Telday H 40/12.5/Telday H 80/12.5

HTN not adequately controlled by telmisartan alone.

Usual initial dose: 1 tab daily. Patient whose BP is not adequately controlled w/ telmisartan monotherapy may be switched to the combination. Dose may be increased to 2 tab daily if necessary.

May be taken with or without food.

Hypersensitivity to telmisartan, hydrochlorothiazide or other sulfonamide-derived drugs. Anuria.

Discontinue as soon as pregnancy is detected. Conditions should be corrected (intravascular vol- or Na-depleted eg, patients treated vigorously w/ diuretics) prior to treatment. Lightheadedness may occur, especially during 1st day of therapy. Not to be used w/ K supplements or salt substitutes that contain K. Not recommended for patients w/ severe hepatic impairment. Start treatment under close medical supervision in patients w/ biliary obstructive disorders or hepatic impairment. Use during the 2nd & 3rd trimester of pregnancy has been associated w/ fetal & neonatal injury including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, & death. Can cause fetal & neonatal morbidity & death when administered to pregnant women. Decision should be made whether to discontinue nursing or the drug. Telmisartan: Changes in renal function may be anticipated in susceptible individuals. Concomitant use w/ ramipril is not recommended. Hydrochlorothiazide: Hypersensitivity reactions may occur in patients w/ or w/o history of allergy or bronchial asthma. Caution in patients w/ impaired hepatic function or progressive liver disease. Exacerbation or activation of SLE. Not to be given w/ lithium. Periodic determinations of serum electrolytes should be performed at appropriate intervals. Hypokalemia may develop, especially w/ brisk diuresis, when severe cirrhosis is present, or after prolonged therapy. Dilutional hyponatremia may occur in edematous patients in hot weather. Hyperuricemia may occur or frank gout may be precipitated. Hyperglycemia may occur. Increased urinary excretion of Mg resulting to hypomagnesemia. Decreased urinary Ca excretion. Increased risk of non-melanoma skin cancer (NMSC) [basal cell carcinoma (BCC) & squamous cell carcinoma (SCC)] w/ increasing cumulative dose of hydrochlorothiazide (HCTZ) exposure.

Fatigue, dizziness, nausea, back pain, dyspepsia, vomiting, hypokalemia, bronchitis, rash & postural hypotension.

Telmisartan: Medial increase in digoxin peak plasma conc & trough conc. Slightly decreased mean warfarin trough plasma conc w/o change in INR. Hydrochlorothiazide: Potentiation of orthostatic hypotension w/ alcohol, barbiturates, or narcotics. Additive effect or potentiation w/ other antihypertensive drugs. Impaired absorption w/ cholestyramine & colestipol resins. Intensified electrolyte depletion, particularly hypokalemia w/ corticosteroids, ACTH. Possible decreased response to pressor amines (eg, norepinephrine). Possible increased responsiveness to skeletal muscle relaxants, non-depolarizing (eg, tubocurarine). Reduce renal clearance of lithium & add a high risk of lithium toxicity. NSAIDs can reduce the diuretic, natriuretic, & antihypertensive effects of diuretics.

Angiotensin II Antagonists / Diuretics

C09DA07 - telmisartan and diuretics ; Belongs to the class of angiotensin II receptor blockers (ARBs) in combination with diuretics. Used in the treatment of cardiovascular disease.

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