Or, simply put, increased blood pressure is the “scourge” of almost the entire elderly generation of people. It affects about 65% of people over 65 years of age and in general about 30% of adults.
The disease is combated with the help of medications, and the market for antihypertensive drugs is now very large. One of the effective medications is Telmisartan.
A drug that reduces the risk of strokes and heart attacks and controls blood pressure, since 1998, has deservedly taken a place in many people's medicine cabinets.
Instructions for use
Telmisartan has a pronounced antihypertensive effect and is widely used to control and maintain blood pressure within acceptable values.
The product is effective throughout the day, the duration of the effect after its use is observed within 48 hours. The drug begins to act within 3 hours after the initial dose, and just a month after the start of treatment with Telmisartan, blood pressure decreases to the maximum level in both the lower and upper values, without affecting the pulse rate.
When the drug is discontinued, the pressure will return to those parameters that were at the beginning of the treatment period, but no withdrawal syndrome is observed.
Clinical studies conducted in 2009 showed that Telmisartan has a positive effect on the cardiovascular system and reduces the risk of strokes and heart attacks, as well as death in patients with a significant cardiovascular risk who cannot take angiotensin-converting enzyme inhibitors. More than 23.5 thousand people took part in the research.
Also, other studies have found that taking Telmisartan in patients with high blood pressure and cardiomyopathy is associated with a decrease in left ventricular mass.
You can read reviews of people who took Telmisartan at the end of the article.
Directions for use
The drug is used regardless of the time of meal, 20-40 mg per day; in some cases, the daily dosage can reach 80 mg.
However, patients with liver problems should not take more than 40 mg per day.
Elderly people or people with renal failure do not need dose adjustment.
Release form and composition
Telmisartan is white or almost white elongated tablets with a ridge on one side, packaged in blisters of 10 pieces. They contain either 40 or 80 mg of telmisartan. The average package volume is 30 tablets.
Active substance– telmisartan.
Other substances components included in the drug are the following: povidone, sodium hydroxide, sorbitol, meglumine, hydroxypropyl methylcellulose, magnesium stearate, mannitol.
Interaction with other drugs
The effect of lowering blood pressure is enhanced by simultaneous administration of Telmisartan and thiazide diuretics (for example, hydrochlorothiazide).
The drug can also enhance the effect of other drugs with a hypotension effect.
If Telmisartan is taken with medications that increase the concentration of potassium in the blood plasma, the risk of developing hyperkalemia, that is, a pathological condition that appears due to a significant increase in the amount of potassium in the blood, increases significantly.
If you take Telmisartan and the drug Digoxin at the same time, the level of the latter in the blood increases, so in this case it is very important to regularly check and monitor the concentration of the second drug in the blood.
When taking medications containing lithium, there is an increase in the amount of this element in the blood, which can have a toxic effect on the body.
Side effects
Telmisartan, like any other drug, has its side effects and contraindications. Side effects:
- cough;
- headaches;
- nausea;
- myalgia;
- diarrhea;
- flu-like symptoms;
- decreased hemoglobin levels;
- pain in the abdomen, chest, lower back;
- increased uric acid levels.
Drivers of vehicles and people working at complex technical sites should carefully evaluate possible side effects before taking the drug before driving or operating precision machinery, since after taking Telmisartan, dizziness or drowsiness may occur, and attention and concentration may be dulled.
People suffering from hyponatremia or having a reduced circulating blood volume may experience symptomatic arterial hypotension after taking the first tablet of the drug.
The use of Telmisartan by patients suffering from renal artery stenosis significantly increases the risk of developing severe hypotension and renal failure. This category of patients should take Telmisartan carefully.
Contraindications
The drug should not be taken during pregnancy. Even those who plan to become a mother should avoid taking Telmisartan. Breastfeeding women should stop breastfeeding during drug therapy.
The safety of taking the drug for children and adolescents has not yet been determined, therefore, to avoid health problems for children, Telmisartan is contraindicated.
You should also not take the medicine in the following cases:
- sensitivity to the components of the drug;
- serious diseases and dysfunction of the liver and kidneys;
- obstruction of the biliary tract.
Storage conditions and periods
The shelf life of Telmisartan from the date of manufacture is no more than 3 years at an air temperature of no higher than 25 degrees.
The first aid kit with the drug is kept in a dry, dark place where children cannot reach it.
Price
In Russia pharmacies sell the German-made product Telmisartan-Richter, the average cost of which is 80 euros per package of tablets in the amount of 98 pieces.
