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Telmisartan: Drug information

Telmisartan: Drug information
(For additional information see "Telmisartan: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Fetal toxicity:

When pregnancy is detected, discontinue telmisartan as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Brand Names: US
  • Micardis
Brand Names: Canada
  • ACH-Telmisartan;
  • AG-Telmisartan;
  • APO-Telmisartan [DSC];
  • Auro-Telmisartan;
  • BIO-Telmisartan;
  • JAMP-Telmisartan;
  • Micardis;
  • MINT-Telmisartan;
  • NRA-Telmisartan;
  • PMS-Telmisartan;
  • SANDOZ Telmisartan;
  • TEVA-Telmisartan
Pharmacologic Category
  • Angiotensin II Receptor Blocker;
  • Antihypertensive
Dosing: Adult
Cardiovascular risk reduction

Cardiovascular risk reduction: Oral: 80 mg once daily. It is not known whether doses <80 mg daily are associated with a reduction in risk of cardiovascular morbidity or mortality.

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use with another appropriate agent (eg, long-acting dihydropyridine calcium channel blocker or thiazide diuretic) (Ref).

Oral: Initial: 20 to 40 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose (eg, increase the daily dose by doubling) as needed up to 80 mg once daily; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Kidney impairment prior to treatment initiation:

Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (Ref). Note: Use with caution in patients with kidney impairment (especially CrCl <30 mL/minute); monitor BP, kidney function, and potassium more frequently (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzed (Ref): No supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Unlikely to be dialyzed (highly protein bound): No dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Alterations in kidney function during treatment :

Small, transient increases in serum creatinine are likely to occur within 4 weeks following initiation of therapy or an increase in dose. If serum creatinine increases by >30%, review for possible etiologies (eg, acute kidney injury, volume depletion, concomitant medications, renal artery stenosis), before determining if dose reduction or discontinuation of telmisartan therapy should be considered (Ref).

Dosing: Hepatic Impairment: Adult

Initiate therapy with low dose; titrate slowly and monitor closely.

Canadian labeling: Recommended initial dose: 40 mg daily

Dosing: Adjustment for Toxicity: Adult

Hyperkalemia: Assess for alternative or contributing factors (eg, diet, concomitant medications) of increased potassium, before determining if dose reduction or discontinuation of telmisartan therapy should be considered (Ref).

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Cardiovascular: Chest pain (≥1%), hypertension (≥1%), intermittent claudication (7%), peripheral edema (≥1%)

Dermatologic: Dermal ulcer (3%)

Gastrointestinal: Abdominal pain (≥1%), diarrhea (3%), dyspepsia (≥1%), nausea (≥1%)

Genitourinary: Urinary tract infection (≥1%)

Nervous system: Dizziness (≥1%), fatigue (≥1%), headache (≥1%), pain (≥1%)

Neuromuscular & skeletal: Back pain (3%), myalgia (≥1%)

Respiratory: Cough (≥1%), flu-like symptoms (≥1%), pharyngitis (1%), sinusitis (3%), upper respiratory tract infection (7%)

<1%: Hypersensitivity: Angioedema

Postmarketing:

Cardiovascular: Edema, hypotension, orthostatic hypotension, syncope

Dermatologic: Diaphoresis, erythema of skin, fixed drug eruption, skin rash, toxicoderma, urticaria

Endocrine & metabolic: Hyperkalemia, hypoglycemia, hyponatremia, increased uric acid

Genitourinary: Erectile dysfunction

Hematologic & oncologic: Anemia, eosinophilia, thrombocytopenia

Hepatic: Hepatic impairment

Hypersensitivity: Anaphylaxis, facial edema, hypersensitivity reaction

Nervous system: Asthenia

Neuromuscular & skeletal: Increased creatinine phosphokinase in blood specimen, rhabdomyolysis

Renal: Acute kidney injury, renal insufficiency

Contraindications

Known hypersensitivity (eg, anaphylaxis, angioedema) to telmisartan or any component of the formulation; concurrent use of aliskiren in patients with diabetes.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications: Concomitant use with aliskiren in patients with moderate to severe renal impairment (GFR <60 mL/minute/1.73 m2); pregnancy; breastfeeding; rare hereditary condition of fructose intolerance (product specific); lactose-intolerant patients (product specific).

