Telmisartan

Pharmacokinetic Profile: Absorption, distribution, metabolism, and excretion follow class pharmacokinetic profile; verify patient renal/hepatic function.

Renal Considerations: No initial dose adjustment in mild-to-moderate renal impairment; monitor serum potassium and creatinine. Avoid in bilateral renal artery stenosis.

Hepatic Considerations: Contraindicated in severe hepatic impairment or biliary obstruction (since >97% cleared via bile). Max 40 mg/day in mild-to-moderate hepatic impairment.

• Hyperkalaemia (especially in CKD or diabetic nephropathy)
• Symptomatic hypotension or orthostatic dizziness in volume-depleted patients
• Transient rise in serum creatinine (up to 20–30% haemodynamic dip)
• Rare angioedema (<0.1%, dramatically lower than ACE inhibitors)

• Potassium-sparing diuretics (Spironolactone), K+ supplements: additive hyperkalaemia
• NSAIDs (Diclofenac, Ibuprofen): blunts antihypertensive effect and precipitates Triple-Whammy AKI
• Lithium: Reversible elevation of serum lithium levels and toxicity
• Digoxin: Telmisartan increases peak plasma digoxin by 49%; monitor digoxin levels

Pregnancy, Lactation, Paediatric & Geriatric Use: Evaluate maternal-foetal benefit-risk ratio and age-appropriate organ function before prescribing.

Clinical & Laboratory Monitoring: Monitor clinical response, baseline renal/hepatic parameters, and relevant serum biomarkers.

• Keep tablets sealed in moisture-barrier aluminium-aluminium blisters until exact moment of taking (Telmisartan tablets are hygroscopic).
• Discontinue immediately and consult physician if pregnancy is detected.
• Avoid salt substitutes containing potassium chloride without checking serum K+.

Storage & Dispensing Governance: Store below 30°C in original moisture-proof Alu-Alu blister packaging.