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Telmisartan is a lifeline for arterial hypertension. "Telmisartan": instructions for use and analogues Telmisartan and instructions for use

Every hypertensive patient should have Telmisartan in their first aid kit.

It stabilizes not only elevated blood pressure levels, but also fights intracranial pressure.

Experts recommend this remedy not only because of its high effectiveness, but also because in most cases it is easily tolerated by patients.

Letters from our readers

Subject: Grandma's blood pressure has returned to normal!

From: Christina ( [email protected])

To: Site Administration

Christina
Moscow

My grandmother's hypertension is hereditary - most likely, I will have the same problems as I grow older.

Telmisartan blood pressure tablets are prescribed for the following pathologies:

prevention of cardiovascular diseases in people of the older age category (from 55 years);
rehabilitation of patients who have suffered a stroke or heart attack.

Effect on blood pressure

The action of Telmisartan is aimed at reducing blood pressure.

The active component of the drug is not excreted from the body throughout the day, which leads to stabilization of pressure for a sufficiently long period of time.

This is very important for monitoring blood pressure levels in the early morning hours, when the patient is still sleeping, which makes the product stand out among its analogues. Doctors prescribe the drug for diabetics and obese people.

The product is available in tablet form. They are white or light yellow in color and have an elongated or round flat-cylindrical shape.

Depending on the pharmaceutical company, they are produced in cardboard packages that contain blisters or plastic jars. Blisters come in 5, 7, 10, 20 pcs., jars - 10, 20, 28, 30, 40, 50, 100 pcs.

Compound

Telmisartan tablets contain different concentrations of the active ingredient - 40 or 80 mg. The active ingredient of the drug is telmisartan. Depending on the dose, the amount of additional substances also varies.

Additional components	Amount of substance depending on dose, mg
Additional components	40 mg	80 mg
Milk sugar (lactose)	296,85	474,9
Caustic soda	3,35	6,7
Povidone	12	24
Meglumine	12	24
Croscarmellose sodium	12	24
Magnesium salt of stearic acid	3,8	6,4

Caustic soda is also known by another name - sodium hydroxide.

The cost of Telmisartan 40 mg averages 250 – 300 rubles. The price for Telmisartan 80 mg ranges from 300 to 430 rubles.

The original drug is produced in India. The price is for 30 tablets per package. This medicine is also produced in Germany, but its cost is several orders of magnitude higher.

Taking the drug is not related to nutrition. The instructions for use of Telmisartan describe at what pressure the medicine can be used. The drug is prescribed to reduce blood pressure.

The treatment course begins with a dosage of 40 mg per day. It is taken once. If the effect is not achieved, the dose is increased to 80 mg. It is important to know that the drug acts according to a cumulative scheme and the maximum positive effect after starting treatment is achieved after 30 – 55 days.

For preventive purposes to strengthen the cardiovascular system, the recommended daily dose Telmisartan 80 mg is 1 tablet. To minimize the risk of heart attack or stroke, the amount of medication taken remains the same. Reducing the amount of the drug may not give the expected result.

In some cases, with stage 1 hypertension, a positive trend in reducing blood pressure levels is observed with a daily dose of 20 mg.

Telmisartan is used to treat arterial hypertension in combination with the thiazide class. An example of such a diuretic is Hydrochlorothiazide.

Complex therapy with these drugs allows you to increase the daily consumption of Telmisartan to 160 mg. This treatment is used for stage 3 hypertension. At the same time, the effectiveness of the drug is clearly felt by patients.

Use by children

The drug is not used in pediatrics, since there is no data on its effect on the children's body. You can take the pills from the age of 18.

Use by the elderly

The drug is well tolerated and quite effective in the treatment of older people. The doses indicated in the instructions for use do not need to be adjusted when people take tablets old age.

The drug is well tolerated by patients, but has a fairly impressive list of possible adverse reactions.