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: Angioedema has been reported rarely with some angiotensin II receptor antagonists (ARBs) and may occur at any time during treatment (especially following first dose). It may involve the head and neck (potentially compromising airway) or the intestine (presenting with abdominal pain). Patients with idiopathic or hereditary angioedema or previous angioedema associated with ACE-inhibitor therapy may be at an increased risk. Prolonged frequent monitoring may be required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. Intramuscular (IM) administration of epinephrine may be necessary. Do not readminister to patients who have had angioedema with ARBs.

• Hyperkalemia: May occur; risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements and/or potassium containing salts. Use cautiously, if at all, with these agents and monitor potassium closely.

• Hypotension: Symptomatic hypotension may occur upon initiation in patients who are salt- or volume-depleted (eg, those treated with high-dose diuretics); correct volume depletion prior to administration. This transient hypotensive response is not a contraindication to further treatment with telmisartan.

• Kidney function deterioration: May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, heart failure) whose glomerular filtration rate (GFR) is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute kidney failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation; consider discontinuation only in patients with progressive and/or significant deterioration in kidney function.

Disease-related concerns:

• Aortic/mitral stenosis: Use with caution in patients with significant aortic/mitral stenosis.

• Ascites: Avoid use in patients with ascites due to cirrhosis or refractory ascites; if use cannot be avoided in patients with ascites due to cirrhosis, monitor blood pressure and renal function carefully to avoid rapid development of renal failure (AASLD [Runyon 2012]).

• Hepatic impairment: Use with caution in patients who have biliary obstructive disorders or hepatic dysfunction.

• Renal artery stenosis: Use telmisartan with caution in patients with unstented unilateral/bilateral renal artery stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in renal function unless possible benefits outweigh risks.

• Kidney impairment: Use with caution with pre-existing renal insufficiency and severe renal impairment.

Special populations:

• Pregnancy: [US Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected.

• Race/Ethnicity: In Black patients, the BP-lowering effects of ARBs may be less pronounced. The exact mechanism is not known; differences in the renin-angiotensin-aldosterone system, low renin levels, and salt sensitivity more commonly found in Black patients may contribute (Brewster 2013; Helmer 2018; manufacturer's labeling).

• Surgical patients: In patients on chronic ARB therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis 2011). Based on current research and clinical guidelines in patients undergoing non-cardiac surgery, continuing ARBs is reasonable in the perioperative period. If ARBs are held before surgery, it is reasonable to restart postoperatively as soon as clinically feasible (ACC/AHA [Fleisher 2014]).

Dosage form specific issues:

• Sorbitol: Some products may contain sorbitol.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Micardis: 20 mg, 40 mg, 80 mg

Generic: 20 mg, 40 mg, 80 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Micardis Oral)

20 mg (per each): $5.61

40 mg (per each): $5.61

80 mg (per each): $5.61

Tablets (Telmisartan Oral)

20 mg (per each): $4.34 - $5.83

40 mg (per each): $4.34 - $5.83

80 mg (per each): $4.34 - $5.83

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

AG-Telmisartan: 40 mg, 80 mg

Micardis: 40 mg, 80 mg

Generic: 40 mg, 80 mg

Administration: Adult

Oral: May be administered without regard to meals.

Use: Labeled Indications

Cardiovascular risk reduction: Cardiovascular risk reduction in patients ≥55 years of age unable to take ACE inhibitors and who are at high risk of major cardiovascular events (eg, myocardial infarction [MI], stroke, death).

Hypertension, chronic: Lower BP to reduce the risk of fatal and nonfatal cardiovascular events, including stroke and MI.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Aliskiren: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider therapy modification

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II: Receptor Blockers may diminish the therapeutic effect of Angiotensin II. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Angiotensin II Receptor Blockers may enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Cardiac Glycosides: Telmisartan may increase the serum concentration of Cardiac Glycosides. Risk C: Monitor therapy

Dapoxetine: May enhance the orthostatic hypotensive effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Drospirenone-Containing Products: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Finerenone: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Heparin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Lithium: Angiotensin II Receptor Blockers may increase the serum concentration of Lithium. Management: Initiate lithium at lower doses in patients receiving an angiotensin II receptor blocker (ARB). Consider lithium dose reductions in patients stable on lithium therapy who are initiating an ARB. Monitor lithium concentrations closely when combined. Risk D: Consider therapy modification

