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