Telmista^® (Tablets) Instructions for Use

ATC Code

C09CA07 (Telmisartan)

Active Substance

Telmisartan (Rec.INN registered by WHO)

Clinical-Pharmacological Group

Angiotensin II receptor antagonist

Pharmacotherapeutic Group

Agents acting on the renin-angiotensin system, angiotensin II receptor antagonists

Pharmacological Action

Antihypertensive agent, angiotensin II receptor antagonist (type AT1). It has a very high affinity for this receptor subtype. By selectively and long-lastingly binding to the receptors, Telmisartan displaces angiotensin II from binding to AT1 receptors.

It does not show affinity for other AT receptor subtypes. The functional significance of other receptor subtypes and the effect of increased (as a result of telmisartan administration) angiotensin II levels on them is not known.

Telmisartan reduces plasma aldosterone levels, does not inhibit plasma renin, does not block ion channels, and does not inhibit ACE (kinase II), which also breaks down bradykinin. Therefore, side effects associated with bradykinin are not observed.

Pharmacokinetics

When taken orally, it is rapidly absorbed from the gastrointestinal tract. Bioavailability is 50%. When taken simultaneously with food, the reduction in AUC ranges from 6% (at a dose of 40 mg) to 19% (at a dose of 160 mg).

After 3 hours, the plasma concentration levels out, regardless of whether it is taken with food or on an empty stomach. Plasma protein binding is 99.5%. The mean apparent V_d at steady state is 500 L.

It is metabolized by conjugation with glucuronic acid. The metabolites are pharmacologically inactive.

T_1/2 is more than 20 hours. It is excreted through the intestines unchanged. Cumulative renal excretion is less than 1%. Total plasma clearance is 1000 ml/min (renal blood flow is 1500 ml/min).

Indications

Arterial hypertension.

ICD codes

Dosage Regimen

Tablets

For adults, the daily dose is 20-40 mg (once daily). In some patients, the antihypertensive effect can be achieved at a dose of 20 mg/day. If necessary, the dose can be increased to 80 mg/day.

No dose adjustment is required for patients with impaired renal function, as well as for elderly patients.

For patients with impaired liver function, the daily dose is 40 mg.

Adverse Reactions

From the central nervous system headache, dizziness, fatigue, insomnia, anxiety, depression, seizures.

From the digestive system abdominal pain, dyspepsia, nausea, diarrhea, increased activity of liver transaminases.

From the respiratory system cough, pharyngitis, upper respiratory tract infections.

From the hematopoietic system decreased hemoglobin level.

Allergic reactions rash; in isolated cases – angioedema.

From the urinary system peripheral edema, urinary tract infections, increased uric acid level, hypercreatininemia.

From the cardiovascular system pronounced decrease in blood pressure, palpitations, chest pain.

From the musculoskeletal system low back pain, myalgia, arthralgia.

From laboratory parameters hyperkalemia, anemia, hyperuricemia.

Other flu-like syndrome.

Contraindications

Biliary obstruction, severe hepatic and renal impairment, pregnancy, lactation (breastfeeding), hypersensitivity to telmisartan.

Use in Pregnancy and Lactation

Telmisartan is contraindicated for use during pregnancy and lactation (breastfeeding).

Use in Hepatic Impairment

Contraindicated in severe hepatic impairment.

Use in Renal Impairment

Contraindicated in severe renal impairment.

Pediatric Use

There are no data on the safety and efficacy of telmisartan use in children and adolescents.

Geriatric Use

No dose adjustment is required for elderly patients.

Special Precautions

Telmisartan should be used with caution in case of impaired liver function, gastric and duodenal ulcer in the acute stage, other gastrointestinal diseases, aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy, coronary artery disease, heart failure.

In patients with bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney, the use of telmisartan increases the risk of severe arterial hypotension and renal failure. Therefore, Telmisartan should be used with caution in this category of patients.

During the use of telmisartan in patients with impaired renal function, it is necessary to monitor the plasma levels of potassium and creatinine.

Currently, there are no data on the use of telmisartan in patients with a recent kidney transplant.

Symptomatic arterial hypotension may occur in patients with reduced circulating blood volume and/or hyponatremia, especially after taking the first dose of telmisartan. Therefore, correction of such conditions is necessary before starting therapy.

It is not recommended to use Telmisartan in patients with primary aldosteronism, as such patients are insensitive to drugs that affect the renin-angiotensin system.

The use of telmisartan is possible in combination with thiazide diuretics, as such a combination provides an additional reduction in blood pressure.

When considering the possibility of increasing the dose of telmisartan, it should be remembered that the maximum antihypertensive effect is usually achieved after 4-8 weeks from the start of treatment.

Use in pediatrics

There are no data on the safety and efficacy of telmisartan use in children and adolescents.

Effect on ability to drive vehicles and operate machinery

The issue of the possibility of engaging in potentially hazardous activities requiring increased attention and rapid psychomotor reactions should be decided only after assessing the individual reaction to Telmisartan.

Drug Interactions

With simultaneous use with antihypertensive drugs, an increase in the antihypertensive effect is possible.

With simultaneous use with potassium-sparing diuretics, heparin, dietary supplements, salt substitutes containing potassium, the development of hyperkalemia is possible.

With simultaneous use with lithium preparations, an increase in the plasma concentration of lithium is possible.

With simultaneous use, an increase in the plasma concentration of digoxin is possible.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.