What are the side effects of Telmikind H (telmisartan and hydrochlorothiazide)?

Side Effects of Telmikind H (Telmisartan/Hydrochlorothiazide)

Telmikind H is generally well-tolerated with a placebo-like safety profile, but you must monitor for electrolyte disturbances (particularly hyperkalemia from telmisartan and hypokalemia from hydrochlorothiazide), hypotension, and renal function changes. 1

Most Common Side Effects

The most frequently reported adverse effects include:

• Sinus pain and congestion (sinusitis) 1
• Back pain 1
• Diarrhea 1
• Dizziness and headache - comparable to placebo rates 2

These common side effects occurred in clinical trials with discontinuation rates of only 4.7% for the telmisartan/hydrochlorothiazide combination, similar to placebo (4.6%) 2.

Serious Side Effects Requiring Immediate Medical Attention

Hypotension (Low Blood Pressure)

You are at highest risk if you:

• Take water pills/diuretics 1
• Follow a low-salt diet 1
• Receive dialysis treatments 1
• Have heart problems 1
• Experience vomiting or diarrhea 1

Action required: If you feel faint or dizzy, lie down immediately and call your doctor 1.

Renal (Kidney) Problems

• Worsening kidney function may occur, particularly in patients with pre-existing kidney disease 1
• Monitor for swelling in feet, ankles, or hands 1
• Watch for unexplained weight gain 1
• Kidney function and serum potassium require monitoring, as with all RAS blockers 3

Electrolyte Abnormalities

Hyperkalemia (High Potassium):

• Occurs from the telmisartan component 1
• Your doctor should check potassium levels regularly 1

Hypokalemia (Low Potassium):

• Occurs from the hydrochlorothiazide component 4
• Treatment-related hypokalaemia occurred in less than 0.1% of patients in large-scale studies 2
• The combination may actually attenuate potassium loss compared to hydrochlorothiazide alone 5

Other electrolyte disturbances from hydrochlorothiazide:

• Hyponatraemia (low sodium) 4
• Hyperuricaemia (elevated uric acid) - occurred in less than 0.1% with the combination 2

Allergic Reactions (Rare but Serious)

Seek immediate medical attention if you develop:

• Swelling of face, tongue, or throat 1
• Difficulty breathing 1
• Skin rash 1

Pregnancy Warning - Critical

Telmikind H can cause injury or death to your unborn baby 1. You must:

• Inform your doctor immediately if you become pregnant 1
• Discuss alternative blood pressure medications if planning pregnancy 1
• Avoid breastfeeding while taking this medication, as it is unknown whether telmisartan passes into breast milk 1

Drug Interactions to Avoid

Do not combine with:

• Aliskiren (especially if you have diabetes) - increases risk of hypotension, syncope, and renal failure 3, 1
• Other RAS blockers (ACE inhibitors) - combination therapy increases adverse events 3

Use caution with:

• Lithium 1
• Digoxin 1
• NSAIDs (aspirin, ibuprofen) 1
• Other blood pressure medications 1

Clinical Tolerance Profile

Large-scale retrospective analysis of 50 studies involving over 16,000 patients demonstrated:

• Overall incidence of all-cause adverse events: 44.8% with telmisartan/HCTZ combination (comparable to 36.1% with placebo) 2
• Drug-related laboratory abnormalities were low across all treatment groups 2
• The excellent clinical tolerance of telmisartan is not compromised by adding low-dose hydrochlorothiazide 6
• Adverse events were reported by only 1.2% of patients in the large SURGE 2 real-world study of 25,882 patients 7

Monitoring Requirements

Your doctor should regularly check:

• Blood pressure (watch for excessive lowering) 1
• Kidney function tests 1
• Serum potassium levels 1
• Electrolytes (sodium, potassium) 4
• Uric acid levels (slight elevation possible) 8

Special Populations

Gender considerations: Plasma concentrations are 2-3 times higher in females, but no dosage adjustment is necessary as blood pressure response and orthostatic hypotension rates are similar 1.

Elderly patients: Pharmacokinetics do not differ significantly, and no dosage adjustment is required 1.