Loop Diuretics: May enhance the hypotensive effect of Angiotensin II Receptor Blockers. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: Angiotensin II Receptor Blockers may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Patiromer: May decrease the serum concentration of Telmisartan. Management: Administer telmisartan at least 3 hours before or 3 hours after patiromer. Risk D: Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Potassium Salts: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Potassium-Sparing Diuretics: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Risk C: Monitor therapy

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Ramipril: Telmisartan may enhance the adverse/toxic effect of Ramipril. Telmisartan may increase the serum concentration of Ramipril. Concentrations of the active metabolite, ramiprilat, may also be increased. Risk X: Avoid combination

Ranolazine: May enhance the adverse/toxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Phosphates: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Sparsentan: May enhance the adverse/toxic effect of Angiotensin II Receptor Blockers. Risk X: Avoid combination

Tacrolimus (Systemic): Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Tacrolimus (Systemic). Risk C: Monitor therapy

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Tolvaptan: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Trimethoprim: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy

Reproductive Considerations

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be used in patients trying to conceive. Angiotensin II receptor blockers (ARBs) are fetotoxic. Transition patients prior to conception to an agent preferred for use during pregnancy unless treatment with an ARB is absolutely necessary (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).

Pregnancy Considerations

Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Exposure to an angiotensin II receptor blocker (ARB) during the first trimester of pregnancy may be associated with an increased risk of fetal malformations (ACOG 2019; ESC [Regitz-Zagrosek 2018]). Following exposure during the second or third trimesters, drugs that act on the renin-angiotensin system are associated with oligohydramnios. Oligohydramnios, due to decreased fetal kidney function, may lead to fetal lung hypoplasia and skeletal malformations. Oligohydramnios may not appear until after an irreversible fetal injury has occurred. ARB use during pregnancy is also associated with anuria, hypotension, kidney failure, skull hypoplasia, and death in the fetus/neonate. Monitor infants exposed to an ARB in utero for hyperkalemia, hypotension, and oliguria. Exchange transfusions or dialysis may be required to reverse hypotension or improve renal function.

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Discontinue ARBs as soon as possible once pregnancy is detected. Agents other than an ARB are recommended for the treatment of chronic hypertension during pregnancy (ACOG 2019; ESC [Cífková 2020]; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]). Closely monitor patients exposed to an ARB during pregnancy with serial ultrasounds.

Breastfeeding Considerations

It is not known if telmisartan is present in breast milk.

Due to the potential for serious adverse reactions in the breastfeeding infant, breastfeeding is not recommended by the manufacturer. When treatment for hypertension is needed in a breastfeeding patient, consider use of an agent other than an angiotensin II receptor blocker (ESC [Cífková 2020]; NICE 2019).

Monitoring Parameters

Blood pressure; serum electrolytes (eg, potassium [especially in patients on concomitant potassium-sparing diuretics, potassium supplements and/or potassium containing salts]); serum creatinine; BUN.

Mechanism of Action

Angiotensin II acts as a vasoconstrictor. In addition to causing direct vasoconstriction, angiotensin II also stimulates the release of aldosterone. Once aldosterone is released, sodium as well as water is reabsorbed. The end result is an elevation in blood pressure. Telmisartan is a nonpeptide AT1 angiotensin II receptor antagonist. This binding prevents angiotensin II from binding to the receptor thereby blocking the vasoconstriction and the aldosterone secreting effects of angiotensin II.

Pharmacokinetics (Adult Data Unless Noted)

Orally active, not a prodrug

Onset of action: 1 to 2 hours

Duration: Up to 24 hours

Distribution: Vd: 500 L

Protein binding: >99.5%; primarily to albumin and alpha1-acid glycoprotein

Metabolism: Hepatic via conjugation to inactive metabolites; not metabolized via CYP

Bioavailability (dose dependent): 42% to 58%; Hepatic impairment: Approaches 100%

Half-life elimination: Terminal: 24 hours

Time to peak, plasma: 0.5 to 1 hours

Excretion: Feces (97%)

Clearance: Total body: 800 mL/minute

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Telmisartan is not removed from blood by hemofiltration.

Hepatic function impairment: Plasma concentrations are increased and absolute bioavailability approaches 100%.

