Telmisartan

CLINICAL USE

Angiotensin-II antagonist:Hypertension

DOSE IN NORMAL RENAL FUNCTION

20–80 mg daily

PHARMACOKINETICS

Molecular weight :514.6

%Protein binding :>99.5

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :500 litres

half-life – normal/ESRD (hrs) :24/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Start with 20 mg and adjust according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unlikely to be dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDsCardiac glycosides: concentration of digoxin increased

Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity

Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics

Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect

Lithium: reduced excretion (possibility of enhanced lithium toxicity)

Potassium salts: increased risk of hyperkalaemia

Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Hyperkalaemia and other side effects are more common in patients with impaired renal functionClose monitoring of renal function required during therapy in patients with renal insufficiencyRenal failure has been reported in association with angiotensin-II inhibitors in patients with renal artery stenosis, post renal transplant, and those with congestive heart failure.

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