Micardis 40mg Boehringer tablets treat idiopathic hypertension (3 blisters x 10 tablets)

Telmisartan does not show partial co -operations at the AT1 receptor. Telmisartan does not show affinity for other receptors, including AT2 and less typical AT receptors. It is unknown the function of these receptors (AT2 and the typical receptors), as well as the effects when they can be stimulated by angiotensin II, when this substance concentration increases due to telmisartan.

Telmisartan reduces plasma aldosteron levels. Telmisartan does not inhibit human blood renin or ionic channels. Telmisartan does not inhibit the enzymes of angiotensin, is the enzyme that causes bradykinin (Kininase II). Therefore, the drug is not likely to cause side effects through Bradykinin intermediaries.

On the human body, a dose of 80 mg of Telmisartan has an almost completely inhibited effect of hypertension due to Angiotensin II. This inhibitory effect is maintained for 24 hours and is still significant until 48 hours.

Pharmacokinetics

absorption

Telmisartan is quickly absorbed, although the absorption amount changes. Absolute average bioavailability of Telmisartan is about 50%. When taken with food, the area under the plasma concentration curve over time (AUC) of Telmisartan may decrease from 6% (at a dose of 40 mg) to about 19% (at a dose of 160 mg). The plasma concentration of Telmisartan is hungry or with food after 3 hours is similar.

AUC is less reduced, does not reduce the effectiveness of treatment.

Observed the difference in plasma concentrations by gender, CMAX and AUC is about 3 times higher and 2 times and 2 times in women than men, but does not affect the effectiveness.

Distribution

Telmisartan is heavily connected to plasma proteins (> 99.5%), mainly with albumin and alpha - 1 glycoprotein acid. Average distribution volume in a stable state of about 500L.

Metabolism

Telmisartan metabolizes by the reaction with glucuronide. Metabolic substances have no pharmacological effects.

Elimination

After drinking (and intravenous injection), Telmisartan eliminates almost entirely through feces, mostly in the form of unchanged. Under 2% of the excretory dose through urine. The total clearance of the plasma is high (about 900 ml/min) compared to the blood flow through the liver (about 1500 ml/min).

Telmisartan has a pharmacokinetic properties decreased according to excess 2 with half -life elimination of the last over 20 hours. The maximum concentration in plasma and smaller levels, the area under the plasma concentration curve over time (AUC) increases without proportional to the dose of treatment. There is no evidence related to the accumulation of telmisartan clinically.

Be cautious when used

Hypertension due to kidney blood vessel disease: Increased risk of strong hypotension and kidney failure when patients have narrowed kidney stenosis on both sides or artery stenosis to the single kidney and the function is treated with drugs acting on the Renin - Antosterone system.

Renal and kidney transplantation: Potentic and serum creatinine should be monitored when using micardis in patients with renal impairment. There is no experience using micardis in new kidney transplant patients.

Intravascular volume loss: Hypotension Special symptoms after the first dose may occur in patients with reduced intravascular volume and/or sodium reduction due to strong diuretic treatment, salt, diarrhea or vomiting diet. Such conditions, especially in reduced internal volume and/or sodium reduction, should be adjusted before using the drug.

Dual Renin - Angiotensin - Aldosterone System: There has been a report on renal function changes (including acute renal failure) in sensitive patients, especially when used in combination with drugs that affect this system. Therefore, the Renin - Angiotensin - Aldosterone dual closing should be limited (for example, a combination of an additional transferred or reiskiren inhibitor with Aliskiren with an Angiotensin II receptor inhibitor) in some cases specifically defined along with the closely monitoring of kidney function.

Other diseases that stimulate the Renin - Angiotensin - Aldosterone system: In patients with renal and vascular functions depend on the activity of the renin - Antotensin - Ordosterone system (for example, patients with severe congestion or kidney disease including kidney stenosis), the use of drugs that affect the renin - angiotensin - aldosterone will cause acute blood pressure, hypertension, hypertonic nitrogen nuclab, nitrogen nitrogen nitrogen nitrogen, nitrogen nitrogen nitror The urinary or acute renal failure (but rare).

