Usual Adult Dose for Hypertension

Amlodipine 5 to 10 mg-Telmisartan 40 to 80 mg orally once a day

Maximum dose: Amlodipine 10 mg-Telmisartan 80 mg orally once a day

Comments:

• Correct volume and salt depletion before initiating therapy.
• Dose titration with the individual components is recommended before switching to this drug; treatment may be initiated with this drug if it is unlikely that blood pressure would be controlled with monotherapy; the usual starting dose for treatment initiation is amlodipine 5 mg-telmisartan 40 mg once a day.
• Patients who experience any dose limiting adverse reactions with amlodipine 10 mg monotherapy may be switched to amlodipine 5 mg-telmisartan 40 mg once a day to reduce the amlodipine dose without reducing the overall expected antihypertensive response.
• Start with a low initial amlodipine dose in patients 65 years or older; initial therapy with this drug is not recommended in patients 75 years or older.
• May increase dose after 2 weeks.

Renal Dose Adjustments

Mild to moderate renal dysfunction: No adjustment recommended
Severe renal dysfunction: Titrate slowly

Liver Dose Adjustments

Liver dysfunction: Not recommended for initial therapy
Biliary obstructive disorder: Initiate at low doses and titrate slowly

Precautions

US BOXED WARNING:

• FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin-angiotensin system (RAS) can cause injury and death to the developing fetus.

Dialysis

Data not available

Other Comments

Administration advice: May take with or without food.

General: Telmisartan plasma concentrations are generally 2 to 3 times higher in females; however, in clinical trials, no significant increases in blood pressure response or orthostatic hypotension were found in women.

Monitoring: Closely monitor patients with heart failure or biliary obstructive disorders who are taking this drug.

Patient advice:

• Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.
• Advise patients to immediately report any signs or symptoms of angioedema (breathing difficulty or swelling of face, eyes, lips, or tongue) and to stop taking this drug until consulting a physician.
• Encourage patients to report any lightheadedness that may occur during treatment initiation and to stop taking this drug until consulting a physician if syncope occurs.
• Dehydration may lead to excess blood pressure reduction; inform patients to contact their healthcare provider if they experience excessive perspiration, vomiting, or diarrhea.