Sex: Plasma concentrations are generally 2 to 3 times higher in women than in men.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Micardis | Micastan | Misarven | Nizortan | Telcard | Teleact | Telma | Telmi | Telvas;
  • (AR) Argentina: Bertel | Gliosartan | Micardis | Misartal | Mitex | Sactan | Telcardia | Telmisartan teva | Telpres;
  • (AT) Austria: Micardis | Telmicard | Telmisartan G.L. | Telmisartan ratiopharm | Telmisartan sandoz | Telmisartan stada | Tolura;
  • (AU) Australia: Apo telmisartan | Chemmart telmisartan | Mizart | Noumed telmisartan | Pharmacor telmisartan | Telmigen | Telmisartan an | Telmisartan drla | Telmisartan gh | Telmisartan rbx | Telmisartan sandoz | Teltartan | Terry white chemists telmisartan;
  • (BD) Bangladesh: Arbitel | Mitosan | Presart | Telcardis | Telma | Telmipres | Telmitan | Telsan | Temcard | Tems;
  • (BE) Belgium: Kinzalmono | Micardis | Telkonol | Telmisartan actavis | Telmisartan eg | Telmisartan sandoz;
  • (BF) Burkina Faso: Carditel | Telmikaa;
  • (BG) Bulgaria: Actelsar | Micardis | Pritor | Tanydon | Telmisartan egis | Telmisartan stada | Telmisartan teva | Telmitan | Telmotens | Telsart | Tezeo | Tolura;
  • (BR) Brazil: Bramicar | Micardis | Misacardio | Misacor | Pritor | Telbax | Telmisartana;
  • (CH) Switzerland: Kinzal | Micardis | Telmisartan helvepharm | Telmisartan mepha | Telmisartan sandoz | Telmisartan spirig hc | Telmisartan zentiva;
  • (CI) Côte d'Ivoire: Arbitel | Carditel | Telmikaa;
  • (CL) Chile: Micardis | Pritoral | Samertan | Telgard | Tellmi | Texinal;
  • (CN) China: An nei qiang | Bang tan | Bo xin shu | Chang ping | De ci | Di sai ping | Fan tan | Heng xue su | Kang chu | Li wen | Mei si | Micardis | Nuo jin ping | Ou mei ning | Ping ke ya xin | Pu mei te | Shu ni ya | Tian yi | Xin yi er | Ya bang heng bei | Yu le ning;
  • (CO) Colombia: Artesartan | Carditel | Cardixil | Cordiax | Micardis | Pritoral | Renangio | Telma | Temiforce | Temiltar | Temred | Tenaracor | Tremistan | Xifen | Zilpen;
  • (CZ) Czech Republic: Micardis | Pritor | Telmark | Telmisartan apotex | Telmisartan egis | Telmisartan mylan | Telmisartan sandoz | Telmisartan teva | Telmisartan xantis | Telmizek | Tezeo | Tolura | Zanacodar;
  • (DE) Germany: Kinzalmono | Micardis | Pritor | Telmisartan 1A Pharma | Telmisartan AbZ | Telmisartan actavis | Telmisartan al | Telmisartan axcount | Telmisartan fair med | Telmisartan fair med healthcare | Telmisartan glenmark | Telmisartan heumann | Telmisartan hexal | Telmisartan hormosan | Telmisartan micro labs | Telmisartan mylan | Telmisartan ratiopharm | Telmisartan stada | Telmisartan zentiva | Tolura;
  • (DO) Dominican Republic: Micardis | Telma | Telx | Telydalt;
  • (EC) Ecuador: Corazox | Cordiax | Indivan | Indivan forte | Micardis | Raas | Tellmi | Telmaxan | Telmigran | Telsar;
  • (EE) Estonia: Micardis | Pritor | Telmisartan ratiopharm | Telmisartan sandoz | Tolura;
  • (EG) Egypt: Biocardis | Chartoreg | Micardis;
  • (ES) Spain: Micardis | Pritor | Telmark | Telmisartan actavis | Telmisartan almus | Telmisartan alter | Telmisartan apotex | Telmisartan aristo | Telmisartan cinfa | Telmisartan combix | Telmisartan ferrer | Telmisartan kern pharma | Telmisartan mabo | Telmisartan mylan | Telmisartan normon | Telmisartan pensa | Telmisartan qualigen | Telmisartan ranbaxy | Telmisartan ratiopharm | Telmisartan sandoz | Telmisartan stada genericos | Telmisartan tarbis | Telmisartan tecnigen | Telmisartan Teva Pharma | Telmisartan vir | Telmisartan zentiva | Tolura;
