Hydrochlorothiazide + Telmisartan

Hydrochlorothiazide + Telmisartan is a combination medicine that helps control high blood pressure. Telmisartan is an angiotensin receptor blocker (ARB) that blocks the hormone angiotensin, relaxing blood vessels and allowing blood to flow more smoothly. Hydrochlorothiazide is a diuretic that removes extra water and electrolytes from the body. This combination can be used alone or with other antihypertensive agents to lower blood pressure and reduce the risk of cardiovascular events.

• Hypertension (high blood pressure) - to lower blood pressure

Adult Dose (Oral):

• Initial: Telmisartan 80 mg + HCTZ 12.5 mg once daily (in patients not adequately controlled on telmisartan 80 mg monotherapy or controlled on HCTZ 25 mg but experiencing hypokalemia)
• May titrate up to 160 mg + 25 mg as needed
• Max: Telmisartan 160 mg & hydrochlorothiazide 25 mg daily

Hepatic Impairment: Initiate with low dose; titrate slowly; monitor

Renal Dose: No dose adjustment necessary; hemodialysis patients are more susceptible to hypotension

Common Side Effects:

• Fatigue
• Dizziness
• Nausea
• Diarrhea
• Sinus inflammation
• Flu-like symptoms
• Upper respiratory tract infection

Others: Drowsiness, flushing, back pain, stomach pain, allergy, fever, leg pain, chest pain, insomnia, dry mouth, elevated liver enzymes, leg cramps, myalgia, dermatitis, weakness, gastric irritation, photosensitivity, urticaria

Precautions:

• Hydrochlorothiazide + Telmisartan may decrease alertness, affect vision or make you feel sleepy and dizzy; do not drive if these symptoms occur
• May cause dehydration; drink plenty of fluids; inform doctor if extreme thirst, very dry mouth or muscle weakness develops
• May cause dizziness; get up slowly when rising from a sitting or lying position
• Not safe during pregnancy and breastfeeding
• Tell doctor about medical history: kidney disease, liver disease, bile duct blockage, dehydration, mineral imbalance, gout, lupus
• If diabetic, monitor blood sugar regularly
• Consult doctor before using potassium supplements or salt substitutes containing potassium

Contraindications:

• Hypersensitivity (anaphylaxis or angioedema)
• Severe hepatic impairment
• Biliary obstructive disorders
• Pregnancy
• Lactation
• Do not co-administer aliskiren in patients with diabetes

Drug Interactions:

• Alcohol, Barbiturates, Narcotics: May potentiate orthostatic hypotension
• Antidiabetic drugs (oral and insulin): Dosage adjustment may be required
• Other antihypertensives: Additive effect
• Lithium: May increase serum lithium concentration
• NSAIDs (aspirin, ibuprofen, naproxen): May reduce antihypertensive effect and cause deterioration of renal function
• Corticosteroids: May intensify electrolyte depletion
• Aliskiren: Do not co-administer in patients with diabetes
• Cholestyramine & Colestipol: Reduced absorption

Food Interactions: It is not known whether it is safe to consume alcohol with Hydrochlorothiazide + Telmisartan; consult your doctor.

Use in Pregnancy: Category D; use of drugs acting on the renin-angiotensin system during the second and third trimesters reduces fetal renal function and increases fetal and neonatal morbidity and death; discontinue when pregnancy is detected.

Use in Lactation: It is not known whether telmisartan is excreted in human milk; thiazides appear in human milk; decide whether to discontinue nursing or discontinue the drug.

Renal Impairment: Safety and efficacy not established in severe renal impairment (CrCl <30 mL/min); not recommended. No dose adjustment required in mild (CrCl 60-90) or moderate (CrCl 30-60) renal impairment.

Hepatic Impairment: Patients with biliary obstructive disorders or hepatic insufficiency should initiate treatment under close medical supervision.

Overdose: Hypotension, dizziness, tachycardia, bradycardia, hypokalemia, hypochloremia, hyponatremia and dehydration; telmisartan is not removed by hemodialysis; degree of hydrochlorothiazide removal by hemodialysis not established.