Rarely happen:

decrease in hemoglobin level in the blood;
failure of sleep and wakefulness;
anxiety, loss of strength, worsening mood;
lack of coordination;
loss of consciousness;
slow heart rate;
sudden rapid decrease in blood pressure;
dyspnea;
failure of breathing rhythm;
painful cramps in the abdominal area;
gastrointestinal disorder - diarrhea, vomiting;
an increase in the level of creatinine in the body, which indicates a malfunction of the kidneys;
pain in muscle tissue;
involuntary contractions of the calf muscles;
hives and severe itching;
decreased concentration;
headache;
infections similar to symptoms of ARVI or influenza;
hyperhidrosis;
an increase in potassium concentration in the body, which can lead to arrhythmia;
pain and tightness in the chest;

Very rare violations include:

blood poisoning;
infectious processes of the genitourinary system (cystitis) and respiratory tract;
ENT infections – pharyngitis, sinusitis;
a decrease in platelet levels, which can cause bleeding;
blurred vision;
increased heart rate;
a sharp decline pressure when changing position (when getting out of bed);
flatulence, belching;
dry mouth;
liver dysfunction and increased concentrations of liver enzymes in the bloodstream;
hyperuricemia, which can cause gout;
redness of the skin;
Quincke's edema;
eczema;

Reactions that occur extremely rarely in patients:

inflammatory processes in tendon tissues;
increased concentration of eosinophils in the body;

If you notice one or more of the above symptoms, you should immediately stop taking the drug and consult a doctor.

Telmisartan is not prescribed in the following cases:

children's and adolescence(up to 18 years old);
pregnancy and lactation;
obstruction of the biliary tract;
severe liver and kidney failure;
not accepting fructose by the body;
glucose-galactose malabsorption;
hypersensitivity to the constituent components;
an increase in the production of the hormone aldosterone - Conn's syndrome, caused by the development of tumor processes in the adrenal glands.

People suffering from coronary artery disease, gastric or duodenal ulcers, and those prone to bleeding, need to periodically analyze their blood counts and listen to their own feelings.

The doctor is obliged to monitor the condition of patients to prevent complications.

Signs of exceeding the dose of the active substance:

a sharp decrease in blood pressure;
acceleration or deceleration of heart rate;
loss of coordination;
increase in creatinine;
renal failure.

Each individual symptom is treated. Hemodialysis is not used to eliminate overdose.

Interaction with other drugs

Telmisartan is able to increase the effectiveness of other drugs used for the prevention and treatment of hypertension (Amlodipine, Baclofen, Amifostine). Therefore, when complex therapy, you should take this into account and start the course with a minimum dosage.

Among the abundance of drugs that lower blood and intracranial pressure without harming the heart rhythm, it is difficult to find a drug with a minimum side effects. Difficult, but possible. Telmisartan is an effective drug in the fight against high blood pressure, to which all of the above directly applies.

The instructions for use of Telmisartan indicate that this drug acts within three hours after administration.

Compound

One tablet of Telmisartan can contain 40 or 80 mg of the active substance - telmisartan. Excipients are sodium hydroxide, meglumine, povidone, magnesium stearate, hydroxypropyl methylcellulose, mannitol.

Telmisartan is included in the RLS (Register of Medicines), it is a medicine approved in the Russian Federation, effective against high blood pressure, without harming the functioning of the heart.

Indications for the use of this drug are chronic hypertension (increased blood and intracranial pressure) and the prevention of cardiovascular diseases.

By-effect

According to the instructions, Telmisartan is characterized by the following side effects:
Diarrhea;
Cough;
Dizziness;
Myalgia;
Headache;
ARVI symptoms;
Decrease in the amount of hemoglobin in the blood;
Pain syndrome in the lumbar region, chest, abdomen;
Increased amount of uric acid;
Drowsiness;

Reduced concentration (use with caution for drivers and those whose work involves high concentration of attention).

Take under medical supervision, with caution

The blurb for Telmisartan states that those with renal artery stenosis should take this medication with caution due to the risk of developing renal failure. Patients with hyponatremia should be prepared to experience symptoms after taking the first Telmisartan tablet..

high blood pressure
While waiting for the baby to be born;
During breastfeeding;
Children under 18 years of age;
If you are allergic to one of the substances included in this drug;
In case of severe impairment of the kidneys and liver;

With obstruction of the biliary tract.

For Telmisartan, the price depends on the country of origin. If this is Germany, then the cost of a package of Telmisartan 98 pieces will be approximately 80 Euros. For Ukrainian Telmisartan 40 mg, the price will be approximately 80 hryvnia per package, which includes 28 tablets.

Analogs of this drug produced in Turkey and produced in Slovenia will cost from 300 to 900 rubles, depending on the number of tablets in the package and dosage. (40 mg or 80 mg). For analogues of Telmisartan 80 mg, the price will definitely be higher.

Telmisartan analogs

Mikardis (Germany);
Telmista (Poland/Slovenia);
Teseo (Poland);
Praytor (Germany);
Twinsta (Slovenia);
Telmisartan-Teva (Hungary);
Telpres (Spain);
Telsartan (India);
Tsart (India);
Hipotel (Ukraine).

