From the Guidelines
Telmisartan should be dosed at 40 mg once daily to start, which can be increased to 80 mg once daily if needed for better blood pressure control, as recommended by the most recent guidelines 1. The medication should be taken at the same time each day, with or without food. Common side effects include:
- Dizziness
- Back pain
- Diarrhea
- Upper respiratory infections More serious but less common side effects include:
- Low blood pressure (especially when standing up quickly)
- Elevated potassium levels
- Decreased kidney function Patients with severe liver disease should use a lower starting dose of 20 mg daily. Telmisartan works by blocking angiotensin II receptors, relaxing blood vessels and lowering blood pressure. It's essential to monitor blood pressure and kidney function regularly while taking this medication. Patients should avoid potassium supplements and salt substitutes containing potassium unless directed by their doctor. If experiencing severe dizziness, fainting, or signs of allergic reaction (rash, swelling, difficulty breathing), medical attention should be sought immediately. Telmisartan should not be taken during pregnancy as it can cause harm to the developing fetus, particularly in the second and third trimesters, as supported by studies 1.
The most recent and highest quality study 1 provides guidance on the use of angiotensin receptor blockers (ARBs) like telmisartan, emphasizing the importance of achieving target doses proven to be beneficial in key randomized controlled trials (RCTs). This study highlights the benefits of ARBs in reducing the risk of heart failure hospitalization and improving symptoms and quality of life. Therefore, the recommended dosing of telmisartan should be prioritized to minimize morbidity, mortality, and improve quality of life.
From the FDA Drug Label
Telmisartan tablets may cause serious side effects, including: Injury or death to your unborn baby. Low blood pressure (hypotension) is most likely to happen if you also: take water pills (diuretics) are on a low-salt diet get dialysis treatments have heart problems get sick with vomiting or diarrhea Kidney problems, which may get worse if you already have kidney disease You may have changes in your kidney test results, and you may need a lower dose of telmisartan tablets. High potassium in the blood (hyperkalemia). Your doctor may check your potassium levels as needed Rare, serious allergic reactions may happen. Tell your doctor right away if you get any of these symptoms: swelling of the face, tongue, throat difficulty breathing skin rash The most common side effects of telmisartan tablets include: sinus pain and congestion (sinusitis) back pain diarrhea
The dosing for telmisartan is as follows:
- Hypertension: The usual starting dose of telmisartan tablets is 40 mg once a day. Blood pressure response is dose-related over the range of 20 to 80 mg.
- Cardiovascular Risk Reduction: The recommended dose of telmisartan tablets is 80 mg once a day. The side effects of telmisartan include:
- Serious side effects: injury or death to an unborn baby, low blood pressure, kidney problems, high potassium in the blood, and rare, serious allergic reactions.
- Common side effects: sinus pain and congestion, back pain, and diarrhea. 2 2 2
From the Research
Telmisartan Dosing
- The recommended dosage of telmisartan is 40 to 80 mg once daily, with maximum blood pressure reduction occurring at this dosage range 3.
- Telmisartan 20 to 160 mg once daily has been shown to produce mean reductions in supine trough systolic blood pressure and diastolic blood pressure of up to 15.5 and 10.5 mm Hg, respectively 3.
- In patients with severe hypertension, telmisartan 80 to 160 mg/day has been shown to be as effective as enalapril 20 to 40 mg/day 3, 4.
Telmisartan Side Effects
- Telmisartan is generally well tolerated, with a tolerability profile similar to that of placebo 3, 4, 5.
- The most common side effects of telmisartan are not specified in the provided studies, but it is noted that telmisartan is less likely to cause persistent, dry cough than lisinopril 3.
- In patients with chronic kidney disease, telmisartan has been shown to be safe and effective in reducing blood pressure and proteinuria, with no significant changes in creatinine clearance 6.
Comparison to Other Antihypertensive Agents
- Telmisartan has been shown to be as effective as other major classes of antihypertensive agents, including amlodipine, atenolol, enalapril, and lisinopril 3, 4, 5.
- Telmisartan 40-80 mg once daily has been shown to be more effective than losartan 50-100 mg once daily in reducing trough seated systolic blood pressure and standing systolic blood pressure 5.
- Telmisartan has been shown to have a greater antihypertensive effect compared to valsartan or losartan 6.