  • (ET) Ethiopia: Teli | Telmilo;
  • (FI) Finland: Kinzalmono | Micardis | Telmisartan actavis | Telmisartan orion | Telmisartan ratiopharm | Telmisartan sandoz | Telmisartan stada | Tolura;
  • (FR) France: Micardis | Pritor | Telmisartan actavis | Telmisartan biogaran | Telmisartan cristers | Telmisartan Dci | Telmisartan eg | Telmisartan mylan | Telmisartan ranbaxy | Telmisartan sandoz | Telmisartan teva | Telmisartan zentiva | Telmisartan zydus | Tolura;
  • (GB) United Kingdom: Micardis | Telmisartan actavis | Telmisartan brown &burk | Tolura;
  • (GR) Greece: Micardis | Pritor | Telmisartan actavis | Telmisartan teva | Telmisartan/mylan | Telmisartan/sandoz | Tesgreco;
  • (HK) Hong Kong: Micardis | Telmisartan sandoz;
  • (HR) Croatia: Micardis | Osan | Pritor | Tolura;
  • (HU) Hungary: Micardis | Pritor | Tanydon | Telmisartan actavis | Telmisartan mylan | Telmisartan ratiopharm | Tezeo | Tolura;
  • (ID) Indonesia: Micardis | Nuzartan | Telmiz | Telsat | Tinov;
  • (IE) Ireland: Micardis | Telmisartan actavis | Telmisartan clonmel | Telmisartan mylan | Telmisartan rowex | Telmisartan Teva Pharma | Tolura;
  • (IN) India: Acmetel | Altelsa | Angitel | Antel | Arbitel | Axetel | Axeten | Bitatel | Cardiology | Cortel | Cresar | Digitel | E Tel | Ecotel | Elzen | Eritel | Extel | Gloritel | Glosartan | Hitarget | Holytel | Hytel | Ibtel | Inditel | Lecardis | Leetel | Macsart | Micardis | Micartel | Miotel | Missile | Mistra | Mytel | Newtel | Ngsart | Nigtel | Novotel | Relmisart | Revosart | Safetelmi | Sartel | Statel | Symtel | T let | T press | T sartan | Tamica | Targit | Tazloc | Tekaira | Tel cad | Telapp | Telast | Telblok | Telca | Telcid | Telcure | Teldawn | Telday | Teleact | Telefix | Telelak | Telexia | Telfirst | Telhim | Teli | Telimac | Telimed | Telin | Telindia | Telinsat | Telismart | Telista | Tellme | Tellzy | Telma | Telmasurge | Telmate | Telmax | Telmed | Telmedip | Telmeron | Telmichek | Telmidil | Telmiduce | Telmifine | Telmiget | Telmigraf | Telmijub | Telmikaa | Telmikan | Telmikind | Telmimac | Telmin | Telminorm | Telmipack | Telmipharm | Telmipil | Telmiprime | Telmipro | Telmirest | Telmiride | Telmirise | Telmisafe | Telmisat | Telmisurge | Telmiten | Telmitop | Telmitrust | Telmivas | Telmiwock | Telmore | Telnic | Telnyle | Telodil | Telong | Telpax | Telpic | Telpil | Telpres | Telsaan | Telsar | Telsart | Telsartan | Telsartan activ | Telsat | Telscan | Telsig | Telsite | Teltab | Teltas | Teltin | Teltop | Teltor | Telvas | Telwake | Telwave | Telx | Telza | Telzox | Temax | Temsan | Terelate | Tetan | Tht | Tigatel | Tilan | Tlm | Tmt | Tsart | Vitatel | Vitel | Weltelmi | Xstan | Yogatel | Zeosartan | Zitelmi;
  • (IT) Italy: Micardis | Pritor | Telmisartan actavis | Telmisartan almus | Telmisartan alter | Telmisartan crinos | Telmisartan doc generici | Telmisartan eg | Telmisartan mylan | Telmisartan pensa | Telmisartan ranbaxy | Telmisartan sandoz | Telmisartan tecnigen | Telmisartan teva italia | Telmisartan zentiva | Tolura;
  • (JO) Jordan: Micardis;
