Home Drug Guide Telmisartan

Drug Guide

Generic Name

Telmisartan

Brand Names Micardis

Classification

Therapeutic: Antihypertensive

Pharmacological: Angiotensin II Receptor Blocker (ARB)

FDA Approved Indications

  • Hypertension
  • Reduction of cardiovascular risk in patients unable to tolerate ACE inhibitors

Mechanism of Action

Telmisartan selectively blocks the angiotensin II type 1 (AT1) receptor, preventing vasoconstriction and aldosterone-mediated volume expansion, thus lowering blood pressure.

Dosage and Administration

Adult: Initially 40 mg once daily; can be titrated up to 80 mg once daily based on response.

Pediatric: Not indicated for pediatric use.

Geriatric: Start at lower dose if necessary; monitor renal function and potassium.

Renal Impairment: Adjust dose cautiously; renal function should be monitored.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Well absorbed, with a bioavailability of approximately 40-42%.

Distribution: Bound to plasma proteins (~99.5%).

Metabolism: Primarily metabolized via glucuronidation; minimal CYP450 involvement.

Excretion: Excreted mainly in feces (74%) and urine (13%).

Half Life: Approximately 24 hours, allowing for once-daily dosing.

Contraindications

  • Pregnancy (Category D), especially in the second and third trimesters
  • History of hypersensitivity to telmisartan or other ARBs
  • Concomitant use with aliskiren in patients with diabetes

Precautions

  • Monitor renal function and serum potassium periodically.
  • Use cautiously in patients with bilateral renal artery stenosis or a single kidney.

Adverse Reactions - Common

  • Dizziness (Common)
  • Back pain (Less common)
  • Upper respiratory tract infection (Common)

Adverse Reactions - Serious

  • Angioedema (Rare)
  • Hypotension (Rare)
  • Elevated serum potassium (Less common)
  • Renal dysfunction (Less common)

Drug-Drug Interactions

  • NSAIDs (may reduce antihypertensive effect and increase risk of renal impairment)
  • Other antihypertensives (additive effect)
  • Potassium-sparing diuretics and potassium supplements (risk of hyperkalemia)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function, and serum electrolytes regularly.

Diagnoses:

  • Risk for impaired kidney function related to medication use
  • Risk for hypotension in patients with dehydration or volume depletion

Implementation: Administer once daily, with or without food.

Evaluation: Assess blood pressure response and monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not discontinue abruptly.
  • Report signs of swelling, difficulty breathing, or hyperkalemia.
  • Limit salt substitutes containing potassium.

Special Considerations

Black Box Warnings:

  • Pregnancy category D; contraindicated in pregnancy.

Genetic Factors: Pharmacogenetic testing not typically required.

Lab Test Interference: May increase serum potassium and serum creatinine levels.

Overdose Management

Signs/Symptoms: Severe hypotension, tachycardia, dizziness.

Treatment: Supportive care, intravenous fluids, and monitoring. No specific antidote; consider activated charcoal if ingestion was recent.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.