Does Telmisartan Increase Uric Acid?
No, telmisartan does not increase uric acid levels and is generally neutral with respect to serum uric acid, unlike losartan which actively lowers uric acid through uricosuric effects.
Key Evidence on Telmisartan and Uric Acid
The FDA drug label for telmisartan does not list hyperuricemia or elevated uric acid as an adverse effect, and clinical laboratory findings from placebo-controlled trials showed no clinically relevant changes in standard laboratory parameters associated with telmisartan administration 1.
In the INNOVATION trial, telmisartan was studied in patients with type 2 diabetes and moderately increased albuminuria, demonstrating renoprotective effects without reports of uric acid elevation 2.
Comparative Evidence: Telmisartan vs. Losartan
The critical distinction is that losartan uniquely lowers uric acid, while telmisartan does not share this property:
- Losartan has been shown to increase urinary uric acid excretion and lower serum uric acid levels through a uricosuric mechanism 3, 4
- In a direct comparison study, switching from telmisartan/HCTZ to losartan/HCTZ resulted in significant decreases in serum uric acid, demonstrating that telmisartan lacks the uric acid-lowering effect of losartan 5
- A crossover study comparing telmisartan/HCTZ with losartan/HCTZ found that serum uric acid was insignificantly higher during telmisartan treatment (P=0.086), suggesting telmisartan is neutral rather than uric acid-lowering 6
Clinical Implications
When choosing an ARB for patients with hyperuricemia or gout:
- The American College of Rheumatology guideline specifically recommends choosing losartan preferentially as an antihypertensive agent for patients with gout, precisely because of its unique uric acid-lowering properties 7
- Telmisartan remains an appropriate choice for blood pressure control in patients with chronic kidney disease and proteinuria, as it effectively reduces proteinuria without adversely affecting uric acid levels 8
- If a patient requires both blood pressure control and uric acid reduction, losartan is the preferred ARB over telmisartan 3, 5
Important Caveats
While telmisartan itself does not increase uric acid, combination products containing thiazide diuretics (such as telmisartan/HCTZ) may still cause hyperuricemia due to the diuretic component, not the telmisartan 5, 6. This is a class effect of thiazide diuretics and should not be attributed to telmisartan itself.