[Indications and Clinical use]: Used for the treatment of primary hypertension
[Indication]: Telmisartan is indicated in the treatment of essential hypertension.
[ontraindications]: Telmisartan is contraindicated during pregnancy. Like other drugs affecting the renin-angiotensin system (RAS), telmisartan can cause birth defects, stillbirths, and neonatal deaths. It should not be taken by breastfeeding women since it is not known whether the drug passes into the breast milk.
[osage and Administration]
Telmisartan is an angiotensin II receptor antagonist with actions similar to those of losartan (p.1327). It is used in the management of hypertension (p.1171). Telmisartan is given orally. After a dose the hypotensive effect peaks within 3 hours and persists for at least 24 hours. The maximum hypotensive effect occurs within about 4 to 8 weeks after starting therapy. In hypertension, telmisartan is given in an initial dose of 40 mg once daily. This may be increased, if necessary, to a maximum dose of 80 mg once daily. Lower doses should be considered in patients with hepatic or renal impairment (see below).
Administration in hepatic or renal impairment giving telmisartan to patients with hepatic impairment resulted in an increase in bioavailability and a reduction in clearance compared with healthy subjects.1. Although telmisartan was well tolerated, it was suggested that lower doses should be considered in patients with hepatic impairment. In the UK telmisartan is contraindicated in severe hepatic impairment and a maximum dose of 40 mg once daily is recommended for patients with mild to moderate impairment telmisartan appears to be well tolerated in patients with renal impairment, including those on dialysis.2 However, in the UK, an initial dose of 20 mg once daily is recommended for patients with severe renal impairment or on haemodialysis.
Adverse effects of losartan have been reported to be usually mild and transient, and include dizziness, headache, and dose-related orthostatic hypotension. Hypotension may occur particularly in patients with volume depletion (for example those who have received highdose diuretics). Impaired renal function and, rarely, rash, urticaria, pruritus, angioedema, and raised liver enzyme values may occur. Hyperkalaemia, myalgia,and arthralgia have been reported. Losartan appears less likely than ACE inhibitors to cause cough. Other adverse effects that have been reported with angiotensin II receptor antagonists include respiratory-tract disorders, back pain, gastrointestinal disturbances, fatigue, and neutropenia. Rhabdomyolysis has been reported rarely.
Telmisartan should be used with caution in patients with hepatic impairment or biliary obstruction.
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