The first two are the most popular in the Russian Federation, since the price for these analogues of Telmisartan is 600 and 1200 rubles, respectively. To the question whether there are Russian analogues of Telmisartan, there is a clear answer - not yet.

Russian patients have to be content with imported pharmaceutical products. Telmisartan Teva, an Israeli product sold all over the world, has proven itself well among domestic patients.

Dosage

For high blood pressure, you should take 1 tablet of Telmisartan 40 mg per day. To prevent cardiovascular diseases (as well as heart attack and stroke), you should take 80 mg of Telmisartan per day.

The patient’s blood pressure is completely normalized after a month of taking this drug. And it begins to act (lower blood pressure) within three hours after administration. Those with minor liver problems should not drink more than 40 mg of this drug in a 24-hour period.

Interaction with other drugs

If you take Telmisartan 80 mg or 40 mg together with Digoxin, the concentration of the latter in the blood will increase. It is not recommended to take the drug described above and potassium-sparing diuretics at the same time. The simultaneous use of Telmisartan and NSAIDs (the same aspirin) reduces the effect, which reduces the patient's high blood pressure.

Taking Telmisartan with other drugs that lower blood pressure can cause an excessive reduction in blood pressure to fatal levels. Therefore, it is better not to take several types of medications at once, the purpose of which is to normalize blood pressure.

If you take Telmisartan 40 or 80 at the same time as corticosteroids, this will reduce the antihypertensive (lowering blood pressure) effect of Telmisartan.

Taking a dose of 80 mg of Telmisartan can completely stop the increase in blood pressure. The blood pressure will be normal within two days.

Doctors prescribe Telmisartan to patients with high blood pressure. This medicine helps control blood pressure levels. It is taken as a prevention of cardiovascular diseases such as stroke and heart attack. The drug has proven itself well, so it can be found in the home medicine cabinet of many hypertensive patients.

The drug is marketed in the form of white-coated tablets. Telmisartan is packaged in blisters of 10 pcs. Each tablet contains 40 or 80 mg active substance. On average, a medicine package contains 30 pills.

The active substance of the drug is telmisartan. It also contains the following components:

Sorbitol;
Hydroxypropyl methylcellulose;
Povidone;
Sodium hydroxide;
Magnesium stearate.

Auxiliary components of the tablet support and enhance therapeutic effect active substance.

The drug is available in tablet form

pharmachologic effect

Telmisartan is a specific angiotensin II receptor antagonist. It goes well with Amlodipine, so they are often taken together. The drug at a dosage of 80 mg is able to completely block the hypertensive properties of angiotensin II. Its effect is observed within 24 hours. It remains for 2 days.

Approximately 3 hours after taking the drug, a decrease in blood pressure occurs. The maximum reduction is observed 4 weeks after starting to take tablets containing the substance termisartan. If necessary, it can be supplemented with amlodipine.

While reducing blood pressure, this drug does not affect the heart rate. The effect occurs only on systolic and diastolic blood pressure. This is the peculiarity of the active component.

If for a number of reasons the patient suddenly stops taking the medicine, that is, the substance telmisartan, and along with it amlodipine, no longer enters his body, then the blood pressure returns to its original value. There is no withdrawal syndrome.

The active component of the drug telmisartan, like its accompanying substance amlodipine, has no effect on indicators of cardiovascular diseases.

Indications

The medication, which is sold in tablet form, is recommended for patients with hypertension. It is often prescribed to people who have a slight increase in blood pressure. Quite often, the medicine is taken by athletes involved in bodybuilding, since during periods of certain cycles they experience an excessive increase in blood pressure.

If you take Telmisartan as the instructions say, you can achieve a significant improvement in your overall well-being, and not just get rid of high blood pressure.

With the help of Telmisartan, diseases such as stroke and atherosclerosis are prevented. This is because the medicine has a positive effect on the structure and function of the brain.

Taking these tablets is important for overweight people, as their active components have a metabolic effect.

Telmisartan is prescribed for hypertension

Instructions for use

All information on how to take the medicine correctly is contained in the instructions for using Telmisartan. According to it, patients need to take the tablets orally. The patient himself can decide whether to drink them or not. There are no restrictions in this regard.

Telmisartan containing 40 mg of active substance or Telmisartan with a double dose of 80 mg can be taken regardless of meals. It is recommended to limit the dosage of the drug to 20 to 40 mg per day. Only in rare cases is it increased to 80 mg. However, this action is prohibited for people who have liver problems.

