Telmisartan/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Micardis HCT, MicardisPlus

• ARB/HCTZ Combos; 
• Thiazide Combos

Combination thiazide diuretic and angiotensin II antagonist
Used for hypertension
Hyperuricemia compared to diuretic monotherapy; additive efficacy; less potassium loss

Indicated for the treatment of hypertension in patients who do not respond to monotherapy.

Hypersensitivity (anaphylaxis, angioedema) to telmisartan, hydrochlorothiazide, or sulfonamides

Pregnancy (2nd and 3rd trimesters): Significant risk of fetal/neonatal morbidity and mortality (see Black Box Warnings)

Anuria

Do not coadminister with aliskiren in patients with diabetes

Not for initial treatment

Telmisartan

• Upper respiratory infection (7%)
• Urinary tract infection (1%)
• Back pain (3%)
• Diarrhea (3%)
• Myalgia (3%)
• Fatigue (1%)
• Sinusitis (3%)
• Peripheral edema (1%)
• Chest pain (1%)
• Hypertension (1%)
• Dyspepsia (1%)
• Headache (1%)
• Dizziness (1%)
• Pharyngitis (1%)

Hydrochlorothiazide

• Anorexia
• Epigastric distress
• Hypotension
• Orthostatic hypotension
• Photosensitivity
• Anaphylaxis
• Anemia
• Confusion
• Erythema multiforme
• Stevens-Johnson syndrome
• Exfoliative dermatitis including toxic epidermal necrolysis
• Dizziness
• Hypokalemia and/or hypomagnesemia
• Hyperuricemia
• Headache

Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

Fixed combination product is not recommended in patients with severe renal or hepatic impairment

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy

Electrolyte disturbances may occur

Photosensitivity may occur; instruct patients to protect skin from sun and undergo regular skin cancer screening

Hyperuricemia may occur or gout may be precipitated in certain patients receiving thiazide therapy

Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides

Thiazides may decrease urinary calcium excretion

Caution in aortic mitral stenosis, hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, bilateral renal artery stenosis or anuria

As a consequence of inhibiting the renin-angiotensin-aldosterone system (RAA), changes in renal function may be anticipated in susceptible individuals; in patients whose renal function depends on RAA (eg, severe CHF), treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death

Can cause fetal harm when administered to a pregnant woman; discontinue drug when pregnancy is dectected and treat hypertension according to guidelines during pregnancy

Because of the potential for serious adverse reactions in the breastfed infant including hypotension, hyperkalemia and renal impairment, advise a nursing woman not to breastfeed during treatment with telmisartan/amlodipine