Telmipres Plus 40/12.5

Indications

Telmisartan and Hydrochlorothiazide are indicated for the management of hypertension (high blood pressure), helping to lower blood pressure levels. Telmipres Plus can be used either as a monotherapy or in combination with other antihypertensive medications. By lowering blood pressure, this treatment reduces the risk of serious cardiovascular events, such as strokes and heart attacks.

Note: Always follow the advice of a registered healthcare professional when using this medication.

Pharmacology

Telmisartan: Telmisartan works by blocking the effects of angiotensin II, a powerful vasoconstrictor in the body. Angiotensin II typically causes blood vessel constriction, stimulates aldosterone production, and promotes sodium retention in the kidneys, all of which can elevate blood pressure. Telmisartan selectively blocks the AT1 receptors (found in vascular smooth muscle and the adrenal glands), inhibiting these harmful effects without interfering with the synthesis of angiotensin II itself. As a result, blood pressure is effectively reduced.
It is important to note that Telmisartan has a significantly higher affinity for AT1 receptors (>3,000 times) compared to AT2 receptors, which are not involved in regulating cardiovascular function.

Hydrochlorothiazide: Hydrochlorothiazide is a thiazide diuretic that reduces blood pressure by promoting the excretion of sodium and chloride from the kidneys. This diuretic action reduces plasma volume, leading to increased aldosterone secretion and potassium loss. The combination with an angiotensin II receptor blocker (ARB) like Telmisartan helps mitigate the potassium loss commonly associated with thiazides. The precise mechanism through which hydrochlorothiazide lowers blood pressure is not fully understood but is likely due to its effects on fluid balance and electrolyte regulation.

Dosage & Administration

For patients whose blood pressure is inadequately controlled with:

• Telmisartan monotherapy 80 mg: Start with Telmisartan and Hydrochlorothiazide 80 mg/12.5 mg once daily. This dose can be increased to 160 mg/25 mg after 2 to 4 weeks, if necessary.
• For patients on Hydrochlorothiazide 25 mg daily or those who experience hypokalemia: Start with Telmisartan and Hydrochlorothiazide 80 mg/12.5 mg once daily, and increase the dose to 160 mg/25 mg after 2 to 4 weeks, if needed.

Telmisartan and Hydrochlorothiazide can be used alongside other antihypertensive medications.

Note: Always consult a registered healthcare provider before taking any medication.

Interactions

Use Telmipres Plus with caution if you are taking medications such as aliskiren, digoxin, lithium, or other antihypertensive drugs. Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen, as well as corticosteroids (e.g., prednisone, hydrocortisone). Additionally, the combination of Telmisartan with other angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (such as losartan, valsartan, or olmesartan) should be avoided due to the risk of adverse effects.
Telmisartan may also interfere with certain lab tests, potentially leading to inaccurate results, including parathyroid hormone and protein-bound iodide tests.

Contraindications

Telmipres Plus is contraindicated in patients with a known hypersensitivity to Telmisartan, Hydrochlorothiazide, or any of the components of this product. Aliskiren should not be co-administered in patients with diabetes.

Side Effects

Common side effects of Telmipres Plus include:

• Dizziness
• Fatigue
• Nausea or stomach discomfort
• Flushing (warmth, redness, or tingling sensations)
• Back pain
  Other potential side effects may include:
• Allergic reactions (e.g., rash, swelling)
• Muscle cramps or weakness
• Insomnia or somnolence
• Dry mouth
  Less common side effects could include:
• Elevated liver enzymes
• Photosensitivity
• Restlessness
• Myalgia (muscle pain)

Pregnancy & Lactation

Pregnancy Category D: The use of Telmisartan and Hydrochlorothiazide during pregnancy, particularly during the second and third trimesters, can harm the fetus by impairing renal function and causing fetal death or serious developmental issues such as lung hypoplasia or skeletal deformities. If pregnancy occurs, discontinuation of this medication is recommended immediately.

Breastfeeding: It is not known whether Telmisartan is excreted in human breast milk, but it has been detected in the milk of lactating rats. Thiazides also appear in breast milk. Due to the potential risks to the infant, a healthcare provider will determine whether to discontinue nursing or the medication, considering the mother’s health needs.

Precautions & Warnings

Before starting Telmipres Plus, inform your doctor about your medical history, especially if you have:

• Kidney or liver issues
• Dehydration or mineral imbalances (e.g., low/high potassium)
• Gout or lupus
• Diabetes (as it may affect your blood sugar levels)

Telmipres Plus may affect potassium levels, so consult your doctor before using potassium supplements or salt substitutes. If you experience dizziness, avoid activities requiring full alertness, such as driving or operating machinery. Report any prolonged vomiting or diarrhea, and ensure adequate fluid intake unless otherwise directed by your doctor.

Use in Special Populations

Pediatric Use: The safety and effectiveness of Telmipres Plus in children have not been established.

Geriatric Use: In elderly patients, it is recommended to start at the lower end of the dosing range, especially if they have diminished hepatic, renal, or cardiac function.

Renal Impairment: The safety and effectiveness of Telmisartan and Hydrochlorothiazide in patients with severe renal impairment (CrCl <30 mL/min) have not been established. The combination is not recommended for these patients. However, no dose adjustment is required for mild to moderate renal impairment (CrCl ≥30 mL/min).

Hepatic Impairment: Patients with liver disorders, including biliary obstruction or hepatic insufficiency, should initiate treatment under close medical supervision.

Overdose Effects

Symptoms of overdose may include:

• Low blood pressure (hypotension)
• Dizziness or fainting
• Rapid or slow heart rate (tachycardia or bradycardia)
• Electrolyte imbalances (e.g., hypokalemia, hyponatremia)
• Dehydration
  Hemodialysis is unlikely to remove Telmisartan from the body, and the extent to which Hydrochlorothiazide is removed by dialysis is not fully understood.

Therapeutic Class

Combined Antihypertensive Preparations

Storage Conditions

Store in a cool, dry place, away from direct light. Keep out of reach of children.