1. Telmisartan
2. Pharmacological Class: Angiotensin II Receptor Blocker (ARB) with Partial PPAR-gamma Agonist Activity • 3. Therapeutic Category: Cardiovascular & Antithrombotic Medicines (Ch 03)
4. Clinical Overview & Verified Formulation Identity
Telmisartan
Code: [3.2] | Stable ID: TIP-MED-000002
Telma (Glenmark), Telmikind (Mankind), Tazloc (USV), Inditel (Zydus)
Oral Tablets: 20 mg, 40 mg, 80 mg
Route: Oral / Parenteral / Topical as specified by formulation
Schedule H Prescription Drug • NLEM 2022 Core Essential Medicine
True
5 & 6. Mechanism of Action & Pharmacodynamics
Selectively and insurmountably blocks binding of Angiotensin II to the AT1 receptor in vascular smooth muscle and adrenal cortex (10,000-fold selectivity over AT2), inhibiting vasoconstriction and aldosterone secretion without inhibiting ACE/kininase II (no bradykinin cough); exhibits partial PPAR-γ agonism.
8. Therapeutic Indications
- Essential hypertension (first-line alone or with CCB/thiazide)
- Cardiovascular risk reduction in atherothrombotic disease
- Diabetic nephropathy with proteinuria in Type 2 DM
10. Dosage and Administration (Educational Reference Summary)
Administration & Timing: Oral; once daily with or without food. Remove hygroscopic blister tablet immediately before ingestion.
11 & 13. Contraindications, Precautions and Warnings
- Pregnancy (2nd/3rd trimester — foetal renal dysplasia, oligohydramnios)
- Bilateral renal artery stenosis
- Biliary cholestasis or severe hepatic impairment
- Concomitant Aliskiren in diabetes or eGFR < 60 mL/min
Contraindicated in severe hepatic impairment or biliary obstruction (since >97% cleared via bile). Max 40 mg/day in mild-to-moderate hepatic impairment.
7, 12, 14–18. Detailed Pharmacokinetics, Interactions, Special Populations & Counselling
7 & 16. Pharmacokinetics (ADME) & Renal / Hepatic Considerations
7. Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion): Absorption, distribution, metabolism, and excretion follow class pharmacokinetic profile; verify patient renal/hepatic function.
16a. Renal Considerations: No initial dose adjustment in mild-to-moderate renal impairment; monitor serum potassium and creatinine. Avoid in bilateral renal artery stenosis.
16b. 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.
12 & 14. Adverse Effects & Drug Interactions
- 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
15, 17 & 18. Special Populations, Clinical Monitoring & Patient Counselling
15. Use in Special Populations (Pregnancy, Lactation, Paediatrics, Geriatrics): Evaluate maternal-foetal benefit-risk ratio, paediatric mg/kg ceiling, and geriatric renal function prior to prescribing.
17. Clinical & Laboratory Monitoring: Monitor clinical response, baseline renal/hepatic parameters, and relevant serum biomarkers.
18. Patient Counselling & Storage:- 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 Notes: Store below 30°C in original moisture-proof Alu-Alu blister packaging.
Visual Pharmacology Illustration (PLATE-8.10)
19. Authoritative References & Source Traceability
Primary Reference Record: Indian Pharmacopoeia (IP 2026) • NLEM 2022 (MoHFW) • CDSCO Approved Prescribing Information
Verification Portals: Indian Pharmacopoeia Commission (IPC) • CDSCO (India Jurisdiction) • NCBI Bookshelf • DailyMed (US FDA Label Reference)
Last Reviewed Date: 2026-11-08 • Related Study Guide: Essential Hypertension Clinical Management →