Telmisartan
MICARDIS
What it isAngiotensin II receptor blocker with partial PPAR-gamma activity; hypertension and cardiovascular risk reduction.
Why this oneThe longest half-life of the ARBs, so it forgives a late dose, and it has outcome data in high-risk patients.
What limits itHyperkalemia and the hemodynamic creatinine rise. Contraindicated in pregnancy.
FDA-approved for
- hypertension (1998)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 40 mg QD | 40–80 mg QD | 80 mg QD |
| Cardiovascular risk reduction | Adults unable to take ACE inhibitors | 80 mg QD | 80 mg QD | 80 mg QD |
Titration Most antihypertensive effect within 2 wk; maximal by 4 wk
Renal No initial dosage adjustment (including hemodialysis); monitor for orthostatic hypotension on dialysis
Hepatic Biliary obstruction or hepatic insufficiency: initiate at low dose, titrate slowly
Instructions
- Take orally once daily, with or without food
- Correct volume/salt depletion before starting
- When initiating for CV risk reduction, monitor BP and adjust other BP-lowering meds as needed
Contraindications
- Do not co-administer with aliskiren in patients with diabetes
Cautions
- Fetal toxicity — discontinue when pregnancy detected
- Hypotension in volume/salt-depleted patients — correct first
- Hyperkalemia (esp. renal impairment, heart failure, K-sparing agents)
- Avoid concomitant ACE inhibitor + ARB (renal dysfunction, hypotension, hyperkalemia)
Adverse reactions
- Back pain, sinusitis, diarrhea (hypertension); intermittent claudication, skin ulcer (CV risk trials)
Pregnancy Can cause fetal harm (2nd/3rd trimester RAS effects) — discontinue when pregnancy detected
Lactation Do not breastfeed during treatment (risk of hypotension, hyperkalemia, renal impairment in infant)
⚠ BOXED WARNING
- Fetal toxicity; discontinue as soon as pregnancy is detected
Principal riskHyperkalemia and acute kidney injury
Cost, est. cash$5–$150/month
Generic entry2014
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityHyperkalemia, kidney injury, fetal toxicity and increased lithium exposure.
Mechanism of action: Telmisartan ballicule
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