Telmisartan + Hydrochlorothiazide: Brands, Price & Uses in Bangladesh

Telmisartan + Hydrochlorothiazide is a fixed-dose combination of telmisartan, an angiotensin II receptor blocker (ARB), and hydrochlorothiazide, a thiazide diuretic, indicated for:

• Established/guideline-supported use: Treatment of hypertension, in patients whose blood pressure is not adequately controlled on either component alone, used alone or together with other antihypertensive agents.
• Cardiovascular risk reduction (guideline-supported): By lowering blood pressure, Telmisartan + Hydrochlorothiazide helps reduce the risk of fatal and non-fatal cardiovascular events such as stroke and myocardial infarction.

Telmisartan + Hydrochlorothiazide is not indicated for initial (first-line) therapy of hypertension. It is intended for patients who have not achieved adequate blood pressure control on monotherapy with telmisartan or hydrochlorothiazide, or as a convenient replacement for patients already controlled on the individual components given separately.

Adult Dosage (Hypertension)

Special Situations

• Hepatic impairment/biliary obstruction: Telmisartan + Hydrochlorothiazide should be used with caution; if used, initiate at the lowest available dose (40 mg/12.5 mg) under close medical supervision, since telmisartan clearance is reduced (see Precautions). Not recommended in severe hepatic impairment.
• Renal impairment: No initial dosage adjustment is needed in mild-to-moderate renal impairment. Telmisartan + Hydrochlorothiazide is not recommended in patients with severe renal impairment (creatinine clearance ≤30 mL/min) or anuria, as thiazides may be ineffective and can precipitate azotemia.
• Volume-depleted patients: Correct volume or salt depletion before starting therapy, or begin under close medical supervision, to reduce the risk of symptomatic hypotension.

Administration

Telmisartan + Hydrochlorothiazide may be taken with or without food, at approximately the same time each day. Swallow the tablet whole with water; do not remove it from the blister pack until immediately before use, as the tablets are moisture-sensitive.

Most of the antihypertensive effect is seen within 2 weeks, with the maximal effect generally achieved by about 4 weeks of therapy.

Most patients tolerate Telmisartan + Hydrochlorothiazide well. Reported adverse effects include:

Common

• Upper respiratory tract infection
• Dizziness
• Sinusitis
• Fatigue
• Diarrhea
• Nausea
• Influenza-like symptoms

Less Common but Clinically Important

• Symptomatic hypotension, particularly after the first dose or a dose increase (see Precautions)
• Electrolyte disturbances — hypokalemia, hyponatremia, hyperkalemia (see Precautions)
• Hyperuricemia and gout flares
• Photosensitivity reactions (skin rash/sunburn-like reaction on sun-exposed areas)
• Worsening of renal function in susceptible patients

Rare/Serious

• Angioedema (swelling of the face, lips, tongue, or throat) — potentially life-threatening; seek emergency care immediately if it occurs
• Acute myopia and secondary angle-closure glaucoma (usually within hours to weeks of starting therapy) — stop the medicine and seek urgent eye care if sudden eye pain or vision changes occur
• Rhabdomyolysis
• Non-melanoma skin cancer with long-term, high cumulative hydrochlorothiazide exposure
• Blood disorders (rare) such as thrombocytopenia or leukopenia

Report any persistent, severe, or unusual side effect to your physician.