telmisartan (Rx)

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

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)

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.

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)