Can telmisartan be given in a twice (bd) daily dose?

Telmisartan Dosing Frequency

Telmisartan should be administered once daily, not twice daily (bd), as the recommended dosing according to clinical guidelines is 80 mg once daily. 1

Evidence-Based Dosing Recommendations

• Telmisartan is specifically listed in clinical guidelines as a once-daily medication with a target dose of 80 mg daily for hypertension and heart failure management 1
• The American College of Cardiology/American Heart Association guidelines clearly specify telmisartan's dosing as "80 mg, once daily" in their target dose tables 1
• The long terminal elimination half-life of telmisartan (>20 hours) makes it suitable for once-daily dosing and contributes to sustained efficacy over the full 24-hour dosing interval 2

Pharmacokinetic Properties Supporting Once-Daily Dosing

• Telmisartan has a prolonged terminal elimination phase (>20 hours) in both healthy subjects and hypertensive patients, which supports once-daily administration 2
• Steady-state plasma concentrations are achieved after 5-7 days of once-daily administration, with no clinically relevant accumulation observed even after 28 days of treatment 2
• Studies have demonstrated that once-daily telmisartan provides effective blood pressure control throughout the entire 24-hour dosing interval, including the critical early morning hours (last 6 hours of the dosing interval) 3

Clinical Efficacy of Once-Daily Dosing

• Once-daily telmisartan at doses of 40-160 mg produces significant reductions in both systolic and diastolic blood pressure, with maximum blood pressure reduction occurring with a dosage of 40-80 mg/day 4
• Telmisartan 80 mg once daily has demonstrated superior efficacy compared to submaximal doses of other ARBs (losartan 50 mg/day or valsartan 80 mg/day) over the entire 24-hour dosing period 4, 5
• In patients unresponsive to previous antihypertensive medications, once-daily telmisartan 80 mg provided effective blood pressure control throughout the 24-hour dosing interval 3

Guideline-Directed Dosing

• All major hypertension and heart failure guidelines consistently recommend telmisartan as a once-daily medication 1
• The 2018 ACC/AHA hypertension guidelines specifically list telmisartan with a usual dose range of 20-80 mg/day with daily (not twice daily) frequency 1
• The KDOQI guidelines for diabetes and chronic kidney disease also list telmisartan as a once-daily medication with a starting dose of 40 mg daily and goal dose of 40-80 mg daily 1

Practical Considerations

• Splitting telmisartan into twice-daily dosing would deviate from established guidelines and could potentially affect medication adherence without providing additional clinical benefit 1, 4
• If blood pressure control is inadequate with maximum once-daily telmisartan (80 mg), guidelines recommend adding a thiazide diuretic rather than splitting the dose 6
• For patients requiring additional blood pressure control, combination therapy with hydrochlorothiazide has shown greater efficacy than increasing telmisartan monotherapy beyond 80 mg 6

In conclusion, based on pharmacokinetic properties, clinical evidence, and established treatment guidelines, telmisartan should be administered once daily, not twice daily.