Generic
Telmisartan
60 brands available in the market
At a glance
Telmisartan is an angiotensin II receptor blocker (ARB) used for hypertension, heart failure, and reduction of cardiovascular morbidity. It relaxes blood vessels by blocking AT1 receptors, lowering blood pressure.
Description
Telmisartan is a non-peptide angiotensin II receptor antagonist. It selectively binds to AT1 receptors, blocking the vasoconstrictive and aldosterone-secreting effects of angiotensin II. It has >3,000-fold greater affinity for AT1 than AT2 receptors. It does not inhibit ACE, so it does not affect bradykinin responses.
Indications
- Essential hypertension
- Reduction of cardiovascular morbidity (atherosclerotic CVD or type 2 diabetes with target organ damage)
- Heart failure
Therapeutic class
Angiotensin II Receptor Blockers
Pharmacological class
ARB (Angiotensin Receptor Blocker)
Pharmacology
Telmisartan blocks AT1 receptors, inhibiting angiotensin II-induced vasoconstriction and aldosterone secretion. This relaxes blood vessels, reduces peripheral vascular resistance, and lowers blood pressure. It does not inhibit ACE, so bradykinin levels are unaffected.
Mechanism of action
Lowers blood pressure by relaxing blood vessels via AT1 receptor blockade.
Dosage
Adult Dose (Oral):
- Hypertension: Start 40 mg/day; dose-related response 20-80 mg; max 80 mg/day; effect seen in 2 weeks, maximum at 4 weeks
- Cardiovascular risk reduction: 80 mg/day
- Elderly: No dose adjustment needed
- Hepatic impairment: Not recommended for initiation in ≥75 years or with hepatic impairment
Administration
- Take with or without food
- Swallow tablet whole; do not chew, crush, or break
- Take at the same time each day
Missed dose
If you miss a dose, skip it and continue with your normal schedule; do not double the dose.
Side effects
Common Side Effects:
- Back pain
- Diarrhea
- Nasal congestion (sinus congestion)
- Sinus pain
Precautions & warnings
- Unsafe in pregnancy (Category D); fetal risk
- Do not use in severe hepatic impairment, biliary obstructive disorders
- Titrate slowly in renal impairment
- Risk of hyperkalemia; avoid potassium supplements and potassium-rich foods
Contraindications
- Severe hepatic impairment
- Biliary obstructive disorders
- Pregnancy
- Lactation
Drug interactions
- Digoxin: Increased plasma levels
- Lithium: Increased serum levels and toxicity
- Warfarin: Decreased plasma levels
- NSAIDs: Antagonize hypotensive effect and increase renal impairment risk
- Aliskiren (diabetes + GFR <60): Increased nephrotoxicity, hyperkalemia, and hypotensive effect (potentially fatal)
Food interactions
Alcohol is unsafe with Telmisartan (excessive blood pressure reduction).
Use in pregnancy
Use in Pregnancy: Unsafe (Category D); evidence of fetal risk; use only in life-threatening situations; consult your doctor.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Probably safe; limited data suggests no significant risk; consult your doctor.
Pediatric use
Safety and efficacy not established in children <18 years
Geriatric use
Elderly: No dose adjustment needed
Renal / hepatic impairment
Renal Impairment: Mild-moderate: no dose adjustment; severe: titrate slowly; dialysis patients risk orthostatic hypotension; consult your doctor.
Hepatic Impairment: Caution and slow titration in biliary obstructive disorders or hepatic insufficiency; do not use in severe liver disease; consult your doctor.
Overdose effects
Overdose may cause hypotension, dizziness, tachycardia; severe cases may cause bradycardia, increased serum creatinine, acute renal failure; provide symptomatic treatment.
Storage conditions
Store below 30°C, protected from light and high humidity; keep out of reach of children.
Chemical structure
Telmisartan