Telmisar/Telmisar 80 Drug Interactions

Interaction studies have only been performed in adults. As with other medicinal products acting on the renin-angiotensin-aldosterone system, Telmisartan may provoke hyperkalaemia. The risk may increase in case of treatment combination with other medicinal products that may also provoke hyperkalaemia (salt substitutes containing potassium, potassium-sparing diuretics, Angiotensin-Converting Enzyme (ACE) inhibitors, angiotensin II receptor antagonists, Non-Steroidal Anti-Inflammatory Medicinal Products (Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)), including selective (Cyclooxygenase (Cox-2) Inhibitors), heparin, immunosuppressives (cyclosporin or tacrolimus), and trimethoprim). The occurrence of hyperkalaemia depends on associated risk factors. The risk is increased in case of the previously mentioned treatment combinations. The risk is particularly high in combination with potassium sparing-diuretics, and when combined with salt substitutes containing potassium. A combination with ACE inhibitors or NSAIDs, for example, presents a lesser risk provided that precautions for use are strictly followed.
Concomitant Use: Not recommended.
Potassium Sparing Diuretics or Potassium Supplements: Angiotensin II receptor antagonists such as Telmisartan, attenuate diuretic induced potassium loss. Potassium sparing diuretics e.g. spironolactone, eplerenone, triamterene, or amiloride, potassium supplements, or potassium-containing salt substitutes may lead to a significant increase in serum potassium. If concomitant use is indicated because of documented hypokalaemia, they should be used with caution and with frequent monitoring of serum potassium.
Lithium: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin converting enzyme inhibitors, and with angiotensin II receptor antagonists, including Telmisartan. If use of the combination proves necessary, careful monitoring of serum lithium levels is recommended.
Concomitant Use Requiring Caution: Non-Steroidal Anti-Inflammatory Medicinal Products: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (i.e. acetylsalicylic acid at anti-inflammatory dosage regimens, Cyclooxygenase (COX-2) inhibitors and non-selective NSAIDs) may reduce the antihypertensive effect of angiotensin II receptor antagonists. In some patients with compromised renal function (e.g. dehydrated patients or elderly patients with compromised renal function), the co-administration of angiotensin II receptor antagonists and agents that inhibit Cyclooxygenase may result in further deterioration of renal function, including possible acute renal failure, which is usually reversible. Therefore, the combination should be administered with caution, especially in the elderly. Patients should be adequately hydrated and consideration should be given to monitoring of renal function after initiation of concomitant therapy and periodically thereafter. In one study the co-administration of Telmisartan and ramipril led to an increase of up to 2.5 fold in the AUC0-24 and Cmax of ramipril and ramiprilat. The clinical relevance of this observation is not known.
Diuretics (thiazide or loop diuretics): Prior treatment with high dose diuretics such as furosemide (loop diuretic) and hydrochlorothiazide (thiazide diuretic) may result in volume depletion, and in a risk of hypotension when initiating therapy with Telmisartan. To be taken into account with concomitant use.
Other antihypertensive agents: The blood pressure lowering effect of Telmisartan can be increased by concomitant use of other antihypertensive medicinal products. Based on their pharmacological properties it can be expected that the following medicinal products may potentiate the hypotensive effects of all antihypertensives including Telmisartan: Baclofen, amifostine. Furthermore, orthostatic hypotension may be aggravated by alcohol, barbiturates, narcotics, or antidepressants.
Corticosteroids (Systemic Route): Reduction of the antihypertensive effect.