TELMISARTAN

TELMISARTAN
(tel-mi-sar'tan)
Micardis
Classifications: angiotensin ii receptor antagonist, antihypertensive;
Therapeutic: antihypertensive, angiotensin ii receptor antagonist

Prototype: Losartan potassium
Pregnancy Category: C first trimester; D second and third trimester

Availability

40 mg, 80 mg tablets

Action

Angiotensin II receptor (type AT1) antagonist. Selectively blocks the binding of angiotensin II to the AT1 receptors in many tissues (e.g., vascular smooth muscles, adrenal glands). Blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II, thus resulting in an antihypertensive effect.

Therapeutic Effect

Effectiveness is indicated by a reduction in BP.

Uses

Treatment of hypertension.

Contraindications

Hypersensitivity to telmisartan or other angiotensin receptor antagonists (e.g., losartan, eprosartan, etc.); pregnancy (category C first trimester; category D second and third trimester), lactation.

Cautious Use

Coronary artery disease (CAD); hypertropic cardiomyopathy; CHF; oliguria; hypotension; renal artery stenosis; older adult patients; biliary obstruction; liver dysfunction; renal impairment. Safety and efficacy in children <18 y are not established.

Route & Dosage

Hypertension
Adult: PO 40 mg q.d., may increase to 80 mg/d

Administration

Oral
  • Do not remove tablets from blister pack until immediately before administration.
  • Correct volume depletion prior to initial dose.
  • Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Back pain, flu-like syndrome, myalgia, headache, fatigue. CNS: Dizziness. CV: Hypotension, hypertension, chest pain, peripheral edema. GI: Diarrhea, dyspepsia, abdominal pain, nausea. Respiratory: Sinusitis, pharyngitis.

Interactions

Drug: Telmisartan may increase digoxin levels.

Pharmacokinetics

Absorption: Absorption is dose dependent, 42% of 40 mg dose is absorbed. Peak: 0.5–1 h. Distribution: >99% protein bound. Metabolism: Minimally metabolized. Elimination: Primarily in feces as unchanged drug. Half-Life: 24 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor BP carefully after initial dose; and periodically thereafter. Monitor more frequently with preexisting biliary obstructive disorders or hepatic insufficiency.
  • Monitor dialysis patients closely for orthostatic hypotension.
  • Lab tests: Periodic Hgb, creatinine clearance, liver enzymes.
  • Monitor concomitant digoxin levels throughout therapy.

Patient & Family Education

  • Report pregnancy to physician immediately.
  • Allow between 2–4 wk for maximum therapeutic response.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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