In Ukraine the drug is called Telmisartan-Ratiopharm, its average cost for 28 pieces is about 82 hryvnia.
Analogues
The following drugs are analogues of Telmisartan:
- Prytor;
- Teseo;
- Twinsta;
Telmista and Micardis are the most common analogues of the drug in Russia. The average cost of Mikardis is about 600 rubles, Telmisty is about 1200 rubles.
Pharmacological action
Antihypertensive agent, angiotensin II receptor antagonist (AT1 type). It has a very high affinity for this receptor subtype. By selectively and long-term binding to receptors, telmisartan displaces angiotensin II from its connection with AT1 receptors. Does not show affinity for other AT receptor subtypes. The functional significance of other receptor subtypes and the effect of increased (as a result of the administration of telmisartan) levels of angiotensin II on them is not known. Telmisartan reduces the level of aldosterone in the blood plasma, does not inhibit plasma renin, does not block ion channels, and does not inhibit ACE (kinase II), which also destroys bradykinin. Therefore, there are no side effects associated with bradykinin.
Pharmacokinetics
When taken orally, it is quickly absorbed from the gastrointestinal tract. Bioavailability is 50%. When taken simultaneously with food, the reduction in AUC ranges from 6% (at a dose of 40 mg) to 19% (at a dose of 160 mg). 3 hours after administration, the plasma concentration levels off, regardless of whether it is taken with food or on an empty stomach. Plasma protein binding is 99.5%. The average values of apparent Vd at the equilibrium stage are 500 l. Metabolized by conjugation with glucuronic acid. Metabolites are pharmacologically inactive.
T1/2 – more than 20 hours. Excreted through the intestines unchanged. Cumulative renal excretion is less than 1%. Total plasma clearance is 1000 ml/min (renal blood flow is 1500 ml/min).
Indications
Arterial hypertension.
Dosage regimen
For adults, the daily dose is 20-40 mg (1 time/day). In some patients, a hypotensive effect can be achieved with a dose of 20 mg/day. If necessary, the dose can be increased to 80 mg/day.
Patients with impaired renal function, as well as elderly patients, do not require dose adjustment.
For patients with impaired liver function, the daily dose is 40 mg.
Side effect
From the side of the central nervous system: headache, dizziness, fatigue, insomnia, anxiety, depression, convulsions.
From the digestive system: abdominal pain, dyspepsia, nausea, diarrhea, increased activity of liver transaminases.
From the respiratory system: cough, pharyngitis, upper respiratory tract infections.
From the hematopoietic system: decrease in hemoglobin level.
Allergic reactions: rash; in a single case - angioedema.
From the urinary system: peripheral edema, urinary tract infections, increased uric acid levels, hypercreatininemia.
From the cardiovascular system: marked decrease in blood pressure, palpitations, chest pain.
From the musculoskeletal system: lower back pain, myalgia, arthralgia.
From the laboratory parameters: hyperkalemia, anemia, hyperuricemia.
Other: flu-like syndrome.
Contraindications for use
Obstruction of the biliary tract, severe dysfunction of the liver and kidneys, pregnancy, lactation (breastfeeding), hypersensitivity to telmisartan.
Use during pregnancy and breastfeeding
Telmisartan is contraindicated for use during pregnancy and lactation (breastfeeding).
Use in children
Drug interactions
When used simultaneously with antihypertensive drugs, the antihypertensive effect may be enhanced.
When used simultaneously with potassium-sparing diuretics, heparin, dietary supplements, salt substitutes containing potassium, hyperkalemia may develop.
When used simultaneously with lithium preparations, an increase in the concentration of lithium in the blood plasma is possible.
With simultaneous use, it is possible to increase the concentration of digoxin in the blood plasma.
Use for liver dysfunction
Contraindicated in severe liver dysfunction.
Use for renal impairment
Contraindicated in severe renal impairment.
Use in elderly patients
Elderly patients do not require dose adjustment.
Special instructions
Telmisartan is used with caution in cases of liver dysfunction, gastric and duodenal ulcers in the acute stage, other gastrointestinal diseases, aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy, coronary artery disease, and heart failure.
In patients with bilateral renal artery stenosis or renal artery stenosis of a single functioning kidney, the use of telmisartan increases the risk of severe arterial hypotension and renal failure. Therefore, telmisartan should be used with caution in this category of patients.
During the period of use of telmisartan in patients with impaired renal function, it is necessary to monitor the content of potassium and creatinine in the blood plasma.
