Telmisartan

Telmisartan is a angiotensin ii receptor blocker (arb, antihypertensive) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• High blood pressure (hypertension) — alone or combined with other blood pressure medicines
• Cardiovascular risk reduction — lowering the risk of heart attack, stroke and cardiovascular death in patients aged 55 or older with high risk (heart disease, stroke, peripheral artery disease or diabetes with organ damage)
• Kidney protection — often chosen for diabetic patients to slow protein loss in urine and kidney damage

Your doctor will decide the right dose of Telmisartan based on your blood pressure readings, kidney function and other health conditions. Treatment usually starts at a lower dose, which may be increased after a few weeks if needed.

• Take it once daily, at about the same time every day, with or without food.
• Swallow the tablet with water; do not crush or chew unless your doctor advises.
• If you miss a dose, take it as soon as you remember unless the next dose is near — never take a double dose.

This is a long-term medicine. Never stop Telmisartan on your own, even if your blood pressure readings look normal — they are normal because the medicine is working.

Most people tolerate telmisartan well, and unlike ACE inhibitors it rarely causes a dry cough. Possible side effects include:

• Dizziness or light-headedness, especially when standing up quickly or at the start of treatment
• Headache, tiredness
• Back pain, muscle cramps or sinus/upper respiratory symptoms
• High blood potassium (may cause muscle weakness or irregular heartbeat)
• Low blood pressure (blurred vision, faintness), especially if you are dehydrated
• Changes in kidney function tests
• Rare but serious: swelling of the face, lips, tongue or throat (angioedema) — stop the medicine and seek emergency care immediately

• Check your blood pressure regularly and keep all follow-up appointments.
• Your doctor may order blood tests for kidney function and potassium, especially after starting or changing the dose.
• Rise slowly from sitting or lying to avoid dizziness; avoid driving until you know how the medicine affects you.
• Tell your doctor if you have kidney disease, liver disease, bile duct problems, heart failure or narrowing of the kidney arteries.
• Vomiting, diarrhoea or excessive sweating can drop your pressure too low — drink fluids and contact your doctor if you feel faint.
• Avoid potassium supplements or potassium-containing salt substitutes unless your doctor approves.
• Women of childbearing age should use reliable contraception and report a planned or suspected pregnancy immediately.

• NSAID painkillers (ibuprofen, diclofenac, naproxen): reduce the blood-pressure effect and can harm the kidneys
• Potassium supplements, potassium-sparing diuretics (spironolactone, amiloride): risk of dangerously high potassium
• ACE inhibitors (ramipril, lisinopril) or aliskiren: combining is generally avoided — higher risk of low pressure, high potassium and kidney problems
• Lithium: telmisartan can raise lithium levels to toxic range
• Digoxin: levels may rise; your doctor may monitor
• Other blood pressure medicines and diuretics: additive pressure-lowering effect

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to telmisartan or any other ARB
• Pregnancy — especially the second and third trimesters; can seriously harm or kill the unborn baby
• Severe liver disease or bile duct obstruction (biliary obstructive disorders)
• Use with aliskiren in patients with diabetes or significant kidney disease

Pregnancy: Telmisartan is contraindicated in pregnancy. Like other ARBs, it can cause serious kidney damage, low amniotic fluid, skull underdevelopment and even death of the unborn baby, particularly in the second and third trimesters. If you become pregnant or plan to conceive, tell your doctor immediately — the medicine will be switched to a pregnancy-safe alternative.

Lactation: Telmisartan is not recommended while breastfeeding because safety data are limited. Your doctor can prescribe a better-studied alternative for nursing mothers.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Telmisartan tablets are moisture-sensitive, so keep them in the original blister pack until use. Keep out of the reach of children. Do not use after the expiry date.