Adult: Initially, 40 mg once daily, then adjust within the range of 20-80 mg once daily according to response. Max: 80 mg once daily. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Oral Cardiovascular risk reduction
Adult: For reduction of the risk of MI, stroke or death from CV causes in patients at high risk of developing major CV events who are unable to take ACE inhibitors: ≥55 years 80 mg once daily. Treatment and dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
What are the brands available for Telmisartan in Malaysia?
Mild to moderate: Max: 40 mg once daily. Severe: Contraindicated.
Administration
Telmisartan May be taken with or without food.
Contraindications
Biliary obstructive disorders. Severe hepatic impairment. Pregnancy (2nd or 3rd trimester). Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m2).
Special Precautions
Patient with idiopathic or hereditary angioedema, history of angioedema associated with ACE inhibitor therapy; volume and/or sodium depletion; low renal blood flow (e.g. heart failure), unstented unilateral or bilateral renal artery stenosis; significant aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy; ascites due to cirrhosis; primary aldosteronism, diabetes mellitus, ischaemic cardiopathy or ischaemic CV disease. Black patients. Patients undergoing surgery. Renal and mild to moderate hepatic impairment. Elderly. Pregnancy (1st trimester) and lactation.
Adverse Reactions
Significant: Hyperkalaemia, symptomatic hypotension; deterioration of renal function and/or increased serum creatinine. Rarely, angioedema. Blood and lymphatic system disorders: Anaemia. Cardiac disorders: Bradycardia, chest pain. Ear and labyrinth disorders: Vertigo. Gastrointestinal disorders: Abdominal pain, diarrhoea, dyspepsia, flatulence, vomiting. General disorders and administration site conditions: Asthenia. Musculoskeletal and connective tissue disorders: Back pain, muscle spasms, myalgia. Nervous system disorders: Syncope. Psychiatric disorders: Insomnia, depression. Renal and urinary disorders: UTI, cystitis. Respiratory, thoracic and mediastinal disorders: URTI, pharyngitis, sinusitis, dyspnoea, cough. Skin and subcutaneous tissue disorders: Pruritus, hyperhidrosis, rash. Vascular disorders: Orthostatic hypotension.
PO: Z (Angiotensin II receptor blockers are generally contraindicated or not recommended, particularly during 2nd and 3rd trimesters, due to adverse effects on the foetal renin-angiotensin system.)
Patient Counseling Information
This drug may cause syncope and vertigo, if affected, do not drive or operate machinery.
Monitoring Parameters
Correct volume depletion prior to treatment initiation. Monitor blood pressure, serum electrolytes, serum creatinine and BUN.
Overdosage
Symptoms: Hypotension, tachycardia, bradycardia, dizziness, increased serum creatinine and acute renal failure. Management: Symptomatic and supportive treatment. May induce emesis, perform gastric lavage or administer activated charcoal. Monitor serum electrolytes and creatinine frequently. Place the patient in supine position and replace salt and volume immediately in case of hypotension.
Drug Interactions
May increase plasma concentration of digoxin and lithium. Increased risk of hyperkalaemia with salt substitutes containing potassium, potassium-sparing diuretics, potassium supplements, heparin, ciclosporin, tacrolimus and trimethoprim. Decreased antihypertensive effect with corticosteroids. May reduce the antihypertensive effect and increase the risk of worsening renal function with NSAIDs (including selective COX-2 inhibitors). Increased risk of hypotension with diuretics, other antihypertensive agents, amifostine and baclofen. Potentially Fatal: Increased risk of hypotension, hyperkalaemia and decreased renal function (including acute renal failure) with aliskiren and ACE inhibitors.
Food Interaction
May aggravate orthostatic hypotension with alcohol.
Lab Interference
May result in false-negative aldosterone/renin ratio (ARR).
Action
Description: Mechanism of Action: Telmisartan is a non-peptide, benzimidazole-derivative angiotensin II type 1 (AT1) receptor antagonist. It blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptors. Onset: 1-2 hours. Duration: Up to 24 hours. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract. Bioavailability: 42-58%. Time to peak plasma concentration: 0.5-1 hour. Distribution: Volume of distribution: 500 L. Plasma protein binding: >99.5%, primarily to α1-acid glycoprotein. Metabolism: Metabolised in the liver via conjugation into inactive metabolites. Excretion: Via faeces (97%). Terminal elimination half-life: 24 hours.
Chemical Structure
Telmisartan Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 65999, Telmisartan. https://pubchem.ncbi.nlm.nih.gov/compound/Telmisartan. Accessed July 30, 2024.
C09CA07 - telmisartan ; Belongs to the class of angiotensin II receptor blockers (ARBs). Used in the treatment of cardiovascular disease.
References
Brayfield A, Cadart C (eds). Telmisartan. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/08/2025.Joint Formulary Committee. Telmisartan. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/08/2025.Micardis 40 mg and 80 mg Tablet (Boehringer Ingelheim [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 06/08/2025.Micardis 40 mg Tablets (Boehringer Ingelheim International GmbH). MHRA. https://products.mhra.gov.uk. Accessed 06/08/2025.Micardis Tablet (Boehringer Ingelheim Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/08/2025.Telmisartan. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/08/2025.Telmisartan. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/08/2025.
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