Drug Class: Angiotensin II inhibitors with thiazides
Usual Adult Dose for Hypertension
Hydrochlorothiazide 12.5 to 25 mg-Telmisartan 80 mg orally once a day
Maximum dose: Hydrochlorothiazide 25 mg-Telmisartan 160 mg orally once a day
Comments:
- This drug may be substituted for the individual titrated components.
- If blood pressure remains uncontrolled by hydrochlorothiazide 25 mg orally once a day monotherapy, may switch to hydrochlorothiazide 12.5 to 25 mg-telmisartan 80 mg orally once a day. Reassess after 2 to 4 weeks; may increase up to hydrochlorothiazide 25 mg-telmisartan 160 mg orally once a day.
- If blood pressure is controlled by hydrochlorothiazide 25 mg orally once a day monotherapy, but hypokalemia occurs, may switch to hydrochlorothiazide 12.5 mg-telmisartan 80 mg orally once a day.
- If blood pressure remains uncontrolled by telmisartan 80 mg orally once a day monotherapy, may switch to hydrochlorothiazide 12.5 mg-telmisartan 80 mg orally once a day; may titrate up to hydrochlorothiazide 25 mg-telmisartan 160 mg orally once a day, if necessary.
Use: Treatment of hypertension; not indicated for initial therapy.
Renal Dose Adjustments
Mild to moderate renal dysfunction (30 mL/min or greater): No adjustment recommended
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended
Liver Dose Adjustments
Mild to moderate liver dysfunction: Initial dose: Hydrochlorothiazide 12.5 mg-Telmisartan 40 mg orally once a day
Severe liver dysfunction: Not recommended
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.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Monitoring: Monitor serum electrolytes, BUN, and serum creatinine periodically.
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.
- 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.
