What is the recommended dosing for telmisartan (Angiotensin II Receptor Blocker)?

Telmisartan Dosing Recommendations

For hypertension, the recommended starting dose of telmisartan is 40 mg once daily, with a dose range of 20-80 mg once daily based on blood pressure response. 1

Dosing for Hypertension

• The usual starting dose is 40 mg once daily 1
• Blood pressure response is dose-related over the range of 20 to 80 mg 1
• Most of the antihypertensive effect appears within 2 weeks, with maximal reduction generally attained after 4 weeks 1
• Maximum blood pressure reduction typically occurs with dosages of 40 to 80 mg/day 2
• No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis 1
• Patients on dialysis may develop orthostatic hypotension and should have their blood pressure closely monitored 1

Dosing for Cardiovascular Risk Reduction

• The recommended dose is 80 mg once daily 1
• It is not known whether doses lower than 80 mg are effective in reducing cardiovascular morbidity and mortality 1

Administration Considerations

• Telmisartan can be administered with or without food 1
• It can be administered with other antihypertensive agents 1
• The drug has a long terminal elimination half-life (>20 hours), making it suitable for once-daily dosing 3
• The long half-life contributes to sustained efficacy over the full 24-hour dosing interval 3

Clinical Efficacy

• At doses of ≥40 mg, telmisartan produces statistically significant reductions in blood pressure 4
• Ambulatory blood pressure monitoring demonstrates smooth, consistent blood pressure-lowering effects at 40 and 80 mg dosages 4
• Telmisartan has demonstrated superior antihypertensive effect toward the end of the dosing interval compared to some other agents 4
• In comparative studies, telmisartan 40-80 mg/day was as effective as amlodipine 5-10 mg/day or atenolol 50-100 mg/day 2

Special Populations

• For patients with biliary obstructive disorders or hepatic insufficiency, initiate telmisartan at low doses and titrate slowly 1
• Monitor for hypotension in volume- or salt-depleted patients 1
• Monitor for hyperkalemia, particularly in patients with advanced renal impairment, heart failure, or on medications that increase potassium levels 1

Available Strengths

• Telmisartan is available in 20 mg, 40 mg, and 80 mg tablets 1