  • (JP) Japan: Micardis | Telmisartan chemiphar | Telmisartan dsep | Telmisartan ee | Telmisartan ffp | Telmisartan jg | Telmisartan kn | Telmisartan kyorin | Telmisartan meiji | Telmisartan nipro | Telmisartan ohara | Telmisartan pfizer | Telmisartan sandoz | Telmisartan sanwa | Telmisartan takeda teva | Telmisartan tanabe | Telmisartan tck | Telmisartan towa | Telmisartan tsuruhara;
  • (KE) Kenya: Arbitel | Carditel | Cilzec | Glentel | Micardis | Micartel | Ontel | Safetelmi | Tasmi | Telcard | Telday | Teli | Tellzy | Telma | Telmed | Telmi | Telmicos | Telmikaa | Telmimark | Telmistal | Telmitan | Telsar | Telsart | Telsarta | Teltas | Telzart | Tsart | Unitel | Zartan;
  • (KR) Korea, Republic of: Anatel | Bertel | Cellmisartan | Cirtelmi | Dongkoo telmisartan | Dongsung telmisartan | Freetension | Gcp telmisartan | Genuone telmisartan | Hypertelmi | I telmi | J telmi | Micardis | Micartan | Micartelmi | Micatan | Micatere | Mirdis | Mirtel | Mirto | Misartan | Mitelis | Monospin | Neo telmi | Newtelmi | Pharmesta | Pharvis telmisartan | Pritelmi | Pritor | Samsung telmisartan | Seoul telmisartan | Silito | Telcadin | Telcardin | Telcatan | Telito | Telmeil | Telmi | Telmi on | Telmibeta | Telmicall | Telmican | Telmicar | Telmicor | Telmicure | Telmidown | Telmidrop | Telmione | Telmir | Telmira | Telmirotan | Telmis | Telmista | Telmitan | Telmitension | Telmito | Telmitrend | Telmiz | Telosartan | Telsartan | Telsas | Teltan | Temisartan | Tertan | Yuyu telmisartan;
  • (KW) Kuwait: Micardis;
  • (LB) Lebanon: Arbivastel | Micardis | Telmicard;
  • (LT) Lithuania: Micardis | Pritor | Telmisartan actavis | Telmisartan egis | Telmisartan inteli | Telmisartan ratiopharm | Telmisartan sandoz | Telsartan | Tezeo | Tolura;
  • (LU) Luxembourg: Kinzalmono | Micardis | Telmisartan eg | Telmisartan mylan | Telmisartan ratiopharm;
  • (LV) Latvia: Micardis | Pritor | Telmisartan actavis | Telmisartan egis | Telmisartan ratiopharm | Telmisartan sandoz | Tezeo | Tolura;
  • (MA) Morocco: Micardis;
  • (MX) Mexico: Apviced | Archer | Armilare kr | Bioperten | Difel | Evins | Floxetin | Floxiten | Gamediolin | Landmix | Legionis | Lesprek | Lonihtal | Micardis | Misarquim | Natrazim | Predxal | Pretz | Raas | Rolet | Rulle | Telarteq | Teldistev | Telmecal | Telmisartan bruluart;
  • (MY) Malaysia: Cresar | Hovid telmisartan | Micardis | Teleact | Telswift | Tolura | Tsart;
  • (NG) Nigeria: Amiatt | Angitel | Cilzec | Cortel | Tasmi | Telma | Telmilo | Telminorm | Teltartan | Temaz | Zotrap;
  • (NL) Netherlands: Dinortes | Kinzalmono | Micardis | Telmisartan actavis | Telmisartan glenmark | Telmisartan mylan | Telmisartan sandoz | Telmisartan Teva Pharma | Telmisartan xiromed;
  • (NO) Norway: Micardis | Telmisartan actavis;
  • (PE) Peru: Cordiax | Micardis | Pritor | Rematral | Renangio | Sartel | Telcard | Teleact | Telmiglob | Telmilow | Telminor | Telmipress | Telmistalid | Telmiswiss | Telzaar | Temisar | Vicarten;
  • (PH) Philippines: Micardis | Micor | Pritor | Teli | Telzyd;
  • (PK) Pakistan: Arsocardis | Cresar | De Nile | Mictel | Misar | Misartan | Normisar | Sartel | T sartan | Tasmi | Tecardic | Telarb | Telday | Telisartan | Telkan | Telmax | Telmi | Telminor | Telmis | Telsan | Telsartan | Telsitan | Teltan | Telus | Tesar | Tiocardis;
