What is the typical dose of telmisartan for hypertension?

Telmisartan Dosing for Hypertension

The standard starting dose of telmisartan for hypertension is 40 mg once daily, with a dose range of 20-80 mg once daily depending on blood pressure response. 1

Initial Dosing

• The usual starting dose is 40 mg once daily for most patients with hypertension 1
• Most of the antihypertensive effect becomes apparent within 2 weeks of starting treatment 1
• Maximum blood pressure reduction is generally attained after 4 weeks of therapy 1
• No initial dosage adjustment is necessary for elderly patients or those with renal impairment, including patients on hemodialysis 1

Dose Titration and Target Dosing

• Blood pressure response is dose-related across the range of 20-80 mg 1
• For optimal blood pressure control, doses of 40-80 mg/day are most effective 2
• If blood pressure control is inadequate at 40 mg, the dose can be increased to 80 mg once daily 1
• Dose adjustments should be made after monitoring blood pressure response, typically no more frequently than every 1-2 weeks 3

Administration Considerations

• Telmisartan can be taken with or without food 1
• It can be administered as a once-daily medication due to its long terminal elimination half-life (>20 hours) 4
• Telmisartan may be administered in combination with other antihypertensive agents if needed for adequate blood pressure control 1
• Patients on dialysis may develop orthostatic hypotension and should have their blood pressure closely monitored 1

Efficacy and Pharmacokinetics

• At doses of ≥40 mg, telmisartan produces statistically significant reductions in blood pressure 3
• Telmisartan demonstrates smooth, consistent blood pressure-lowering effects throughout the 24-hour dosing interval 3
• Studies show telmisartan has superior blood pressure control toward the end of the dosing interval compared to some other antihypertensives like losartan 5
• Steady-state plasma concentrations are typically reached after 5-7 days of once-daily administration 4

Special Considerations

• Monitor for hypotension in volume- or salt-depleted patients (e.g., those on high-dose diuretics) 1
• If hypotension occurs, place the patient in a supine position and consider IV normal saline if necessary 1
• Telmisartan is contraindicated in patients with known hypersensitivity to the medication 1
• Do not co-administer aliskiren with telmisartan in patients with diabetes 1
• Telmisartan is contraindicated during pregnancy due to risk of fetal harm 1

Combination Therapy

• If monotherapy is inadequate, telmisartan can be combined with hydrochlorothiazide for enhanced blood pressure lowering effects 6
• The addition of hydrochlorothiazide to telmisartan provides greater blood pressure reduction than either agent alone 6

Telmisartan's once-daily dosing, placebo-like tolerability profile, and effective blood pressure control make it a suitable option for patients with hypertension 3.