Indications & Dose:
Hypertension
Usually effective dose of telmisartan is 40mg/12.5mg once daily. increased upto 80/12.5mg as per patient response.
RENAL IMPAIRED PATIENTS
The usual regimens of therapy (Telmisartan + hydrochlorothiazide) may be followed as long as the patient’s creatinine clearance is more 30mL/min. In patients with more severe renal impairment it is not recommended to use thiazide.
HEPATIC IMPAIRED PATIENTS
In patients with mild to moderate hepatic impairment the dosage should not exceed 40mg+12.5 mg once daily.
Contraindications:
USE IN PREGNANCY
When used in pregnancy during the second and third trimesters, drugs that act directly on the rennin-angiotensin system can cause injury and even death to the developing fetus. When pregnancy is detected, (Telmisartan + hydrochlorothiazide) tablets should be discontinued as soon as possible.
Side Effects:
Cautions:
Precautions:
Hepatic impairment Telmisartan + hydrochlorothiazide should be used with caution in patients with impaired hepatic function or progressive liver disease since minor alterations of fluid and electrolyte balance may precipitate hepatic coma.
Renovascular hypertension: There is an increased risk of severe hypotension and renal insufficiency when patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney are treated with medicinal products that affect the renin-angiotensin-aldosterone system. Renal impairment and kidney transplantation. There is less experience in patients with mild to moderate renal impairment, therefore, periodic monitoring of potassium, creatinine and uric acid serum levels is recommended. Thiazide diuretic-associated azotemia may occur in patients with impaired renal function.
Intravascular hypovolemia. Symptomatic hypotension, especially the first dose, may occur in patients who are volume and/or sodium depleted by vigorous diuretic therapy, dietary salt restriction, diarrhea or vomiting. Such conditions should be corrected before the administration of telmisartan + hydrochlorothiazide.
Stimulation of the renin-angiotensin-aldosterone system In patients whose vascular tone and renal function depend predominantly on the activity of the renin-angiotensin-aldosterone system (e g., patients with severe congestive heart failure or underlying renal disease, including renal artery stenosis), treatment with medicinal products that affect this system has been associated with acute hypotension. hyperazotemia. oliguria, or rarely acute renal failure. Primary aldosteronism Patients with primary aldosteronism generally will not respond to antihypertensive medicinal products acting through inhibition of the renin-angiotensin system. Therefore, the use of (Telmisartan + hydrochlorothiazide( in not recommended.
Aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy An with other vasodilators special caution is indicated in patients suffering from aerotic or mitral stenosis, or Obstructive hypertrophic cardiomyopathy.
Metabolic and endocrine effects: Thiazide therapy may impair glucose tolerance. In diabetic patients dosage adjustments of insulin or oral hypoglycemic agents may be required Latent diabetes mellitus may become manifest during thiazide therapy Increase in cholesterol and triglyceride levels have been associated with thiazide diuretic therapy. Hyperuricemia may occur or frank gout may be precipitated in some patients receiving thiazide therapy.
Electrolyte imbalance For any patient receiving diuretic therapy, periodic determination of serum electrolytes should be performed at appropriate intervals. Thiazide, including hydrochlorothiazide, can cause fluid or electrolyte imbalance (including hyperkalemia, hypokalemia, hyponatremia, hypochloremic alkalosis, hypercalcemia hypomagnesemia).
Others.
NURSING MOTHERS
(Telmisartan + hydrochlorthiazide, iv contraindicated during lactation since it is not known whether telmisartan s excreted in human milk Thiazides appear in human m 1k and may inhibit lactation
PEDIATRIC USE
Safety and effectiveness in pediatric patients have riot been established.
Interaction:
Warnings:
Adverse Effects:
Lactations:
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Common; Bronchitis, pharyngitis. sinusitis, upper respiratory tract infections, urinary tract infections, hypercholesterolemia, hypokalemia. anxiety, dizziness, vertigo, abdominal pain, diarrhea, dyspepsia, gastritis, eczema, arthralgia, osteoarthritis, back pain, muscle spasms or pain in extremity, myalgia, erectile dysfunction, influenza-like illness, pain.
Uncommon; Hypersensitivity, diabetes mellitus inadequate control, hyperuricemia.
As with other angiotensin II antagonists isolated cases of angioneurotic oedema, urticaria and other related reactions have been reported
Patient And Carer Advice:
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team