  • (PL) Poland: Actelsar | Micardis | Polsart | Pritor | Telmabax | Telmisartan apotex | Telmisartan Bluefish | Telmisartan egis | Telmisartan genoptim | Telmisartan mylan | Telmisartan orion | Telmisartan sandoz | Telmisartanum 123ratio | Telmix | Telmizek | Tezeo | Tolura | Zanacodar;
  • (PR) Puerto Rico: Micardis;
  • (PT) Portugal: Micardis | Pritor | Telmisartan actavis | Telmisartan alter genericos | Telmisartan azevedos | Telmisartan basi | Telmisartan Ciclum | Telmisartan evertine | Telmisartan Generis | Telmisartan Labesfal | Telmisartan mylan | Telmisartan pharmakern | Telmisartan ratiopharm | Telmisartan sandoz | Telmisartan teva | Telmisartan tolife | Telmisartan zentiva | Tolura;
  • (PY) Paraguay: Cardiosan | Isquelium | Karima | Micardis | Nimicor | Prilartan | Tellmi | Telminest | Telmisartan bauel top | Telmisartan bergamo | Telmisartan bioethic pharma | Telmisartan bioteng | Telmisartan dallas | Telmisartan grenbia | Telmisartan heisecke | Telmisartan imedic | Telmisartan libra | Telmisartan pharma | Telmisartan prosalud | Temisar | Tensartan;
  • (QA) Qatar: Micardis | Telmart | Telzap;
  • (RO) Romania: Tanydon | Telmark | Telmisartan dr. reddy's | Telmisartan mylan | Telmisartan teva | Telmotens | Tolura;
  • (RU) Russian Federation: Micardis | Pritor | Tanydol | Telminorm | Telmisartan richter | Telmisartan stada | Telmisartan sz | Telmista | Telpres | Telsartan | Telzap | Tezeo;
  • (SA) Saudi Arabia: Micardis | Nizortan;
  • (SE) Sweden: Kinzalmono | Micardis | Telmark | Telmisartan ebb | Telmisartan sandoz | Telmisartan stada | Telmisartan Teva Pharma | Tolura;
  • (SG) Singapore: Actelsar | Jubitel | Micardis | Telgio | Telmisartan sandoz | Telmotens | Telstan | Teltas | Tolura;
  • (SI) Slovenia: Micardis | Pritor | Telmisartan actavis | Telmisartan lek | Tolura;
  • (SK) Slovakia: Micardis | Pritor | Tanydon | Telmark | Telmisartan +Pharma | Telmisartan actavis | Telmisartan egis | Telmisartan mylan | Telmisartan ratiopharm | Telmisartan sandoz | Telmisartan teva | Telmisartan xantis | Telmizek | Tezeo | Tolura | Zanacodar;
  • (TH) Thailand: Micardis | Pritor;
  • (TN) Tunisia: Micardis | Telmisartan mylan | Telmycor;
  • (TR) Turkey: Micardis | Pritor | Qualtan | Telmitek | Telvis | Telzap;
  • (TW) Taiwan: Micardis | Telcard | Telsar;
  • (UA) Ukraine: Arbitel | Hypotel | Micardis | Pritor | Telmista | Telpres | Telsartan;
  • (UG) Uganda: Arbitel | Aristo telvas | Carditel | Cilzec | Safetelmi | Teli | Telmilo | Telpress;
  • (UY) Uruguay: Aratel | Cardium | Micardis | Miocor | Pritor | Taroplen | Telmir athena;
  • (VE) Venezuela, Bolivarian Republic of: Micardis | Obcardis | Pritor | Telma | Telmisartan farmoz | Telmisartana | Telydalt;
  • (VN) Viet Nam: Agimstan | Bosagas | Cilzec | Mibetel | Savi telmisartan | Sicaduse | Telmisarex | Visartis | Zhekof;
  • (ZA) South Africa: Adco telmisartan | Cardiz | Cardtense | Hartel | Micardis | Mizart | Pritor | Telgen | Telmisartan 40 teva | Telmisartan 80 teva | Telpres | Telza | Tesar | Tesminol | Tolura;
  • (ZM) Zambia: Arbitel | Cresar | Safetelmi | Teli | Telma | Telmikaa;
  • (ZW) Zimbabwe: Telday | Teli | Teltas 40 | Teltas 80
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Topic 10275 Version 411.0

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