When prescribing this medication, the doctor must ask the patient whether he is taking any other medications. This is because Telmisartan is incompatible with some of them. The following nuances are taken into account:

To achieve the best result, you need to take Telmisartan tablets with thiazide diuretics, for example, with the drug Hydrochlorothiazide;
It is prohibited to take it simultaneously with medications that can increase the total concentration of potassium. Because of this, hyperkalemia may develop;
You should not take this drug with lithium-containing drugs at the same time, as this can lead to increased toxic effects on the body;
Combining the medication with diuretics is strictly prohibited, as this will cause severe dehydration of the body.

To avoid negative consequences, you must strictly follow all the specialist’s instructions regarding the duration of therapy, the daily dosage of Telmisartan and the possibility of using other drugs in treatment.

Side effects

If the patient does not adhere to the rules regarding taking Telmisartan, then he may experience side effects. They manifest themselves in the form of the following states:

Headache;
Nausea and vomiting;
Dizziness;
Diarrhea;
Dizziness;
Flu-like symptoms;
Pain in the abdomen and chest;
Increased uric acid levels;
Decreased hemoglobin.

Every patient should be aware of the side effects of the medication. They should be studied especially carefully by patients who plan to take it at the workplace. Workers at complex technical facilities and drivers should handle tablets with caution. After all, after taking the medicine, they may experience nausea, severe drowsiness and partial loss of concentration.

Quite often, doctors note the appearance of symptomatic arterial hypertension in patients who have been diagnosed with hyponatremia. The same applies to patients with reduced circulating blood volume.

A drug used to treat hypertension may cause severe hypertensive disease in patients with renal artery stenosis. Those who plan to take blood pressure medications should be aware of this. Abuse of Telmisartan increases the risk of renal failure.

The drug may affect concentration, which is unacceptable in some professions

Contraindications

Before starting treatment with Telmisartan, you need to familiarize yourself with its contraindications. The medicine should not be taken by pregnant women. It is also not suitable for those who are planning to become pregnant soon. Young mothers will have to stop breastfeeding if they need to be treated with this medication.

The medication has other contraindications:

Hypersensitivity to the components of the drug;
Obstruction of the biliary tract;
Impaired kidney or liver function.

In such conditions, taking the medicine can be very dangerous. Reviews from doctors about the drug confirm this information. Therefore, before starting treatment, it is necessary to get checked at the hospital. This will help determine whether a particular patient has contraindications to such treatment for high blood pressure.

Drug overdose

No cases of drug overdose have been officially recorded. Therefore, there is no information about this.

special instructions

Telmisartan should be taken with caution by people who have kidney or liver problems. The drug can significantly complicate these conditions and cause deterioration in health. Against this background, the likelihood of developing renal failure and severe arterial hypotension increases. However, there is no information about how the drug affects patients who have undergone kidney transplantation.

If patients with kidney problems still have to take antihypertensive medication, they must regularly check the level of creatinine and potassium in the blood.

In case of kidney disease, Telmisartan is prescribed with caution.

If a patient has a reduced blood volume or has been diagnosed with hyponatremia, he may experience a sharp drop in blood pressure. This happens especially often when the drug is taken for the first time. To avoid side complications, it is necessary to get rid of the conditions listed above before starting the treatment course.

Patients with high blood pressure who have coronary artery disease or cardiopathy should take Telmisartan with caution. If blood pressure decreases too much, they may develop cerebrovascular accident or myocardial infarction.

For people with primary aldosteronism, it does not make sense to prescribe treatment with Telmisartan, since in their case the drug is ineffective. Therefore, doctors do not even consider it when selecting the optimal medication to lower high blood pressure in a patient.

The risk of developing hyperkalemia increases several times after taking this medication in the following cases:

In the presence of heart failure;
With the development of renal failure;
When used in medicinal purposes potassium-sparing diuretics;
When treated with drugs that increase the concentration of potassium in the blood.

To avoid complications, it is necessary to constantly monitor the level of potassium in the blood.

The active substance of the drug is excreted mainly with bile. If the patient has problems with the liver, then this process will be significantly slowed down. You also need to pay attention to this.

Analogs

Treatment with Telmisartan gives positive results in almost all cases. But sometimes it is prohibited. In such a situation, the specialist has to adjust the course of treatment that he has already selected for the patient. He will be interested in drug analogues. This medication can be replaced by:

"Micardis Plus";
"Mikardis";
"Twinsta";
"Prytor";
"Teseo";
"Telmista."

