MICARDIS®

Telmisartan
Available strengths: 40 mg and 80 mg tablets

Medical Description

MICARDIS® (telmisartan) is an oral antihypertensive medicine belonging to the angiotensin II receptor blocker (ARB) class. It is used primarily for the treatment of hypertension (high blood pressure). By blocking the effects of angiotensin II, telmisartan promotes vasodilation and reduces the activity of the renin–angiotensin–aldosterone system (RAAS), resulting in lower blood pressure.

Effective control of hypertension helps reduce the long-term risk of cardiovascular complications, particularly stroke and myocardial infarction. WHO recognizes ARBs, including telmisartan, as an established class of medicines used in pharmacological treatment of hypertension in adults.

Available Strengths

The usual starting dose for hypertension is 40 mg once daily, with the dose adjusted according to the patient's blood-pressure response. The antihypertensive dose range is generally 40–80 mg once daily.

Indications

MICARDIS is indicated for:

• Treatment of hypertension in adults.
• Reduction of blood pressure to help reduce the risk of cardiovascular events associated with uncontrolled hypertension.
• Cardiovascular risk reduction in certain high-risk patients who are unable to take ACE inhibitors, where telmisartan 80 mg once daily is the recommended dose according to U.S. prescribing information.

Mechanism of Action

Telmisartan is a selective angiotensin II type 1 (AT₁) receptor blocker.

Angiotensin II normally binds to AT₁ receptors and causes:

• Vasoconstriction
• Increased peripheral vascular resistance
• Stimulation of aldosterone secretion
• Increased sodium and water retention

Telmisartan selectively blocks the binding of angiotensin II to the AT₁ receptor. This reduces angiotensin-II-mediated vasoconstriction and aldosterone-related effects, resulting in vasodilation and reduced blood pressure.

Telmisartan does not inhibit angiotensin-converting enzyme (ACE) and therefore does not directly inhibit the breakdown of bradykinin.

Clinical Benefits

When appropriately prescribed, MICARDIS may:

• Lower elevated blood pressure.
• Reduce vascular resistance through blockade of angiotensin II.
• Provide 24-hour antihypertensive activity with once-daily administration.
• Help reduce the long-term cardiovascular consequences associated with uncontrolled hypertension.

The antihypertensive effect is generally apparent within approximately 2 weeks, with maximal blood-pressure reduction generally reached by about 4 weeks of treatment.

Dosage & Administration

For hypertension:

• The usual starting dose is 40 mg once daily.
• Depending on the response, the dose may be increased to 80 mg once daily.
• The dosage should be individualized according to blood-pressure response and the patient's clinical condition.
• MICARDIS may be taken with or without food.
• It should preferably be taken at approximately the same time each day.
• Do not increase, decrease, or discontinue the dose without medical advice.

For cardiovascular risk reduction:
The recommended telmisartan dose in the U.S. prescribing information is 80 mg once daily. Blood pressure should be monitored because additional adjustment of other blood-pressure-lowering medicines may be necessary.

Important Warnings & Precautions

Pregnancy
Telmisartan can cause serious fetal harm when administered during pregnancy, particularly during the second and third trimesters. MICARDIS should be discontinued and medical advice sought promptly if pregnancy is detected.

Low blood pressure / volume depletion
Patients who are dehydrated or sodium-depleted, including those receiving intensive diuretic treatment or experiencing significant vomiting or diarrhea, may be more susceptible to symptomatic hypotension.

Kidney function
Renal function should be monitored in susceptible patients. Telmisartan can cause changes in renal function, particularly in patients with conditions that depend on the renin–angiotensin system for maintenance of renal perfusion.

Hyperkalemia
Telmisartan may increase serum potassium concentrations. Patients with renal impairment, diabetes, heart failure, or those taking other medicines that increase potassium may require closer monitoring.

Hepatic impairment
Because telmisartan is substantially eliminated through the hepatobiliary system, patients with hepatic impairment may require particular caution and medical supervision.

Possible Adverse Effects

Possible adverse effects include:

• Dizziness
• Headache
• Back pain
• Diarrhea
• Fatigue
• Hypotension

Clinically important but less common reactions may include:

• Hyperkalemia
• Worsening renal function or acute kidney injury
• Significant hypotension
• Angioedema
• Hypersensitivity reactions

Patients should seek urgent medical attention for signs of angioedema such as swelling of the face, lips, tongue or throat, particularly if associated with difficulty breathing or swallowing.

Important Drug Interactions

Tell the physician or pharmacist about all medicines and supplements being used. Important interactions include:

• Aliskiren — concomitant use with telmisartan is contraindicated in patients with diabetes.
• ACE inhibitors — combined blockade of the renin–angiotensin system is generally not recommended because it may increase the risk of hypotension, hyperkalemia and renal impairment.
• Potassium supplements and potassium-containing salt substitutes — may increase the risk of hyperkalemia.
• Potassium-sparing diuretics — may further increase potassium levels.
• NSAIDs — may reduce antihypertensive efficacy and increase the risk of renal impairment, particularly in susceptible patients.
• Lithium — ARBs may increase lithium concentrations and toxicity risk.

Monitoring

Depending on the patient's condition, healthcare professionals may monitor:

• Blood pressure
• Renal function (serum creatinine/eGFR)
• Serum potassium
• Sodium and other electrolytes when clinically indicated
• Signs and symptoms of hypotension
• Blood glucose in patients with diabetes or increased metabolic risk

WHO recommends appropriate assessment and monitoring as part of pharmacological hypertension management, including consideration of kidney function and cardiovascular risk. 

Storage

Store MICARDIS according to the conditions specified on the original product packaging. Keep the tablets in their original package, protected from excessive moisture and heat, and keep out of the reach of children.

Medical Disclaimer

MICARDIS® (telmisartan) is a prescription antihypertensive medicine and should be used under the supervision of a qualified healthcare professional. This information is provided for educational purposes only and does not replace professional medical advice, diagnosis, or individualized treatment. Do not start, stop, or change the dose without consulting your physician. Inform your healthcare professional if you are pregnant, planning pregnancy, breastfeeding, or have kidney, liver, heart, diabetes, or electrolyte-related conditions.

References

• U.S. National Library of Medicine — DailyMed: MICARDIS (telmisartan) Prescribing Information
• DailyMed — Telmisartan Tablets: Indications, Dosage, Warnings and Precautions
• World Health Organization (WHO) — Guideline for the Pharmacological Treatment of Hypertension in Adults
• NIH/PubMed — Pharmacological and Clinical Profile of Telmisartan
• NIH PubChem — Telmisartan pharmacology and mechanism

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