Telmisartan Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Hypertension

Initial dose: 40 mg orally once a day with or without food, assuming adequate intravascular volume
Maintenance dose: 20 mg to 80 mg orally once a day

Usual Adult Dose for Cardiovascular Risk Reduction

Cardiovascular risk reduction in patients unable to take ACE inhibitors: 80 mg orally once a day with or without food

It is unknown whether doses lower than 80 mg are effective in reducing the risk of cardiovascular morbidity or mortality.

When initiating telmisartan for cardiovascular risk reduction, monitoring of blood pressure is recommended, and appropriate adjustment of medications that lower blood pressure may be necessary.

Renal Dose Adjustments

The manufacturer recommends caution when administering telmisartan to patients with renal dysfunction.

Liver Dose Adjustments

The manufacturer recommends initiating telmisartan at low doses and titrating slowly in patients with liver dysfunction.

Dose Adjustments

In patients with possible intravascular volume depletion, telmisartan should be administered with caution and a lower dose should be considered.

No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis. Patients on dialysis may develop orthostatic hypotension; their blood pressure should be closely monitored.

Precautions

Patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics), may exhibit symptomatic hypotension after initiation of therapy with telmisartan. This condition should be corrected prior to administration of telmisartan, or treatment should be started under close medical supervision with a reduced dose.

Because the majority of telmisartan is eliminated by biliary excretion, patients with biliary obstructive disorders or hepatic insufficiency can be expected to have reduced clearance. Telmisartan should be initiated at low doses and titrated slowly in these patients.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Telmisartan is not significantly removed by hemodialysis. An increased risk of hypotension exists if the dose is given immediately following dialysis. Ideally, the drug should be given when the patient is hemodynamically stable.

Other Comments

Most of the antihypertensive effect of telmisartan is apparent within 2 weeks and maximal reduction is generally attained after 4 weeks. When additional blood pressure reduction beyond that achieved with 80 mg telmisartan is required, a diuretic may be added.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

Telmisartan may be administered with or without food.

When telmisartan is used for cardiovascular risk reduction, monitoring of blood pressure is recommended, and if appropriate, adjustment of medications that lower blood pressure may be necessary.

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