telmisartan/hydrochlorothiazide (Rx)Brand and Other Names:Micardis HCT, MicardisPlus

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

telmisartan/hydrochlorothiazide

tablet

  • 40mg/12.5mg
  • 80mg/12.5mg
  • 80mg/25mg
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Hypertension

Dosage range: 80-160 mg telmisartan/12.5-25 mg hydrochlorothiazide PO qDay

Renal impairment

Dose adjustment not necessary

Hemodialysis patients are more susceptible to hypotension

Hepatic Impairment

Biliary obstruction or hepatic insufficiency is expected to reduce clearance

Initiate therapy with low dose; titrate slowly; monitor

Safety and efficacy not established

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Interactions

Interaction Checker

telmisartan/hydrochlorothiazide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Telmisartan

            • Upper respiratory infection (7%)
            • Urinary tract infection (1%)
            • Back pain (3%)
            • Diarrhea (3%)
            • Myalgia (3%)
            • Fatigue (1%)
            • Sinusitis (3%)
            • Peripheral edema (1%)
            • Chest pain (1%)
            • Hypertension (1%)
            • Dyspepsia (1%)
            • Headache (1%)
            • Dizziness (1%)
            • Pharyngitis (1%)

            Frequency Not Defined

            Hydrochlorothiazide

            • Anorexia
            • Epigastric distress
            • Hypotension
            • Orthostatic hypotension
            • Photosensitivity
            • Anaphylaxis
            • Anemia
            • Confusion
            • Erythema multiforme
            • Stevens-Johnson syndrome
            • Exfoliative dermatitis including toxic epidermal necrolysis
            • Dizziness
            • Hypokalemia and/or hypomagnesemia
            • Hyperuricemia
            • Headache
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            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system causing oligohydramnios, which may result in fetal injury and/or death

            Contraindications

            Hypersensitivity (anaphylaxis, angioedema) to telmisartan, hydrochlorothiazide, or sulfonamides

            Pregnancy (2nd and 3rd trimesters): Significant risk of fetal/neonatal morbidity and mortality (see Black Box Warnings)

            Anuria

            Do not coadminister with aliskiren in patients with diabetes

            Not for initial treatment

            Cautions

            Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

            Fixed combination product is not recommended in patients with severe renal or hepatic impairment

            Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy

            Electrolyte disturbances may occur

            Photosensitivity may occur

            Hyperuricemia may occur or gout may be precipitated in certain patients receiving thiazide therapy

            Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides

            Thiazides may decrease urinary calcium excretion

            Caution in  aortic mitral stenosis, hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, bilateral renal artery stenosis or anuria

            As a consequence of inhibiting the renin-angiotensin-aldosterone system (RAA), changes in renal function may be anticipated in susceptible individuals; in patients whose renal function depends on RAA (eg, severe CHF), treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death

            Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy; avoid combined use of RAS inhibitors; closely monitor blood pressure, renal function and electrolytes in patients on benazepril and other agents that affect the RAS

            Not for coadministration with aliskiren in patients with diabetes; avoid use of aliskiren with benazepril in patients with renal impairment (GFR <60 ml/min/1.73 m²)

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            Pregnancy & Lactation

            Pregnancy Category: C (1st trimester); D (2nd & 3rd trimesters)

            Lactation: discontinue drug or do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
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