telmisartan: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
telmisartan: clinical details
Prescribing considerations
- Correct clinically significant volume or sodium depletion before initiation.
- Assess renal impairment, renovascular disease, hepatic disease, hyperkalaemia risk and concurrent medicines affecting the renin–angiotensin system.
- Use caution in aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy and ischaemic cardiovascular disease.
- Telmisartan is generally ineffective in primary aldosteronism and is not recommended for this condition.
- Safety and efficacy below 18 years have not been established for the selected product.
Contraindications and cautions
- Hypersensitivity to telmisartan or an excipient.
- Second or third trimester of pregnancy.
- Biliary obstructive disorders.
- Severe hepatic impairment.
- Concurrent aliskiren in diabetes or renal impairment with a glomerular filtration rate below the product-defined threshold.
Monitoring
- Assess blood pressure, renal function and serum potassium before and during treatment, with closer review after clinically relevant changes or acute illness.
- Monitor serum sodium where clinically indicated, particularly with volume depletion or interacting treatment.
- Consider blood-glucose monitoring in people using insulin or other glucose-lowering medicines.
- Monitor digoxin or lithium concentrations when relevant combinations cannot be avoided.
Clinical pharmacology
Telmisartan is a selective, long-binding AT1-receptor antagonist. It is highly protein bound, undergoes glucuronide conjugation and is eliminated mainly unchanged through the faeces; urinary excretion is minimal and it is not removed by dialysis.
Formulation and product differences
- The selected product is an uncoated, white to off-white tablet supplied in aluminium blisters and should remain in its original package until use because it is moisture sensitive.
- It contains mannitol and is essentially sodium-free.
- Crushing or dispersing telmisartan tablets for adults with swallowing difficulty is an off-label administration method requiring individual assessment.
telmisartan preparations and strengths
Tablet
Route: Oral
Strengths: 20 mg, 40 mg, 80 mg
telmisartan interactions
Check prescribed, over-the-counter and complementary products because telmisartan can affect blood pressure, kidney function and potassium.
ACE inhibitors or other ARBs
Combining renin–angiotensin system blockers increases the risks of low blood pressure, high potassium and impaired kidney function and is generally not recommended.
Aliskiren
The combination is contraindicated in people with diabetes or impaired renal function and otherwise requires careful clinical justification.
Potassium supplements, potassium-containing salt substitutes or potassium-sparing diuretics
These can cause a clinically important rise in blood potassium and require avoidance or close monitoring.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.