Micardis (telmisartan) is an angiotensin II receptor blocker (ARB) indicated for the treatment of hypertension in adults. It may be used alone or in combination with other antihypertensive agents. By selectively blocking the binding of angiotensin II to the AT1 receptor, Micardis inhibits the vasoconstrictive and aldosterone-secreting effects of angiotensin II, leading to relaxation of blood vessels and reduction in blood pressure. This medication offers 24-hour efficacy with a single daily dose, supporting consistent hemodynamic control. It is also indicated to reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years of age or older at high risk of developing major cardiovascular events who are unable to take ACE inhibitors.

Features

• Active ingredient: Telmisartan
• Drug class: Angiotensin II receptor blocker (ARB)
• Available in tablet strengths: 20 mg, 40 mg, 80 mg
• Once-daily oral dosing
• Bioavailability: Approximately 42%
• Half-life: Approximately 24 hours
• Excretion: Primarily fecal (>97%)
• No significant food effect on absorption

Benefits

• Provides effective and sustained 24-hour blood pressure reduction with a single daily dose
• Reduces the risk of major cardiovascular events (myocardial infarction, stroke, cardiovascular death) in high-risk patients
• Generally well-tolerated with a side effect profile comparable to placebo in clinical trials
• Does not require dosage adjustment in patients with renal impairment
• May be used as part of a combination therapy regimen with other antihypertensive agents
• Offers potential metabolic benefits including improved insulin sensitivity

Common use

Micardis is primarily prescribed for the management of hypertension (high blood pressure) in adult patients. It is also used for cardiovascular risk reduction in patients 55 years of age or older who are at high risk for developing major cardiovascular events and are unable to take ACE inhibitors. The medication may be used as monotherapy or in combination with other antihypertensive drugs such as thiazide diuretics or calcium channel blockers. Clinical studies have demonstrated its efficacy across various patient populations, including those with isolated systolic hypertension, diabetic hypertension, and renal impairment.

Dosage and direction

The recommended initial dose of Micardis is 40 mg once daily. Blood pressure response is dose-related over the range of 20 to 80 mg. Most of the antihypertensive effect is apparent within 2 weeks and maximal reduction is generally attained after 4 weeks. The dosage may be increased to 80 mg once daily if blood pressure is not adequately controlled. Micardis may be administered with or without food. For patients with hepatic impairment, consideration should be given to initiation of Micardis at a dose of 20 mg once daily. No initial dosage adjustment is necessary for elderly patients or those with renal impairment.

Precautions

Patients should be monitored for hypotension, especially in volume-depleted patients or those receiving concurrent diuretics. Periodic assessment of renal function is recommended, particularly in patients with renal artery stenosis. Serum potassium should be monitored, especially in patients with impaired renal function, diabetes, or those taking potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium. Use with caution in patients with hepatic impairment. Not recommended during pregnancy due to potential risk of fetal injury. Patients should be advised against becoming pregnant while taking Micardis.

Contraindications

Micardis is contraindicated in patients with known hypersensitivity to telmisartan or any component of this product. Do not co-administer with aliskiren in patients with diabetes. Avoid use in patients with severe hepatic impairment. Contraindicated during the second and third trimesters of pregnancy due to risk of fetal injury and death. Should not be used in patients with bilateral renal artery stenosis or unilateral renal artery stenosis to a solitary kidney.

Possible side effects

The most common adverse reactions (≥1% and greater than placebo) include: upper respiratory infection, back pain, sinusitis, diarrhea, and pharyngitis. Serious but less common side effects may include: symptomatic hypotension, hyperkalemia, renal impairment, and angioedema. Laboratory findings may include increased serum creatinine, elevated liver enzymes, and increased serum potassium. Postmarketing reports include: renal failure, rhabdomyolysis, decreased hemoglobin, thrombocytopenia, and urticaria. Most adverse events have been mild and transient in nature.

Drug interaction

Concomitant use with other drugs that affect the RAS may increase the risk of hypotension, hyperkalemia, and renal impairment. NSAIDs may reduce the antihypertensive effect and increase the risk of renal impairment. Lithium levels may increase when co-administered with Micardis. Digoxin peak and trough concentrations may be increased. Telmisartan may increase the hypotensive effect of other antihypertensive agents. Co-administration with potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium.

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. If the missed dose is not remembered until the next day, the patient should skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. Patients should be advised to maintain regular dosing intervals for optimal blood pressure control.

Overdose

The most likely manifestation of overdose would be hypotension and tachycardia. Bradycardia could occur from parasympathetic (vagal) stimulation. If symptomatic hypotension should occur, supportive treatment should be instituted. Telmisartan is not removed by hemodialysis. Treatment should be symptomatic and supportive. Management should include monitoring of vital signs and serum electrolytes. Volume repletion with intravenous normal saline may be appropriate for hypotension.

Storage

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Keep container tightly closed. Protect from moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging. Store in the original container to protect from light. Do not transfer to other containers as this may affect stability.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. The prescribing physician should be consulted for specific dosing recommendations and monitoring parameters based on individual patient characteristics. This information may not include all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

Clinical trials have demonstrated Micardis to be effective in reducing blood pressure with once-daily dosing. The ONTARGET trial showed telmisartan was not inferior to ramipril in reducing cardiovascular events with better tolerability. Multiple studies have confirmed its efficacy in various patient populations, including those with diabetes and renal impairment. Real-world evidence supports its sustained antihypertensive effect and good tolerability profile. Many clinicians appreciate its metabolic neutral properties and once-daily dosing convenience, which may improve adherence. However, individual responses may vary, and some patients may require combination therapy for adequate blood pressure control.