The most popular and often recommended analogues of Telmisartan are medications"Mikardis" and "Telmista". They attract the attention of patients who cannot afford to purchase expensive medicine. In pharmacies, buy “Mikardis” for 600 rubles, and “Telmista” can be bought for 1200 rubles.

Price

High blood pressure medicine, which comes in tablet form, can be purchased at many pharmacies. Telmisartan will cost the buyer about 6,000 rubles for 98 pills. This price indicates that this product is expensive. Quite often, patients are interested in its analogues, since few people can allocate so much money to purchase the drug.

pharmachologic effect

Antihypertensive agent, angiotensin II receptor antagonist (type AT1). It has a very high affinity for this receptor subtype. By selectively and long-term binding to receptors, telmisartan displaces angiotensin II from its connection with AT1 receptors. 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 the administration of telmisartan) levels of angiotensin II on them is not known. Telmisartan reduces the level of aldosterone in the blood plasma, does not inhibit plasma renin, does not block ion channels, and does not inhibit ACE (kinase II), which also destroys bradykinin. Therefore, there are no side effects associated with bradykinin.

Pharmacokinetics

When taken orally, it is quickly 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). 3 hours after administration, the plasma concentration levels off, regardless of whether it is taken with food or on an empty stomach. Plasma protein binding is 99.5%. The average values of apparent Vd at the equilibrium stage are 500 l. Metabolized by conjugation with glucuronic acid. Metabolites are pharmacologically inactive.

T1/2 – more than 20 hours. 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.

Dosage regimen

For adults, the daily dose is 20-40 mg (1 time/day). In some patients, a hypotensive effect can be achieved with a dose of 20 mg/day. If necessary, the dose can be increased to 80 mg/day.

Patients with impaired renal function, as well as elderly patients, do not require dose adjustment.

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

Side effect

From the side of the central nervous system: headache, dizziness, fatigue, insomnia, anxiety, depression, convulsions.

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: decrease in hemoglobin level.

Allergic reactions: rash; in a single case - angioedema.

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

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

From the musculoskeletal system: lower back pain, myalgia, arthralgia.

From the laboratory parameters: hyperkalemia, anemia, hyperuricemia.

Others: flu-like syndrome.

Contraindications for use

Obstruction of the biliary tract, severe dysfunction of the liver and kidneys, pregnancy, lactation ( breast-feeding), increased sensitivity to telmisartan.

Use during pregnancy and breastfeeding

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

Use in children

Drug interactions

When used simultaneously with antihypertensive drugs, the antihypertensive effect may be enhanced.

When used simultaneously with potassium-sparing diuretics, heparin, dietary supplements, salt substitutes containing potassium, hyperkalemia may develop.

When used simultaneously with lithium preparations, an increase in the concentration of lithium in the blood plasma is possible.

With simultaneous use, it is possible to increase the concentration of digoxin in the blood plasma.

Use for liver dysfunction

Contraindicated in severe liver dysfunction.

Use for renal impairment

Contraindicated in severe renal impairment.

Use in elderly patients

Elderly patients do not require dose adjustment.

special instructions

Telmisartan is used with caution in cases of liver dysfunction, gastric and duodenal ulcers in the acute stage, other gastrointestinal diseases, aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy, coronary artery disease, and heart failure.

In patients with bilateral renal artery stenosis or renal artery stenosis 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 period of use of telmisartan in patients with impaired renal function, it is necessary to monitor the content of potassium and creatinine in the blood plasma.

There are currently no data on the use of telmisartan in patients with recent kidney transplantation.

In patients with reduced blood volume and/or hyponatremia, symptomatic arterial hypotension may occur, especially after taking the first dose of telmisartan. Therefore, before carrying out therapy, correction of such conditions is necessary.

The use of telmisartan is possible in combination with thiazide diuretics, because This 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 hypotensive effect is usually achieved 4-8 weeks after the start of treatment.

Use in pediatrics

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

Impact on the ability to drive vehicles and operate machinery

Question about the possibility of classes potentially dangerous species activities requiring increased attention and rapid psychomotor reactions should be decided only after assessing the individual response to telmisartan.

Telmista: instructions for use and reviews

Telmista is an antihypertensive drug.

Release form and composition

Dosage form Telmista - tablets: almost white or white; at a dose of 20 mg - round, 40 mg - biconvex, oval, 80 mg - biconvex, capsule-shaped (in a blister of combined material 7 pcs., in a cardboard box 2, 4, 8, 12 or 14 blisters; in a blister 10 pcs., in a cardboard box 3, 6 or 9 blisters).

