Telmisartan

# Telmisartan ## Overview - **Classification**: Angiotensin II Receptor Blocker (ARB) - **Mechanism**: Selectively blocks the binding of angiotensin II to the AT1 receptor, preventing vasoconstriction and aldosterone secretion. ## Primary Indications 1. **Hypertension**: Treatment of essential hypertension in adults. 2. **Cardiovascular (CV) Risk Reduction**: Reduction of cardiovascular morbidity in adults 55 years or older at high risk of CV events. ## Adult Dosing ### Standard Dosing **Hypertension** - **Dose**: Initiate **40 mg** - **Frequency**: Once daily - **Route**: Oral - **Maximum Dose**: **80 mg** once daily (BP effect after 4-8 weeks) **Cardiovascular Risk Reduction** - **Dose**: **80 mg** - **Frequency**: Once daily - **Route**: Oral ### Dose Adjustments - **Renal Impairment**: No initial dose adjustment required. Monitor renal function periodically. Not dialyzable. - **Hepatic Impairment**: Max dose **40 mg** once daily in mild to moderate hepatic impairment. Contraindicated in severe hepatic impairment. - **Elderly Patients**: No dose adjustment typically needed. Monitor closely for signs of hypotension and renal function. ## Pediatric Dosing *Telmisartan is not recommended for pediatric patients under 18 years of age due to lack of established safety and efficacy.* ### Neonates (0-28 days) - **Special Notes**: Safety and efficacy not established. Not recommended. ### Infants (1-12 months) - **Special Notes**: Safety and efficacy not established. Not recommended. ### Children (1-12 years) - **Special Notes**: Safety and efficacy not established. Not recommended. ### Adolescents (13-18 years) - **Special Notes**: Safety and efficacy not established. Not recommended. ## Safety Information ### Contraindications - **Absolute**: Pregnancy (particularly 2nd and 3rd trimesters) - **Absolute**: Hypersensitivity to telmisartan or any component - **Absolute**: Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (CrCl < **60 mL/min**) ### Common Adverse Effects - **Common (1-10%)**: Dizziness, back pain, diarrhea, sinusitis, dyspepsia, fatigue - **Serious but Rare**: Angioedema, hyperkalemia, acute renal failure, symptomatic hypotension ### Key Drug Interactions - **Potassium-sparing diuretics, K+ supplements**: Increased risk of **hyperkalemia**. Avoid co-administration or monitor K+ closely. - **NSAIDs (including COX-2 inhibitors)**: May reduce antihypertensive effect and increase risk of **renal impairment**. Monitor BP and renal function. - **Lithium**: Increased serum lithium concentrations and toxicity. Monitor lithium levels closely. - **Aliskiren**: Increased risk of hypotension, hyperkalemia, and renal impairment (especially in DM or renal impairment). **Contraindicated** in these populations. - **Digoxin**: Increased peak and trough digoxin concentrations. Monitor digoxin levels when initiating, adjusting, or discontinuing telmisartan. ## Monitoring & Follow-up - **Before Treatment**: Baseline blood pressure (BP), renal function (SCr, BUN), serum electrolytes (potassium). - **During Treatment**: BP regularly. Renal function and electrolytes periodically (e.g., annually or as clinically indicated). - **Clinical Signs**: Monitor for dizziness, lightheadedness (hypotension), and signs of angioedema (swelling of face, lips, tongue). ## Clinical Pearls - 💡 **Timing**: Can be taken with or without food. - 💡 **Full Effect**: Maximum BP reduction typically achieved after **4 to 8 weeks** of therapy. - 💡 **Pregnancy Warning**: Counsel all women of childbearing potential about the risks during pregnancy. Discontinue if pregnancy is detected. - 💡 **Consistency**: Emphasize consistent daily administration for optimal blood pressure control. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.