Telmisartan/Hydrochlorothiazide

Telmisartan/Hydrochlorothiazide is a combination medication used to treat high blood pressure (hypertension). 

• Telmisartan/Hydrochlorothiazide is available under the following different brand names: Micardis HCT, MicardisPlus

Common side effects of Telmisartan/Hydrochlorothiazide include:

• Dizziness,
• Lightheadedness, and
• Blurred vision as the body adjusts to the medication.
• Tiredness,
• Flu symptoms,
• Nausea,
• Diarrhea, or
• Cold symptoms such as stuffy nose, sneezing, and sore throat.

Serious side effects of Telmisartan/Hydrochlorothiazide include:

• Fainting,
• Unusual changes in the amount of urine (not including the normal increase in urine when you first start this drug),
• Toe or joint pain,
• Symptoms of a high potassium blood level (such as muscle weakness, slow or irregular heartbeat),
• Decrease in vision, or
• Eye pain.

Rare side effects of Telmisartan/Hydrochlorothiazide include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Tablet

• 40 mg/12.5 mg
• 80 mg/12.5 mg
• 80 mg/25 mg

Hypertension

Adult dosage

• Dosage range: 80-160 mg telmisartan/12.5-25 mg hydrochlorothiazide orally once a day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Telmisartan/Hydrochlorothiazide has severe interactions with the following drugs:
  • aliskiren
  • elagolix
• Telmisartan/Hydrochlorothiazide has serious interactions with at least 26 other drugs.
• Telmisartan/Hydrochlorothiazide has moderate interactions with at least 228 other drugs.
• Telmisartan/Hydrochlorothiazide has minor interactions with at least 134 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity (anaphylaxis, angioedema) to telmisartan, hydrochlorothiazide, or sulfonamides
• Pregnancy (2nd and 3rd trimesters): Significant risk of fetal/neonatal morbidity and mortality (see Black Box Warnings)
• Anuria
• Do not coadminister aliskiren in patients with diabetes
• Not for initial treatment

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Telmisartan/Hydrochlorothiazide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Telmisartan/Hydrochlorothiazide?”

Cautions

• Acute transient myopia and acute angle-closure glaucomas have been reported, particularly with h history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)
• The fixed combination product is not recommended in patients with severe renal or hepatic impairment
• Dual blockade renin-angiotensin system with arbs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy
• Electrolyte disturbances may occur
• Photosensitivity may occur; instruct patients to protect the skin from the sun and undergo regular skin cancer screening
• Hyperuricemia may occur or gout may be precipitated in certain patients receiving thiazide therapy
• Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides
• Thiazides may decrease urinary calcium excretion
• Caution in aortic mitral stenosis, hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, bilateral renal artery stenosis or anuria
• As a consequence of inhibiting the renin-angiotensin-aldosterone system (RAA), changes in renal function may be anticipated in susceptible individuals; in patients whose renal function depends on RAA (.g, severe CHF), treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death
• Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy; avoid combined use of RAS inhibitors; closely monitor blood pressure, renal function, and electrolytes in patients on benazepril and other agents that affect the RAS
• Not for coadministration with aliskiren in patients with diabetes; avoid the use of aliskiren with benazepril in patients with renal impairment (GFR below 60 ml/min/1.73 m²)

Pregnancy and Lactation

• Can cause fetal harm when administered to a pregnant woman; discontinue drug when pregnancy is detected and treat hypertension according to guidelines during pregnancy
• Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death
• Reports of hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death owing to oligohydramnios
• Oligohydramnios in this setting has also been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development

Lactation

• Because of the potential for serious adverse reactions in the breastfed infant including hypotension, hyperkalemia, and renal impairment, advise a nursing woman not to breastfeed during treatment with telmisartan/amlodipine
• There is no information regarding the presence of telmisartan in human milk, the effects on the breastfed infant, or the effects on milk production
• Limited published studies report that amlodipine is present in human milk; however, there is insufficient information to determine the effects of amlodipine on the breastfed infant