Composition of one tablet:

active substance: telmisartan – 20, 40 or 80 mg;
excipients: sodium hydroxide, lactose monohydrate, magnesium stearate, meglumine, povidone K30, sorbitol (E420).

Pharmacological properties

Pharmacodynamics

Telmisartan, the active substance of Telmista, has antihypertensive properties, being an angiotensin II receptor antagonist (AT 1 receptor blocker). By displacing angiotensin II from its connection with the receptor, it does not have an agonist effect on this receptor. Telmisartan can selectively and for a long time bind only to angiotensin II receptors of the AT 1 subtype. It does not have an affinity for other angiotensin receptors, the functional significance of which and the result of the excessive (due to the use of telmisartan) influence of angiotensin II on them have not been studied.

Telmisartan reduces the level of aldosterone in the blood plasma, does not affect the concentration of renin and does not block ion channels. The active substance does not suppress ACE (angiotensin-converting enzyme), which also destroys bradykinin, so there are no adverse reactions caused by bradykinin.

Telmisartan, taken at a dose of 80 mg, completely blocks the hypertensive effect of angiotensin II. After the first dose of the drug, the onset of the hypotensive effect is noted within 3 hours, the effect persists for 24 hours and remains significant for up to two days. A stable hypotensive effect usually develops 4–8 weeks from the start of treatment with regular use of telmisartan.

For arterial hypertension, the drug helps reduce systolic and diastolic blood pressure (BP). Telmisartan has no effect on heart rate (heart rate).

In patients who abruptly discontinue telmisartan, blood pressure gradually returns to its original value; no withdrawal syndrome is observed.

Pharmacokinetics

absorption: when taken orally, it is quickly absorbed into gastrointestinal tract. Bioavailability is 50%. When taken concomitantly with food, the reduction in AUC (area under the pharmacokinetic curve) ranges from 6% to 19% at a dose of 40 and 160 mg, respectively. 3 hours after taking telmisartan, its concentration in the blood plasma levels off (does not depend on the time of food intake). AUC and maximum concentration of the substance in blood plasma (Cmax) in women are approximately 2 and 3 times higher, respectively, than in men. No significant effect on efficiency was noted;
distribution and metabolism: 99.5% of the substance is bound to plasma proteins (mainly alpha-1 glycoprotein and albumin). The apparent volume of distribution at equilibrium concentration is on average 500 l. Metabolism occurs by conjugation with glucuronic acid to form pharmacologically inactive metabolites;
excretion: T 1/2 (half-life) – more than 20 hours. The substance is predominantly excreted unchanged through the intestines, with urine - less than 2%. The total plasma clearance is quite high compared to the hepatic blood flow (approximately 1500 ml/min) and is about 900 ml/min.

The main pharmacokinetic parameters of telmisartan when used in children and adolescents aged 6 to 18 years for 4 weeks at a dose of 1 or 2 mg/kg are generally comparable to those in adult patients and confirm the nonlinearity of the pharmacokinetics of the active substance, especially in relation to C max.

Indications for use

arterial hypertension;
high risk of cardiovascular diseases in patients over 55 years of age - to reduce cardiovascular morbidity and mortality.

Contraindications

Absolute:

severe forms of liver dysfunction (according to the Child-Pugh classification - class C);
obstruction of the biliary tract;
combined use with aliskiren in patients with severe or moderate renal failure (glomerular filtration rate less than 60 ml/min/1.73 m2) or with diabetes mellitus;
lactase/sucrase/isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption;
pregnancy and lactation period;
age under 18 years;
individual hypersensitivity to telmisartan or any of the auxiliary components of the drug.

Relative (diseases/conditions in which the use of Telmista requires caution):

impaired renal and/or liver function;
bilateral renal artery stenosis or stenosis of the artery of a single kidney;
conditions after kidney transplantation (due to lack of experience in use);
hyperkalemia;
hyponatremia;
chronic heart failure;
narrowing of the mitral and/or aortic valve;
HOCM (hypertrophic obstructive cardiomyopathy);
decrease in BCC (circulating blood volume) due to previous treatment with diuretics, limited intake of table salt, vomiting or diarrhea;
primary hyperaldosteronism (safety and effectiveness have not been established).

Instructions for use Telmista: method and dosage

Telmista tablets are taken orally regardless of meal time.

