telmisartan (Rx)

Brand and Other Names:Micardis
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 20mg
  • 40mg
  • 80mg
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Hypertension

40 mg/day PO initially; titrated to 20-80 mgday PO, depending on response; patients with volume depletion should receive the lower dosage initially, under close supervision

Dosing considerations

  • Generally, adjust dosage monthly; adjust more aggressively in high-risk patients
  • Also given in combination with hydrochlorothiazide (Micardis HCT) or amlodipine (Twynsta)

Cardiovascular Risk Reduction

80 mg/day PO; whether dosages <80 mg/day reduce risk of cardiovascular morbidity or mortality is unknown

Dosing Modifications

Renal impairment: Dosage adjustment not necessary; hemodialysis (HD) patients at risk for orthostatic hypotension

Hepatic impairment: Initiate at low dosage; titrate slowly; monitor

<18 years old: Safety and efficacy not established

Hypertension

20 mg/day PO initially; maintenance: 20-80 mg/day

Cardiovascular Risk Reduction

80 mg/day PO

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Interactions

Interaction Checker

and telmisartan

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Upper respiratory tract infection (URTI) (7%)

            Back pain (3%)

            Diarrhea (3%)

            Myalgia (3%)

            Sinusitis (3%)

            Chest pain (1%)

            Hypertension (1%)

            Headache (1%)

            Dizziness (1%)

            Pharyngitis (1%)

            <1%

            Abnormal ECG

            Anemia

            Angina

            Angioedema

            Bradycardia

            Eczema

            Epistaxis

            Gout

            Hypercholesterolemia

            Hyperkalemia

            Hypoglycemia

            Otitis media

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            Warnings

            Black Box Warnings

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

            Contraindications

            Hypersensitivity (anaphylaxis, angioedema)

            Pregnancy (2nd and 3rd trimesters); significant risk of fetal or neonatal morbidity and mortality (see Black Box Warnings)

            Bilateral renal artery stenosis

            Do not coadminister with aliskiren in patients with diabetes

            Cautions

            Correct any volume or salt depletion before initiating therapy; observe for signs and symptoms of hypotension

            Less blood pressure response in black patients than in white patients

            Risk of sensitivity reactions, including anaphylactoid reactions or angioedema

            Congestive heart failure (CHF); risk of renal dysfunction

            Renal impairment, obstructive biliary disease, or hepatic impairment

            Dual blockade of the renin-angiotensin system with angiotensin-receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, or aliskiren is associated with increased risk of hypotension, hyperkalemia, and altered renal function (including acute renal failure) in comparison with monotherapy

            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: 1st trimester, C; 2nd and 3rd trimesters, D

            Lactation: Not known whether drug is excreted in breast milk; avoid using

            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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            Pharmacology

            Mechanism of Action

            Angiotensin II receptor blocker; inhibits vasoconstrictor and aldosterone-secreting effects of angiotensin II

            Absorption

            Onset: 1-2 hr

            Duration: <24 hr

            Peak plasma time: 0.5-1 hr

            Distribution

            Protein bound: >99.5%

            Vd: 500 L

            Metabolism

            Metabolized in liver to inactive metabolite

            Elimination

            Half-life: 24 hr

            Dialyzable: No (HD)

            Excretion: Feces (>97%), urine (small amount)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            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
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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