Telmipres Plus(Telmisartan & Hydrochlorothiazide)
Therapeutic Group: Cardiovascular
Presentation
Telmipres Plus 40/12.5: Each tablet contains Telmisartan BP 40 mg & Hydrochlorothiazide BP 12.5 mg.
Telmipres Plus 80/12.5: Each tablet contains Telmisartan BP 80 mg & Hydrochlorothiazide BP 12.5 mg.
Telmipres Plus 80/25: Each tablet contains Telmisartan BP 80 mg & Hydrochlorothiazide BP 25 mg.
Description
Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. Its action is therefore independent of the pathways for angiotensin II synthesis. Telmisartan has much greater affinity (>3,000 fold) for the AT1 receptor than for the AT2 receptor. Because telmisartan does not inhibit ACE (kininase II), it does not affect the response to bradykinin. Telmisartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation. Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium salt and chloride in approximately equivalent amounts. Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of an angiotensin II receptor antagonist tends to reverse the potassium loss associated with these diuretics.
Indications
Telmisartan & Hydrochlorothiazide is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
Dosage & Administration
Usual starting dose of telmisartan/hydrochlorothiazide is 80 mg/12.5 mg once daily. It can be titrated up to 160 mg/25 mg as needed.
Side Effects
The most common side effects of Telmisartan & Hydrochlorothiazide include: fatigue, influenza-like symptoms, dizziness, diarrhea, nausea etc.
Precautions
1.Fetal toxicity
2. Hypotension in Volume-Depleted Patients
3.Thiazide diuretics should be used with caution in patients with impaired hepatic function or progressive liver disease
4.Detection of possible electrolyte imbalance should be performed at appropriate intervals
Use in Pregnancy & Lactation
Pregnancy: Pregnancy Category D.
Pediatric use: Safety and effectiveness of Telmisartan in pediatric patients have not been established.
Geriatric use: No overall differences in effectiveness and safety were observed in these patients compared to younger patients.
Hepatic impairment: Not recommended for patients with severe hepatic impairment. Patients with biliary obstructive disorders or hepatic insufficiency should have treatment started under close medical supervision using the 40/12.5 mg combination.
Renal impairment: Treatment may be followed as long as the patient’s creatinine clearance is >30 mL/min. In patients with more severe renal impairment, Telmisartan & Hydrochlorothiazide are not recommended.
Drug Interaction
1.NSAIDS: Increased risk of renal impairment and loss of antihypertensive effect
2. Digoxin, Lithium, alcohol, barbiturates, or narcotics, antidiabetic drugs (oral agents and insulin), corticosteroids
Over Dose
The most likely manifestation of overdosage with Telmisartan & Hydrochlorothiazide would be hypotension, dizziness and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation.
Storage
Do not store above 30 degree C. Protect from light and high humidity. Keep out of the reach of children.
Commercial Pack
Telmipres Plus 40/12.5: Each box contains 3 Alu-Alu blister strips of 10 tablets.
Telmipres Plus 80/12.5: Each box contains 3 Alu-Alu blister strips of 10 tablets.
Telmipres Plus 80/25: Each box contains 3 Alu-Alu blister strips of 10 tablets.