Telmisartan

A to Z Drug Facts

  Action Antagonizes the effect of angiotensin II (vasoconstriction and aldosterone secretion) by blocking the angiotensin II (AT₁ receptor) in vascular smooth muscle and the adrenal gland, producing decreased BP.

  Indications Treatment of hypertension.

  Contraindications Standard considerations.

  Route/Dosage

Adults: PO 20 to 80 mg/day; usual starting dose 40 mg/day.

  Interactions

Digoxin: May increase plasma levels of digoxin, that may increase toxicity.

Lithium: Plasma concentrations may be increased by telmisartan, resulting in an increase in the pharmacologic and adverse effects of lithium.

  Lab Test Interferences None well documented.

  Adverse Reactions

EENT: Sinusitis; pharyngitis. GI: Diarrhea. RESPIRATORY: Upper respiratory tract infection. OTHER: Back pain.

  Precautions

Pregnancy: Category C (first trimester); category D (second and third trimester). Can cause injury or death to the fetus if used during second or third trimester. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Renal function impairment: Use with caution in patients whose renal function may depend on the activity of the renin-angiotensin-aldosterone system (eg, patients with severe CHF); use may be associated with oliguria, progressive azotemia, acute renal failure, and death. Hepatic function impairment: Use with caution.

  Administration/Storage

• Store at room temperature.
• Do not remove tablets from their blisters or containers until immediately before administration.
• Anticipate combination with a diuretic if target BP values are not reached.
• Do not administer to patients with intravascular volume depletion until the condition has been corrected.
• Administer with caution and under close medical supervision to patients with biliary obstructive disorders or hepatic insufficiency.
• Do not administer to pregnant women.

  Assessment/Interventions

• Obtain patient history and drug history including allergies.
• Monitor patient for potential adverse effects and drug interactions.
• Monitor BP and pulse. Should hypotension, tachycardia, or bradycardia occur, withhold the medication and notify health care provider.
• Closely monitor patients on dialysis for orthostatic hypotension.
• Monitor BP, especially patients on dialysis.
• Monitor patient for signs of hypersensitivity including angioedema involving swelling of the face, lips, and tongue, or difficulty breathing.

  Patient/Family Education

• Instruct patient to take the medication as prescribed at the same time each day.
• Inform patient that telmisartan controls but does not cure hypertension.
• Caution patient to take the dose exactly as prescribed and not to stop taking the medication even if feeling better. Instruct patient not to increase or decrease the dosage.
• Instruct family and patient in BP and pulse measurement skills. Caution patient to call primary health care provider should abnormal measurements occur.
• Instruct patient in methods of fall prevention including rising slowly and sitting on the side of the bed before standing, especially early in therapy.
• Inform patient of the importance of adjunct therapies such as dietary planning, regular exercise program, weight reduction, low sodium diet, alcohol reduction, smoking cessation, and stress management.
• Instruct patient to report symptoms of weakness, fatigue, dizziness, or lightheadedness to health care provider.
• Caution patient to notify health care provider or dentist of use of this product prior to surgery or treatment.
• Advise women to contact health care provider if pregnant, planning to become pregnant, or breastfeeding. Inform the patient of potential harm to the fetus.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts