Scope and a short outline of the key ideas

Telmisartan, marketed under brand names such as Micardis among others, is an angiotensin II receptor blocker (ARB). It lowers blood pressure by relaxing vascular smooth muscle coupled with thereby reducing systemic vascular resistance and cardiac workload.

In clinical practice it is prescribed for treating raised blood pressure and in selected patients to decrease cardiovascular risk. Telmisartan may be used on its own or combined with other antihypertensive agents; see the section on choosing among backup options: a comparison for commonly combined classes.

Common tablet strengths available in the UK include 20 mg and 40 mg. Some manufacturers also supply an 80 mg strength depending on stock. In the interest of safety, refer to the safety a division in the text. proactive precautions and for possible unwanted effects consult unfavorable effects.

Clinical purposes

Telmisartan is typically used for:

  • Treatment of essential hypertension in adults where lowering blood pressure is indicated.
  • Reducing the risk of cardiovascular events in patients at high risk, for example those with established atherosclerotic disease or type 2 diabetes with target organ damage, particularly when ACE inhibitors are not suitable.

Blood pressure response is often noticeable within two to four weeks, though maximal benefit can take longer. Do not stop therapy abruptly without consulting your prescriber.

Dosing and administration considerations

The following is general dosing information and does not replace individual advice from a clinician.

  • Typical initial dose for many adults: 40 mg once daily.
  • Usual maintenance range: 20 mg to 80 mg once daily depending on response and tolerance.
  • Take at the same time each day. Tablets may be taken with or without food but aim to be consistent.
  • Allow several weeks for full antihypertensive effect. Continue treatment even if you feel well unless advised otherwise.

Certain groups, such as those who are volume depleted or taking strong diuretics, may start at 20 mg. If blood pressure targets are not reached combination therapy may be considered; see social the act of interactions influence perceptions and decisions. of medicationss and recommended precautions when deciding combinations.

Protective measures and safety guidelines information

Before you press on telmisartan tell your doctor or pharmacist if any of the following apply to you:

  • Known kidney disease, reduced kidney function, liver disease, heart failure or known renal artery stenosis.
  • High blood potassium, recent severe diarrhea or vomiting, or dehydration.
  • Concurrent use of diuretics, potassium supplements, potassium-containing salt substitutes or other medicines acting on the renin angiotensin aldosterone system.
  • History of allergic reactions to ARBs or prior angioedema with ACE inhibitors or ARBs.
  • If you are pregnant, trying to conceive or breastfeeding. ARBs are not safe in pregnancy and should be stopped if pregnancy is confirmed; discuss another route choices and contraception in liaison with your clinician.

Telmisartan can cause lightheadedness particularly after the first dose or following increases in dose. Stand up slowly from sitting or lying positions until you know how the medicine affects you. Limit alcohol while taking this medicine and make sure any treating clinicians know you are on telmisartan when undergoing procedures.

Critical Safety Warning bulletins and Contraindicated situations

  • Do not take telmisartan if you are pregnant. If pregnancy is suspected stop the medicine and contact your clinician immediately.
  • Known hypersensitivity to telmisartan or any product excipient.
  • Markedly reduced liver function or certain cholestatic liver disorders where use may not be appropriate.
  • Do not intermix aliskiren with an ARB in people with diabetes. Combining ACE inhibitors, ARBs and renin inhibitors increases the risk of renal impairment, high potassium and symptomatic hypotension and should usually be avoided unless monitored by a specialist.

Harmful effects

If you experience severe allergic reactions such as swelling of the face, lips, mouth, throat, difficulty breathing, fainting or severe dizziness seek emergency medical help immediately.

Other reported adverse reactions include:

  • Common or mild: dizziness, a pounding headache, back pain, nasal congestion, diarrhea, nausea, tiredness, cough, abdominal pain, muscle cramps.
  • Fluid related: peripheral edema, for example swelling of ankles or feet.
  • Laboratory changes: increased serum potassium (hyperkalaemia) in susceptible patients.
  • Blood pressure related: symptomatic low blood pressure particularly in those who are volume depleted.
  • In patients with advanced cardiovascular disease: worsening heart failure, chest pain, arrhythmias or myocardial infarction may occur but are often related to underlying disease.