There are currently no data on the use of telmisartan in patients with recent kidney transplantation.
In patients with reduced blood volume and/or hyponatremia, symptomatic arterial hypotension may occur, especially after taking the first dose of telmisartan. Therefore, before carrying out therapy, correction of such conditions is necessary.
The use of telmisartan is possible in combination with thiazide diuretics, because This combination provides an additional reduction in blood pressure.
When considering the possibility of increasing the dose of telmisartan, it should be remembered that the maximum hypotensive effect is usually achieved 4-8 weeks after the start of treatment.
Use in pediatrics
There are no data on the safety and effectiveness of telmisartan in children and adolescents.
Impact on the ability to drive vehicles and operate machinery
The question of the possibility of engaging in potentially hazardous activities that require increased attention and rapid psychomotor reactions should be decided only after assessing the individual response to telmisartan.
Telmisartan
Composition and release form of the drug
Pills white or white with a yellowish tint, round, flat-cylindrical, with a chamfer and a notch.
Excipients: lactose monohydrate (milk sugar) - 474.9 mg, croscarmellose sodium - 24 mg, K25 - 24 mg, meglumine - 24 mg, sodium hydroxide - 6.7 mg, magnesium stearate - 6.4 mg.
5 pcs. - contour cellular packaging (1) - cardboard packs.
5 pcs. - contour cellular packaging (2) - cardboard packs.
5 pcs. - contour cellular packaging (3) - cardboard packs.
5 pcs. - contour cellular packaging (4) - cardboard packs.
5 pcs. - contour cellular packaging (5) - cardboard packs.
5 pcs. - contour cellular packaging (8) - cardboard packs.
5 pcs. - contour cellular packaging (10) - cardboard packs.
7 pcs. - contour cellular packaging (1) - cardboard packs.
7 pcs. - contour cellular packaging (2) - cardboard packs.
7 pcs. - contour cellular packaging (3) - cardboard packs.
7 pcs. - contour cellular packaging (4) - cardboard packs.
7 pcs. - contour cellular packaging (5) - cardboard packs.
7 pcs. - contour cellular packaging (8) - cardboard packs.
7 pcs. - contour cellular packaging (10) - cardboard packs.
10 pcs. - contour cellular packaging (1) - cardboard packs.
10 pcs. - contour cellular packaging (2) - cardboard packs.
10 pcs. - contour cellular packaging (3) - cardboard packs.
10 pcs. - contour cellular packaging (4) - cardboard packs.
10 pcs. - contour cellular packaging (5) - cardboard packs.
10 pcs. - contour cellular packaging (8) - cardboard packs.
10 pcs. - contour cellular packaging (10) - cardboard packs.
20 pcs. - contour cellular packaging (1) - cardboard packs.
20 pcs. - contour cellular packaging (2) - cardboard packs.
20 pcs. - contour cellular packaging (3) - cardboard packs.
20 pcs. - contour cellular packaging (4) - cardboard packs.
20 pcs. - contour cellular packaging (5) - cardboard packs.
20 pcs. - contour cellular packaging (8) - cardboard packs.
20 pcs. - contour cellular packaging (10) - cardboard packs.
10 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
20 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
28 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
30 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
40 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
50 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
100 pcs. - cans made of polyethylene terephthalate (1) - cardboard packs.
Pharmacological action
Antihypertensive agent, angiotensin II receptor antagonist (AT1 type). It has a very high affinity for this receptor subtype. By selectively and long-term binding to receptors, telmisartan displaces angiotensin II from its connection with AT1 receptors. Does not show affinity for other AT receptor subtypes. The functional significance of other receptor subtypes and the effect of increased (as a result of the administration of telmisartan) levels of angiotensin II on them is not known. Telmisartan reduces the level of aldosterone in the blood, does not inhibit plasma renin, does not block ion channels, and does not inhibit ACE (kinase II), which also destroys bradykinin. Therefore, there are no side effects associated with bradykinin.
Pharmacokinetics
When taken orally, it is quickly absorbed from the gastrointestinal tract. Bioavailability is 50%. When taken simultaneously with food, the reduction in AUC ranges from 6% (at a dose of 40 mg) to 19% (at a dose of 160 mg). 3 hours after administration, the plasma concentration levels off, regardless of whether it is taken with food or on an empty stomach. Plasma protein binding is 99.5%. The average values of apparent Vd at the equilibrium stage are 500 l. Metabolized by conjugation with glucuronic acid. Metabolites are pharmacologically inactive.
