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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.
Inhibits vasoconstricting effects and blocks aldosterone-producing effects of angiotensin II at various receptor sites, including vascular smooth muscle and adrenal glands
Tablets: 20 mg, 40 mg, 80 mg
Indications and dosages
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
• Hypersensitivity to drug or its components
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).
• Don't remove tablet from blister pack until just before giving.
• Know that drug may be used alone or with other antihypertensives.
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
Other: pain, flu or flulike symptoms, hypersensitivity
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
• 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.
• 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.
Pharmacologic: angiotensin ii receptor antagonists
Time/action profile (antihypertensive effect)
|PO||within 3 hr*||4 wks†||24 hr†|
Adverse Reactions/Side Effects
Central nervous system
Ear, Eye, Nose, Throat
Fluid and Electrolyte
- abdominal pain
- impaired renal function
- back pain
- angioedema (life-threatening)
Drug-Drug interactionAdditive 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 dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/minMay ↑ serum digoxin levels.NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.↑ risk of renal dysfunction when used with ramipril ; concurrent use not recommended.
Cardiovascular Risk Reduction
- Assess BP (lying, sitting, standing) and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
- Monitor frequency of prescription refills to determine compliance.
- Assess patients for signs of angioedema (dyspnea, facial swelling).
- Lab Test Considerations: Monitor renal function. May cause ↑ BUN and serum creatinine.
- May cause hyperkalemia.
Potential Nursing DiagnosesRisk for injury (Adverse Reactions)
Noncompliance (Patient/Family Teaching)
- Volume depletion should be corrected, if possible, before initiation of therapy.
- Emphasize the importance of continuing to take as directed, even if feeling well. Take missed doses as soon as remembered if not almost time for next dose; do not double doses. Instruct patient to take medication 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.
- 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 them to check BP at least weekly and to report significant changes.
- Caution patient to avoid sudden changes in position to decrease orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase 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 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 if difficulty swallowing or breathing occur.
- Emphasize the importance of follow-up exams to evaluate effectiveness of medication.
- Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected or if breastfeeding.
- Decrease in BP without appearance of excessive side effects.
- Decreased risk of myocardial infarction, stroke, or cardiovascular death.