If long term effects continue or cause concern speak to your healthcare professional. See also drug and drug people engage through a series of the exchange that happens when people meets. which may raise the risk of some damaging effects.

Interacting drug effects

The following medicines and substances can interact with telmisartan and may require the act of monitoring, dose adjustment or avoidance:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen: may lessen blood pressure control and increase the risk of kidney injury in elderly or dehydrated patients.
  • Diuretics, including thiazide and loop diuretics: can increase the risk of symptomatic hypotension when telmisartan is started.
  • Potassium-sparing diuretics, potassium supplements and potassium-containing salt substitutes: increase the risk of hyperkalaemia.
  • ACE inhibitors and direct renin inhibitors like aliskiren: combined RAAS blockade elevates risks of renal problems, high potassium and low blood pressure and is generally not recommended.
  • Lithium: telmisartan may increase lithium levels and careful real time monitoring is required if combined.
  • Digoxin: levels can be affected and time sensitive monitoring may be necessary when coadministered.

Always inform prescribers and pharmacists about prescribed medicines, over the counter products and herbal supplements to avoid harmful combinations. See further safety and required precautions information.

Medication dose missed and severe fatal overdose

If you miss a scheduled dose take it as soon as you remember unless the next dose is due soon. If it is nearly time for the next dose skip the the dose was omitted and return to your regular dosing schedule. Do not exceed the usual dose by taking a double dose to cover a the dose was omitted.

Overdose risk may present with marked dizziness, fainting or very low blood pressure. If you suspect an take too much medicine call NHS 111, your doctor or attend the nearest emergency department immediately. Take the medicine packaging with you if available to aid identification.

Digital temporary storage helps stage tasks before final processing. stability guidance

Keep telmisartan tablets in their original container and out of the reach and sight of children. Store below 25 C; excursions between 15 C and 30 C are generally acceptable. Protect from moisture and avoid storing in bathrooms or other damp places.

Relative options and comparisons

When telmisartan is not suitable, other options may be considered. Choice depends on medical history, side effect profile and cost. Typical option choices include:

  • Other ARBs: losartan, candesartan, valsartan, irbesartan, olmesartan. Telmisartan tends to have a long half life allowing once daily dosing; losartan is often one of the least expensive ARBs.
  • ACE inhibitors: ramipril, lisinopril, enalapril. Effective antihypertensives but may cause cough or rarely angioedema and are contraindicated in pregnancy.
  • Calcium channel blockers: amlodipine and others. Frequently recommended first line for many patients including older adults and people of Black African or Caribbean heritage.
  • Thiazide or thiazide-like diuretics: bendroflumethiazide, indapamide. Often combined with ARBs when monotherapy does not achieve targets.
  • Beta blockers: bisoprolol, atenolol. Usually chosen when additional signals such as angina or arrhythmia are present rather than for isolated mild hypertension.

For a brief comparison of typical private costs see prices in the United Kingdom. Your prescriber will balance efficacy, treatment side effects and cost when suggesting broadened options.

Price dynamics in the UK

Private retail prices vary by brand vs generic, pack size, and pharmacy. The figures below are approximate price range for a pack of 28 tablets and exclude any consultation or dispensing fees.

  • Generic telmisartan 20 mg: around 2 to 6 GBP per 28 tablets.
  • Generic telmisartan 40 mg: around 3 to 8 GBP per 28 tablets.
  • Generic telmisartan 80 mg: around 5 to 10 GBP per 28 tablets.
  • Micardis brand packs where available: often higher, for example roughly 12 to 30 GBP per 28 tablets depending on supplier.

Representative private prices for some other selections (approximate):

  • Cozaar and losartan (two names for the same drug) 50 mg: approximately 1 to 3 GBP per 28 tablets.
  • Candesartan used to lower blood pressure 8 mg: approximately 2 to 6 GBP per 28 tablets.
  • Valsartan is a BP lowering medication 80 mg: approximately 2 to 6 GBP per 28 tablets.
  • Amlodipine 5 mg: frequently priced under 1 GBP for 28 tablets.

On the NHS prescription charges may apply in England for most adults per item; prescriptions are currently free in Scotland, Wales and Northern Ireland. Prescription prepayment certificates and exemption categories can reduce or eliminate charges. Examine the data current NHS guidance for up to date key information.

Additional aspects about Micardis