Telmisartan + Hydrochlorothiazide

Indications

Telmisartan + Hydrochlorothiazide is used for: Hypertension, Treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.

Adult Dose

Oral Hypertension Adult 1 tab (40-80 mg telmisartan/12.5-25 mg) once daily. Max: Telmisartan 160 mg & hydrochlorothiazide 25 mg daily. Hepatic Impairment Initiate therapy with low dose; titrate slowly; monitor

Child Dose

Renal Dose

Renal impairment Dose adjustment not necessary Hemodialysis patients are more susceptible to hypotension

Administration

May be taken with or without food.

Contra Indications

Severe hepatic impairment, biliary obstructive disorders. Pregnancy. Lactation.

Precautions

Hepatic insufficiency, biliary obstruction, renal impairment, renaly artery stenosis. Correct volume depletion before initiating treatment. Monitor serum potassium levels regularly, especially in elderly and renally-impaired patients. Lactation: discontinue drug or do not nurse

Pregnancy-Lactation

Pregnancy Can cause fetal harm when administered to a pregnant woman; discontinue drug when pregnancy is dectected and treat hypertension according to guidelines during pregnancy Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death Reports of hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death owing to olihydramnios Oligohydramnios in this setting has also been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development Lactation Because of the potential for serious adverse reactions in the breastfed infant including hypotension, hyperkalemia and renal impairment, advise a nursing woman not to breastfeed during treatment with telmisartan/amlodipine There is no information regarding the presence of telmisartan in human milk, the effects on the breastfed infant, or the effects on milk production Limited published studies report that amlodipine is present in human milk; however, there is insufficient information to determine the effects of amlodipine on the breastfed infant

Interactions

Lithium, kaliuretic diuretics, laxatives, corticosteroids, ACTH, amphotericin, carbenoxolone, penicillin G, salicylates, K-sparing diuretics, K supplements, K salt substitutes drugs that cause hyperkalaemia, digitalis glycosides, antiarrhythmic agents, drugs known to induce torsades de pointes, alcohol, barbiturates, narcotics, oral antidiabetics, insulin, anion-exchange resins, NSAIDs, nondepolarising skeletal muscle relaxants, pressor amines, allopurinol, Ca salts, beta-blockers, diazoxide, anticholinergics, amantadine, cytotoxics.

Adverse Effects

Side effects of Telmisartan + Hydrochlorothiazide : 1-10% Telmisartan Upper respiratory infection (7%), Urinary tract infection (1%), Back pain (3%), Diarrhea (3%), Myalgia (3%), Fatigue (1%), Sinusitis (3%), Peripheral edema (1%), Chest pain (1%), Hypertension (1%), Dyspepsia (1%), Headache (1%), Dizziness (1%), Pharyngitis (1%) Frequency Not Defined Hydrochlorothiazide Anorexia, Epigastric distress, Hypotension, Orthostatic hypotension, Photosensitivity, Anaphylaxis, Anemia, Confusion, Erythema multiforme, Stevens-Johnson syndrome, Exfoliative dermatitis including toxic epidermal necrolysis, Dizziness, Hypokalemia and/or hypomagnesemia, Hyperuricemia Potentially Fatal: Rarely angioedema, rash, pruritus and urticaria.

Mechanism of Action

Hydrochlorothiazide inhibits the reabsorption of Na and chloride in the distal tubules causing increased excretion of Na and water K and hydrogen ions. Telmisartan is a nonpeptide AT1 angiotensin II receptor antagonist. It exerts antihypertensive activity by preventing angiotensin II from binding to AT1 receptors thus inhibiting the vasoconstricting and aldosterone-secreting effects of angiotensin II.