Hydrochlorothiazide + Telmisartan

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Generic Name of Hydrochlorothiazide + Telmisartan - Learn More

Hydrochlorothiazide + Telmisartan

Hydrochlorothiazide + Telmisartan Precaution - What You Need to Know

When combining hydrochlorothiazide (HCTZ) with telmisartan, several precautions should be considered, especially in patients with certain medical conditions:
- Renal Function: Both HCTZ and telmisartan can affect renal function. HCTZ is a diuretic that increases urine output and may cause dehydration, which can worsen kidney function. Telmisartan, an angiotensin II receptor blocker (ARB), can reduce renal blood flow, particularly in patients with pre-existing kidney disease. Close monitoring of renal function, including serum creatinine and blood urea nitrogen (BUN) levels, is recommended during treatment, especially during initiation or dose escalation.
- Electrolyte Imbalances: HCTZ is a thiazide diuretic, which can cause electrolyte disturbances such as hypokalemia (low potassium) and hyponatremia (low sodium). On the other hand, telmisartan can increase potassium levels (hyperkalemia). This combination requires monitoring of potassium levels to avoid severe imbalances, as either low or high potassium can lead to dangerous cardiac arrhythmias.
- Pregnancy and Breastfeeding: Both HCTZ and telmisartan are contraindicated during pregnancy, particularly in the second and third trimesters, due to the potential for harm to the fetus. Telmisartan can cause fetal injury and death when used in pregnancy, and HCTZ may reduce placental perfusion, leading to adverse fetal outcomes. These medications should also be avoided in breastfeeding, as both can pass into breast milk.
- Hypotension: Patients with volume depletion, such as those who have been on diuretics like HCTZ, may experience severe hypotension (low blood pressure) upon initiating telmisartan. Close monitoring of blood pressure is necessary, particularly during the first few weeks of treatment or after dose adjustments.
- Angioedema: Though rare, telmisartan, like other ARBs, has been associated with a risk of angioedema, a serious allergic reaction characterized by swelling of the face, lips, or throat. If this occurs, discontinuation of telmisartan is necessary, and emergency medical attention should be sought immediately.

Hydrochlorothiazide + Telmisartan Indication - Uses and Benefits

The combination of hydrochlorothiazide and telmisartan is primarily indicated for the management of hypertension (high blood pressure). Telmisartan works by blocking the effects of angiotensin II, a hormone that constricts blood vessels and raises blood pressure. By inhibiting this hormone's action, telmisartan leads to vasodilation and reduced blood pressure. On the other hand, hydrochlorothiazide is a diuretic that works by increasing the excretion of sodium and water from the kidneys, which reduces blood volume and further lowers blood pressure.

This combination is also beneficial in patients with heart failure or those at risk of cardiovascular events, such as stroke or heart attack. While this combination is not directly used for heart failure management, the blood pressure-lowering effects can help reduce the burden on the heart in these patients. In patients with chronic kidney disease, telmisartan can help prevent the progression of renal damage by reducing the workload on the kidneys.

Hydrochlorothiazide + Telmisartan Contraindications - Important Warnings

The combination of hydrochlorothiazide and telmisartan is contraindicated in the following situations:
- Pregnancy: Both hydrochlorothiazide and telmisartan are contraindicated during pregnancy, especially in the second and third trimesters, due to the risk of fetal harm. Telmisartan can cause serious fetal injury or death, and HCTZ can reduce placental perfusion, leading to adverse effects on the fetus.
- Severe Renal Impairment: In patients with severe renal impairment (creatinine clearance <30 mL/min), the use of hydrochlorothiazide and telmisartan is contraindicated. Both medications are primarily eliminated through the kidneys, and their use in patients with impaired renal function can exacerbate kidney damage.
- Hyperkalemia: The combination should not be used in patients with existing hyperkalemia (high potassium levels) since telmisartan can increase potassium levels. This could lead to dangerous cardiac arrhythmias.
- Angioedema: If a patient has a history of angioedema related to an ACE inhibitor or an ARB, the use of telmisartan is contraindicated due to the risk of recurrent angioedema.
- Hypersensitivity: Known hypersensitivity to telmisartan, hydrochlorothiazide, or any of the excipients in the formulation is a contraindication. Severe allergic reactions, including rashes and anaphylaxis, may occur in sensitive individuals.

Hydrochlorothiazide + Telmisartan Side Effects - What to Expect

The combination of hydrochlorothiazide and telmisartan can lead to a variety of side effects, ranging from mild to severe:
- Common Side Effects:
- Dizziness or Lightheadedness: Especially during the initiation of therapy or dose escalation, due to the blood pressure-lowering effects of both drugs.
- Fatigue: Some patients may feel unusually tired or weak.
- Electrolyte Imbalances: Patients may experience low potassium (hypokalemia) or low sodium (hyponatremia) due to HCTZ, or high potassium (hyperkalemia) due to telmisartan.
- Headache: A common side effect of blood pressure-lowering medications.

