Maximum Daily Dose of Telmisartan
The maximum daily dose of telmisartan is 80 mg once daily for both hypertension and cardiovascular risk reduction. 1
FDA-Approved Dosing
The FDA label provides clear guidance on telmisartan dosing:
For hypertension: The usual starting dose is 40 mg once daily, with blood pressure response being dose-related over the range of 20 to 80 mg. 1
For cardiovascular risk reduction: The recommended dose is 80 mg once daily. 1
Maximum dose: 80 mg once daily is the highest dose studied and approved, and it is not known whether doses lower than 80 mg are effective for cardiovascular risk reduction. 1
Clinical Evidence Supporting Maximum Dose
Research confirms that 80 mg represents the therapeutic ceiling:
Maximum blood pressure reduction occurs with dosages of 40 to 80 mg/day, with no additional benefit demonstrated at higher doses. 2
Telmisartan at 40 mg and 80 mg once daily produces effective and sustained blood pressure reduction with placebo-like tolerability. 3
In comparative studies, telmisartan 80 mg/day was more effective than submaximal doses of losartan (50 mg/day) or valsartan (80 mg/day). 2
Practical Dosing Approach
Start at 40 mg once daily and titrate to 80 mg once daily if needed for blood pressure control. 1 Most of the antihypertensive effect appears within 2 weeks, with maximal reduction generally attained after 4 weeks. 1
If blood pressure remains uncontrolled on telmisartan 80 mg monotherapy, add hydrochlorothiazide 12.5-25 mg rather than exceeding the 80 mg maximum dose. 4 The combination of telmisartan 80 mg/HCTZ 12.5 mg significantly decreased blood pressure by 23.9/14.9 mm Hg and was well tolerated. 4
Special Populations
No initial dosage adjustment is necessary for elderly patients or those with renal impairment, including patients on hemodialysis. 1 However, patients on dialysis may develop orthostatic hypotension and require close blood pressure monitoring. 1