For arterial hypertension, it is recommended to start taking 20 or 40 mg of the drug once a day. In some patients, it is possible to achieve a hypotensive effect at a dose of 20 mg/day. In case of insufficient therapeutic effect, the dose can be increased to the maximum daily dose of 80 mg. When increasing the dose, it must be taken into account that the maximum hypotensive effect of Telmista is usually achieved 4–8 weeks from the start of therapy.

To reduce cardiovascular morbidity and mortality, it is recommended to take 80 mg of the drug once a day.

On initial stage treatment, additional methods of normalizing blood pressure may be required.

No dosage adjustment is required for patients with renal failure, including those on hemodialysis.

In case of dysfunction lung liver or moderate severity (according to the Child-Pugh classification - class A and B), the maximum daily dose of Telmista is 40 mg.

In elderly patients, the pharmacokinetics of telmisartan does not change, so there is no need to adjust the dose of the drug for them.

Side effects

When using Telmista, the following adverse reactions from systems and organs are possible:

heart: tachycardia, bradycardia;
blood vessels: orthostatic hypotension, significant decrease in blood pressure;
digestive system: diarrhea, abdominal pain, dyspepsia, stomach discomfort, flatulence, vomiting, dysgeusia (taste distortion), dry oral mucosa, liver dysfunction/liver disease;
blood and lymphatic system: thrombocytopenia, eosinophilia, anemia, sepsis (including fatal sepsis);
nervous system: insomnia, anxiety, depression, vertigo, fainting;
immune system: hypersensitivity (urticaria, erythema, angioedema), anaphylactic reactions, itching, eczema, skin rash (including drug rash), hyperhidrosis, angioedema (even death), toxic skin rash;
organ of vision: visual disorders;
respiratory system, organs chest and mediastinum: cough, shortness of breath, upper respiratory tract infections, interstitial lung diseases (a cause-and-effect relationship with the use of telmisartan has not been established);
musculoskeletal and connective tissue: back pain, arthralgia, muscle spasms (calf muscle cramps), myalgia, leg pain, tendon pain (symptoms similar to manifestations of inflammation and degeneration of tendon tissue);
kidneys and urinary tract: renal dysfunction (including acute renal failure), urinary tract infections (including cystitis);
body as a whole: general weakness, flu-like syndrome, chest pain;
instrumental and laboratory studies: increased levels of uric acid, creatinine in the blood plasma, decreased hemoglobin levels, increased activity of liver transaminases, CPK (creatine phosphokinase) in the blood plasma, hypoglycemia (in patients with diabetes), hyperkalemia.

The relationship between the severity of side effects and the age, gender or race of patients has not been established.

Overdose

In case of an overdose of Telmista, the following symptoms may appear: tachycardia, bradycardia, significant decrease in blood pressure.

special instructions

The simultaneous use of Telmista and ACE inhibitors or a direct renin inhibitor, aliskiren, due to its dual effect on the RAAS (renin-angiotensin-aldosterone system), worsens renal function (including can lead to acute renal failure), and also increases the risk of developing arterial hypotension and hyperkalemia . If such concomitant therapy is absolutely necessary, it should be carried out under close medical supervision, and renal function, blood pressure levels and plasma electrolytes should be regularly checked.

In patients with diabetic nephropathy, it is not recommended to use telmisartan and ACE inhibitors simultaneously.

In cases where vascular tone and renal function depend predominantly on the activity of the RAAS (for example, in patients with kidney disease, including bilateral renal artery stenosis or stenosis of the artery of a solitary kidney, or with chronic heart failure), the use of drugs affecting the RAAS can lead to the development hyperazotemia, acute arterial hypotension, oliguria and acute renal failure (in rare cases).

When using potassium-sparing diuretics, potassium-containing salt substitutes, additives and other agents that increase the concentration of potassium in the blood plasma (for example, heparin) together with Telmista, it is necessary to monitor the level of potassium in the blood.

Since telmisartan is excreted mainly in the bile, in case of obstructive diseases of the biliary tract or impaired liver function, the clearance of the drug may be reduced.

For diabetes mellitus and additional cardiovascular risk, for example, coronary heart disease ( coronary disease heart), the use of Telmista can cause fatal myocardial infarction and sudden cardiovascular death. In patients with diabetes mellitus, coronary artery disease may not be diagnosed, since its symptoms in this case do not always appear. Therefore, before starting drug therapy, it is necessary to conduct appropriate diagnostic examinations, including an exercise test.

