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Telmisartan: Indications, Dosing, Side Effects and Interactions
Telmisartan clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Telmisartan: Indications, Dosing, Side Effects and Interactions
Telmisartan clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 20-40 mg once daily for at least 4 weeks, increased if necessary up to 80 mg once daily.
**Prevention of cardiovascular events in patients with established atherosclerotic cardiovascular disease, or type 2 diabetes mellitus with target-organ damage**
- **Adult** (By Mouth): 80 mg once daily.
Cautions
II receptor antagonists Aortic or mitral valve stenosis; elderly (lower initial doses may be appropriate); hypertrophic cardiomyopathy; patients of black African or African-Caribbean origin; patients with a history of angioedema; patients with primary aldosteronism (may not benefit from an angiotensin-II receptor antagonist); renal artery stenosis Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
II receptor antagonists The combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an angiotensin-II receptor antagonist with aliskiren is contra-indicated in patients with diabetes mellitus Contra-indications For telmisartan Biliary obstructive disorders; cholestasis
Side effects
II receptor antagonists Common or very common Abdominal pain; asthenia; back pain; cough; diarrhoea; dizziness; headache; hyperkalaemia; hypotension; nausea; postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics); renal impairment; vertigo; vomiting Uncommon Angioedema; myalgia; skin reactions; thrombocytopenia Rare or very rare Arthralgia; hepatic function abnormal Side-effects For telmisartan Uncommon Anaemia; arrhythmias; chest pain; cystitis; depression; dyspnoea; flatulence; gastrointestinal discomfort; hyperhidrosis; increased risk of infection; insomnia; muscle spasms; sciatica; syncope Rare or very rare Anxiety; drowsiness; dry mouth; eosinophilia; hypoglycaemia; influenza like illness; interstitial lung disease; liver disorder; pain in extremity; sepsis; taste altered; tendon pain; visual impairment
Interactions
**Severe interactions:**
- Potassium sparing diuretics e.g.
**Other interactions (15):**
- Digoxin When telmisartan was co-administered with digoxin, median increases in digoxin peak plasma concentration (49%) and in trough concentration (20%) were observed.
- When initiating, adjusting, and discontinuing telmisartan, monitor digoxin levels in order to maintain levels within the therapeutic range.
- As with other medicinal products acting on the renin-angiotensin-aldosterone system, telmisartan may provoke hyperkalaemia (see section 4.4).
- The risk may increase in case of treatment combination with other medicinal products that may also provoke hyperkalaemia (salt substitutes containing potassium, potassium-sparing diuretics, ACE...
- The risk is particularly high in combination with potassium sparing-diuretics, and when combined with salt substitutes containing potassium.
- Concomitant use not recommended Potassium sparing diuretics or potassium supplements Angiotensin II receptor antagonists such as telmisartan, attenuate diuretic induced potassium loss.
Pregnancy
Important safety information For all angiotensin II receptor antagonists MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
II receptor antagonists Information on the use of angiotensin-II receptor antagonists in breast-feeding is limited. They are not recommended in breast-feeding. Alternative treatment options, with better established safety profile during breast-feeding, are preferable M (recommendation also supported by specialist sources).
Hepatic impairment
II receptor antagonists In general, manufacturers advise caution in mild to moderate impairment (limited information available); avoid in severe impairment (no information available). Hepatic impairment For telmisartan Dose adjustments Manufacturer advises maximum 40 mg daily in mild to moderate impairment.
Renal impairment
II receptor antagonists Dose adjustments In general, manufacturers advise start with low dose and adjust according to response. Renal impairment For telmisartan Dose adjustments Manufacturer advises initial dose of 20 mg once daily in severe impairment.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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