- Serious Side Effects:
- Angioedema: This rare but serious allergic reaction causes swelling of the face, lips, tongue, and throat and can obstruct the airway. If angioedema occurs, the patient should stop taking telmisartan immediately and seek emergency medical care.
- Hyperkalemia: Increased potassium levels due to telmisartan can cause dangerous heart arrhythmias. Symptoms of hyperkalemia include muscle weakness, fatigue, palpitations, and irregular heartbeats.
- Renal Dysfunction: Both HCTZ and telmisartan can worsen kidney function, especially in patients with pre-existing kidney disease. Monitoring of renal function, including serum creatinine and BUN, is recommended.
- Hypotension: Excessive lowering of blood pressure can lead to dizziness, fainting, and other symptoms of low blood pressure. This can be particularly problematic when initiating therapy or adjusting doses.
- Rash: Both drugs can cause rashes or allergic reactions, and severe reactions may necessitate discontinuation of treatment.

Hydrochlorothiazide + Telmisartan Pregnancy Category ID - Safety Information

3

Hydrochlorothiazide + Telmisartan Mode of Action - How It Works

- Hydrochlorothiazide: HCTZ works as a thiazide diuretic by inhibiting the sodium-chloride symporter in the distal convoluted tubule of the nephron in the kidney. This prevents the reabsorption of sodium and chloride, leading to increased excretion of sodium, chloride, and water. The decrease in blood volume helps to lower blood pressure. It also reduces calcium excretion, which can have additional benefits in reducing the risk of kidney stone formation.
- Telmisartan: Telmisartan is an angiotensin II receptor blocker (ARB). It selectively inhibits the binding of angiotensin II to its receptor (AT1 receptor), preventing vasoconstriction and aldosterone secretion. This leads to vasodilation and a reduction in blood pressure. By blocking angiotensin II, telmisartan also helps to reduce the strain on the heart and kidneys, improving cardiovascular outcomes in patients with hypertension and chronic kidney disease.

Together, HCTZ and telmisartan provide a dual mechanism of action for lowering blood pressure: HCTZ reduces blood volume, while telmisartan reduces vasoconstriction and fluid retention.

Hydrochlorothiazide + Telmisartan Drug Interactions - What to Avoid

Several drug-drug and drug-food interactions need to be considered when using the combination of hydrochlorothiazide and telmisartan:
- Other Antihypertensive Drugs: Concomitant use with other antihypertensive agents, such as ACE inhibitors, other ARBs, beta-blockers, or calcium channel blockers, can lead to an additive blood pressure-lowering effect. This may cause hypotension, particularly after the first dose, and should be monitored.
- Lithium: Both HCTZ and telmisartan can increase lithium levels, leading to lithium toxicity. Symptoms of lithium toxicity include tremors, confusion, and nausea. If these drugs must be used together, lithium levels should be closely monitored.
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): NSAIDs can reduce the effectiveness of both HCTZ and telmisartan in lowering blood pressure and may impair renal function, particularly in patients with pre-existing kidney issues. These medications should be used cautiously together, and kidney function should be monitored.
- Potassium Supplements or Potassium-Sparing Diuretics: Since telmisartan can increase potassium levels, combining it with potassium-sparing diuretics (e.g., spironolactone) or potassium supplements can lead to hyperkalemia, which can be life-threatening. Potassium levels should be monitored regularly.
- Corticosteroids: The use of corticosteroids may increase the risk of electrolyte imbalances, particularly hypokalemia, when combined with HCTZ. Serum potassium levels should be checked, and adjustments made as needed.
- Food and Alcohol: High-sodium foods can reduce the effectiveness of hydrochlorothiazide, while alcohol can enhance the hypotensive effect of both medications. Alcohol should be consumed cautiously.

Hydrochlorothiazide + Telmisartan Pregnancy Category Note - Key Information

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimesters)

Hydrochlorothiazide + Telmisartan Adult Dose - Recommended Dosage

For the treatment of hypertension, the typical starting dose of the combination is 12.5 mg of hydrochlorothiazide and 40 mg of telmisartan once daily. The dose can be adjusted based on the patient’s blood pressure response, and the maximum recommended dose is 25 mg of HCTZ and 80 mg of telmisartan once daily. In patients who require additional blood pressure control, higher doses of telmisartan may be used, but close monitoring of blood pressure, renal function, and electrolytes is essential.

Hydrochlorothiazide + Telmisartan Child Dose - Dosage for Children

This combination is not typically recommended for use in pediatric patients due to the lack of established safety and efficacy. If it is considered in children, a lower starting dose of both medications should be used, with careful monitoring of blood pressure, renal function, and electrolytes. Pediatric dosing should be individualized based on the child's age, weight, and clinical condition.

Hydrochlorothiazide + Telmisartan Renal Dose - Dosage for Kidney Conditions

In patients with mild renal impairment (creatinine clearance 30-60 mL/min), the standard dose of hydrochlorothiazide and telmisartan can generally be used, but renal function should be monitored closely. In moderate renal impairment (creatinine clearance 10-30 mL/min), dose adjustments may be needed, especially for telmisartan. In severe renal impairment (creatinine clearance <10 mL/min), the use of this combination is generally contraindicated due to the risk of further kidney dysfunction.