T1/2 – more than 20 hours. Excreted through the intestines unchanged. Cumulative renal excretion is less than 1%. Total plasma clearance is 1000 ml/min (renal blood flow is 1500 ml/min).
Indications
Contraindications
Obstruction of the biliary tract, severe dysfunction of the liver and kidneys, pregnancy, lactation (breastfeeding), hypersensitivity to telmisartan.
Dosage
For adults, the daily dose is 20-40 mg (1 time/day). In some patients, a hypotensive effect can be achieved with a dose of 20 mg/day. If necessary, the dose can be increased to 80 mg/day.
Patients with impaired renal function, as well as elderly patients, do not require dose adjustment.
For patients with impaired liver function, the daily dose is 40 mg.
Side effects
From the side of the central nervous system: headache, dizziness, fatigue, insomnia, anxiety, depression, convulsions.
From the digestive system:, dyspepsia, nausea, diarrhea, increased activity of liver transaminases.
From the respiratory system: cough, pharyngitis, upper respiratory tract infections.
From the hematopoietic system: decrease in hemoglobin level.
Allergic reactions: rash; in a single case - angioedema.
From the urinary system: peripheral edema, urinary tract infections, increased uric acid levels, hypercreatininemia.
From the cardiovascular system: marked decrease in blood pressure, palpitations, chest pain.
From the musculoskeletal system: lower back pain, myalgia, arthralgia.
From the laboratory parameters: hyperkalemia, anemia, hyperuricemia.
Other: flu-like syndrome.
Drug interactions
When used simultaneously, the antihypertensive effect may be enhanced.
When used simultaneously with potassium-sparing diuretics, heparin, dietary supplements, salt substitutes containing potassium, hyperkalemia may develop.
When used simultaneously with lithium preparations, an increase in the concentration of lithium in the blood plasma is possible.
With simultaneous use, it is possible to increase the concentration of digoxin in the blood plasma.
Special instructions
Telmisartan is used with caution in cases of liver dysfunction, gastric and duodenal ulcers in the acute stage, other gastrointestinal diseases, aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy, coronary artery disease, and heart failure.
In patients with bilateral renal artery stenosis or renal artery stenosis of a single functioning kidney, the use of telmisartan increases the risk of severe arterial hypotension and. Therefore, telmisartan should be used with caution in this category of patients.
During the period of use of telmisartan in patients with impaired renal function, it is necessary to monitor the content of potassium and creatinine in the blood plasma.
There are currently no data on the use of telmisartan in patients with recent kidney transplantation.
In patients with reduced blood volume and/or hyponatremia, symptomatic arterial hypotension may occur, especially after taking the first dose of telmisartan. Therefore, before carrying out therapy, correction of such conditions is necessary.
The use of telmisartan is possible in combination with thiazide diuretics, because This combination provides an additional reduction in blood pressure.
When considering the possibility of increasing the dose of telmisartan, it should be remembered that the maximum hypotensive effect is usually achieved 4-8 weeks after the start of treatment.
Use in pediatrics
Impact on the ability to drive vehicles and operate machinery
The question of the possibility of engaging in potentially hazardous activities that require increased attention and rapid psychomotor reactions should be decided only after assessing the individual response to telmisartan.
Pregnancy and lactation
Telmisartan is contraindicated for use during pregnancy and lactation (breastfeeding).
Use in childhood
There are no data on the safety and effectiveness of telmisartan in children and adolescents.
For impaired renal function
Contraindicated in severe renal impairment.
For liver dysfunction
Contraindicated in severe liver dysfunction.
Use in old age
Elderly patients do not require dose adjustment.
Depending on the release form, one tablet contains 80 or 40 mg of the active substance.
Additional Ingredients:
- sodium hydroxide;
- hydroxypropyl methylcellulose;
- povidone;
- meglumine;
- mannitol;
- Magnesium stearate.
Release form
Available in the form of white or almost white tablets, oblong in shape. There is a mark on one side of the tablet.
Pharmacological action
Refers to drugs for treatment arterial hypertension .
Pharmacodynamics and pharmacokinetics
Pharmacodynamics
Telmisartan is a selective angiotensin II receptor antagonist. It competes with angiotensin for binding to AT1 receptors. No affinity with other receptors was noted.
Telmisartan does not suppress the action of renin, ACE, does not block the channels responsible for the conduction of ions, reduces the content V .