In patients with diabetes mellitus who are treated with insulin or oral hypoglycemic drugs, hypoglycemia may develop during therapy with Telmista. Such patients need to monitor the concentration of glucose in the blood, since depending on this indicator it is necessary to adjust the dose of insulin or hypoglycemic drugs.

In primary hyperaldosteronism, the use of antihypertensive drugs - RAAS inhibitors - is usually not effective. Such patients are not recommended to take Telmista.

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

Studies have shown that Telmista is less effective in patients of the Negroid race. Liver dysfunction with the use of telmisartan was observed in most cases in Japanese residents.

Impact on the ability to drive vehicles and complex mechanisms

When driving vehicles and performing all types of activities that require a quick mental, motor reaction and increased attention, it is necessary to take into account the likelihood of drowsiness and dizziness during treatment with the drug and exercise caution.

Use during pregnancy and lactation

According to the instructions, Telmista is contraindicated during pregnancy. If pregnancy is diagnosed, the drug should be stopped immediately. If necessary, antihypertensive drugs of other classes approved for use during pregnancy should be prescribed. Women planning a pregnancy are also advised to use alternative therapy.

Preclinical studies of the drug did not reveal any teratogenic effects. But it has been established that the use of angiotensin II receptor antagonists in the second and third trimesters of pregnancy causes fetotoxicity (oligohydramnios, decreased renal function, delayed ossification of fetal skull bones) and neonatal toxicity (arterial hypotension, renal failure, hyperkalemia).

Newborns whose mothers took Telmista during pregnancy require medical supervision due to the possible development of arterial hypotension.

Since information about the penetration of telmisartan into breast milk absent, the drug is contraindicated to take during breastfeeding.

Use in childhood

The safety and effectiveness of telmisartan in pediatrics have not been established, therefore Telmista 40 mg, 80 mg and 20 mg tablets are prohibited for use in children and adolescents under 18 years of age.

For impaired renal function

In patients with impaired renal function, the use of the drug requires caution.

In severe or moderate renal failure (glomerular filtration rate less than 60 ml/min/1.73 m2), the co-administration of Telmista and aliskiren is contraindicated.

For liver dysfunction

It is not recommended to take the drug in patients with severe liver dysfunction (Child-Pugh class C).

In case of mild to moderate liver failure (according to the Child-Pugh classification - class A and B), the use of Telmista requires caution. The maximum daily dose of the drug in this case should not exceed 40 mg.

Use in old age

There is no need to adjust the dose of Telmista for elderly patients.

Drug interactions

The use of telmisartan simultaneously with certain drugs can lead to the development of the following effects:

antihypertensive drugs: increased antihypertensive effect;
warfarin, digoxin, ibuprofen, glibenclamide, hydrochlorothiazide, paracetamol, amlodipine and simvastatin: clinical meaningful interaction not visible. In some cases, it is possible to increase the digoxin content in the blood plasma by an average of 20%. When used together with digoxin, it is recommended to periodically monitor its plasma concentration;
potassium-sparing diuretics (eg, spironolactone, amiloride, triamterene, eplerenone), potassium substitutes, ACE inhibitors, angiotensin II receptor antagonists, NSAIDs (non-steroidal anti-inflammatory drugs), including selective cyclooxygenase-2 inhibitors, heparin, immunosuppressants (tacrolimus or cyclosporine) and trimethoprim: increased risk of hyperkalemia (due to a synergistic effect);
ramipril: 2.5-fold increase in Cmax and AUC 0-24 of ramipril and ramiprilat;
Lithium preparations: a reversible increase in the concentration of lithium in the blood plasma (has been reported in rare cases) with an accompanying toxic effect. It is recommended to periodically check plasma lithium levels;
NSAIDs (including acetylsalicylic acid, non-selective NSAIDs and cyclooxygenase-2 inhibitors): decreased hypotensive effect of telmisartan, increased risk of acute renal failure due to dehydration. At the beginning of combination therapy with telmisartan and NSAIDs, it is necessary to compensate for volumetric volume and check renal function;
amifostine, baclofen: potentiation of the hypotensive effect of telmisartan;
Barbiturates, alcohol, antidepressants and narcotic drugs: worsening orthostatic hypotension.

Analogs

Analogues of Telmista are: Mikardis, Teseo, Telmisartan-Richter, Telmisartan-SZ, Telpres, Telsartan and others.

Terms and conditions of storage

Store at a temperature not exceeding 25 °C out of the reach of children.

Shelf life – 3 years.