis

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.

telmisartan

(tĕl′mĭ-sär′tăn)
n.
An angiotensin II receptor blocker drug, C33H30N4O2, used primarily to treat hypertension.

telmisartan

Micardis® Cardiology An angiotensin II receptor antagonist for treating HTN. See Angiotensin II receptor antagonist.