A dose of 80 mg almost completely eliminates the increase caused by angiotensin II. The maximum effect lasts 24 hours, then gradually decreases. In this case, the significant effect of the drug is felt for at least 48 hours after taking the tablets.
Telmisartan reduces both systolic and diastolic blood pressure, but has no effect on heart rate. There was no addictive effect or clinically significant accumulation in the body.
Pharmacokinetics
After oral administration, the medicine is well and quickly absorbed. Bioavailability is approximately 50%. Binds very well to plasma proteins.
Maximum plasma concentrations are usually higher in women when taking the same dose. But this does not affect the efficiency.
Occurs in the liver. In this case, inactive is formed, which is eliminated mainly through the intestines. The half-life from the body is about 20 hours.
Indications for use
Used for treatment arterial hypertension and for the prevention of mortality from diseases of the cardiovascular system after peripheral vascular diseases, with left ventricular hypertrophy .
Contraindications
It is prohibited to prescribe Telmisartan for:
- obstructive diseases of the biliary tract;
- severe liver failure ;
- primary aldosteronism ;
- fructose intolerance ;
- excessive sensitivity to the active substance or any other ingredient included in the drug;
- under the age of 18.
Side effects
Side effects are observed relatively infrequently.
One in 100-1000 patients who take the medicine will experience the following symptoms:
- anemia ;
- vertigo ;
- fainting ;
- bradycardia ;
- a sharp drop in blood pressure;
- dyspnea ;
- painful sensations in the abdomen;
- acute or other renal dysfunction;
- high level of creatinine in the blood;
- back pain;
- convulsions calves;
- muscle pain;
- increased sweating;
- rashes;
- hyperkalemia ;
- weakness;
- pain in the chest area.
1 in 1000-10000 patients experience:
- infectious diseases of the urinary and respiratory tract (, sinusitis ) or sepsis ;
- thrombocytopenia ;
- level reduction;
- feeling of restlessness;
- visual disturbances;
- drop in blood pressure when changing body position (from horizontal to vertical);
- stomach discomfort;
- feeling of dry mouth;
- liver dysfunction;
- increased liver activity;
- increased plasma concentrations of uric acid;
- joint pain;
- toxic rashes;
- eczematous rash.
Side effects that are very rare or the frequency of which cannot be accurately determined:
- tendon pain similar to tendinitis ;
- increased level of eosinophils in the blood.
Telmisartan, instructions for use (Method and dosage)
Instructions for use of Telmisartan include taking the medication orally, regardless of food intake.
Telmisartan for the treatment of arterial hypertension
Usually prescribed 40 mg per day. But the dose can be reduced to 20 mg if the medicine turns out to be effective at this dosage.
If you cannot achieve the desired effect with a daily dose of 40 mg, you can increase it, but to a maximum of 80 mg. The entire dose is taken at one time. When making a decision regarding dosage adjustment, it is necessary to take into account that the maximum effect is not achieved immediately, but after approximately 1-2 months of regularly taking the tablets.
In order to lower blood pressure, Telmisartan is often prescribed simultaneously with thiazide diuretics.
Telmisartan for prolonging life in cardiovascular diseases
The effectiveness of Telmisartan for the prevention of mortality in people with diseases of the cardiovascular system was noted at a dosage of 80 mg per day. Whether a similar result is observed at lower doses is unknown.
If you have problems with the kidneys or liver, you need to make sure that this dosage does not cause side effects on these organs. It is advisable to start with a dose of 20 mg per day. For most patients with impaired liver function, a dose above 40 mg per day is dangerous.
Overdose
Overdose symptoms:
- drop in blood pressure;
- or, in more rare cases, bradycardia ;
- feeling ;
- increased creatinine levels in the blood;
- heavy.
In case of overdose, symptomatic treatment is indicated. We need constant monitoring of the levels of electrolytes and creatinine in plasma and their correction if necessary.
Telmisartan is ineffective in the treatment of overdose.
Interaction
Interaction of Telmisartan with other drugs:
- , Amifostin and other antihypertensive drugs – the hypotensive effect is enhanced;
- barbiturates, narcotic drugs, ethanol and antidepressants - aggravate the manifestations of orthostatic hypotension or increase the risk of its occurrence;
- , and some other diuretics - the hypotensive effect increases;
- – concentration increases Digoxin in plasma;
- lithium preparations – a reversible increase in the concentration of lithium in the blood; monitoring of this indicator is necessary;
- NSAIDs – increases the risk of acute symptoms renal failure , especially when dehydrated;
- potassium-sparing diuretics, potassium,
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