Telmitan Plus

Telmisartan: Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). It is the principal pressor agent of the renin-angiotensin system. Its effects include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation, and renal reabsorption of sodium.

Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. It does this by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. So its action doesn't depend on the pathways that make angiotensin II. There is also an AT2 receptor found in many tissues, but AT2 is not known to be associated with cardiovascular homeostasis. Telmisartan has much greater affinity (>3,000-fold) for the AT1 receptor than for the AT2 receptor. It does not inhibit ACE (kininase II), and it does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation.

Blockade of the angiotensin II receptor removes the negative regulatory feedback of angiotensin II on renin secretion. Plasma renin activity and circulating angiotensin II levels therefore rise, but this rise does not overcome the effect of telmisartan on blood pressure.

Hydrochlorothiazide: Hydrochlorothiazide is a thiazide diuretic. Thiazides act on the renal tubular mechanisms of electrolyte reabsorption and directly increase the excretion of sodium salt and chloride in approximately equivalent amounts. Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume. This brings increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of an ARB tends to reverse the potassium loss seen with these diuretics. The mechanism of the antihypertensive effect of thiazides is not fully understood.

Telmisartan and hydrochlorothiazide is Pregnancy Category D. Medicines that act on the renin-angiotensin system, when taken in the second and third trimesters, reduce the baby's kidney function and raise the risk of illness and death in the baby, both before and after birth. The low amniotic fluid (oligohydramnios) that results can be linked with underdeveloped lungs (fetal lung hypoplasia) and skeletal deformations. In the newborn, possible harmful effects include skull hypoplasia, anuria, hypotension, renal failure and death. If pregnancy is detected, stop Telmisartan and hydrochlorothiazide as soon as possible.

Nursing mothers

It is not known whether telmisartan passes into human milk, but it was found in the milk of lactating rats. Thiazides do appear in human milk. Because the nursing infant could be harmed, the decision has to be made either to stop nursing or to stop the medicine, taking into account how important the medicine is to the mother.

Pediatric Use: The safety and effectiveness of Telmisartan and Hydrochlorothiazide in children have not been established.

Geriatric Use: In elderly patients, the dose should be chosen with care, and treatment usually starts at the low end of the dosing range. This is because decreased liver, kidney or heart function is more common in older people, and so are other diseases and other drug therapy.

Use in Patients with Hepatic Impairment: People with biliary obstructive disorders or hepatic insufficiency should start treatment under close medical supervision.

Use in Patients with Renal Impairment: The safety and effectiveness of Telmisartan and Hydrochlorothiazide in patients with severe renal impairment (Cr.Cl. <30 ml/min) have not been established, so the tablets are not recommended for them. No dose adjustment is needed in patients with mild (Cr.Cl. 60 to 90 ml/min) or moderate (Cr.Cl. 30 to 60 ml/min) renal impairment.

An overdose of Telmisartan with Hydrochlorothiazide is most likely to cause hypertension, dizziness, tachycardia, bradycardia, hypokalemia, hypochloremia, hyponatremia and dehydration, among other effects. Hemodialysis does not remove Telmisartan. How far it removes Hydrochlorothiazide has not been established.

Keep Telmisartan + Hydrochlorothiazide out of the reach of children. Store it in a cool, dry place and protect it from light.