Increasing primary aldosteron: Patients with primary aldosteron increases will not respond to hypertension drugs affected by the inhibition of the renin -askiotensin system. Therefore, micardis should not be used in these patients.

Mitral valve stenosis and aortic valve, obstructive hypertrophy of myocardial disease: like other vasodilators, special attention should be paid to patients with aortic valve stenosis or mitral valve or congested heart muscle.

Hemorrhage hyperpass: When treated with drugs that affect the renin - Antotensin - Ordosterone system can cause hyperkalemia, especially in patients with renal impairment and/or heart failure.

Recommended monitoring of serum potassium in patients at risk. Based on the experience of using drugs on the Renin - Angiotensin - Aldosterone system, the use in collaboration with potassium -keeping diuretics, potassium supplements, replacement salt containing potassium or other drugs that can increase potassium (heparin ...), can increase serum potassium, so pay attention when using these drugs with micardis.

Hepatic failure: Telmisartan is excreted mainly through bile. The removal is impaired in patients with biliary obstruction or liver failure. Need to use micardis cautious in these patients.

Sorbitol: The drug contains 338 mg of sorbitol in each maximum daily recommended daily. Therefore, this drug should not be used in patients with rare genetic pathologies, which are fructose intolerance.

Diabetes treatment: In patients with diabetes, there is an additional cardiovascular risk, for example, patients with diabetes accompanied by coronary artery disease (CAD), the risk of myocardial infarction leading to death and death due to cardiovascular disease is not expected to increase when treated with medications that reduce blood pressure such as ARB group and ACE inhibitors. In patients with diabetes, coronary artery disease (CAD) may have no manifestations, so the disease is not diagnosed.

Patients with diabetes should be evaluated and diagnosed appropriately, for example screening measures to assess the effect of training on the heart to detect and treat coronary artery disease and before using micardis 40mg.

Studies on angiotensin transferring enzyme inhibitors show that Angiotensin receptor inhibitors include clear micardis for poor hypotension effect in black people compared to other people with colored, maybe due to lower rates of black hypertension with lower lenin.

As all anti -hypertension drugs, excessive decrease in blood pressure in patients with heart disease or cardiovascular disease due to ischemia can lead to myocardial infarction or stroke.

The ability to drive and operate machinery

does not study the impact on the ability to drive and operate machinery. However, when driving and operating machinery, it should be noted that dizziness or drowsiness may occasionally appear when using medication to treat hypertension.

pregnancy

do not recommend the use of angiotensin II receptor inhibitors during the first three months of pregnancy and should not start treatment during pregnancy. When the patient is diagnosed with pregnancy, immediately stop treatment with Angiotensin II receptor antagonists and if necessary, start with an alternative therapy.

Contraindicated use of Angiotensin II receptor inhibitors in the middle and last three months of pregnancy.

Pre -clinical studies using Telmisartan do not indicate teratogenic effects, but shows the toxicity to the fetus.

Using Angiotensin II receptor inhibitors in the middle and the last three months of pregnancy toxic to the fetus (impaired renal function, amniotic fluid, slow chemistry) and toxic to babies (kidney failure, low blood pressure, hyperboly).

Patients with pregnancy plans should switch to alternative hypertension therapies that have drug safety data proved to be used during pregnancy unless the continued use of Angiotensin II receptor antagonists are thought to be really necessary.

If you use the Angiotensin II receptor antagonist for three months of pregnancy, it is recommended that the ultrasound will check the kidney function and the skull. Young children of mothers treated with Angiotensin II receptor antagonists should be closely monitored.

Lactation period

Contraindicated micardis 40mg in women who are breastfeeding because it is not clear whether the drug is excreted through breast milk. Animal studies show that there is Telmisartan secretion into mother milk.

Interactive drug

micardis can increase the effects of other anti -hypertension drugs. No other clinical interactions are not seen.

There is no clinical significant interaction when using Telmisartan simultaneously with Digoxin, Warfarin, Hydrochlorothiazide, Glibenclamide, Ibuprofen, Paracetamol, Simvastatin and Amlodipine. Digoxine bottom concentration in plasma increased by 20%, which should be considered for monitoring digoxin levels in plasma.

In a combination of Telmisartan with Ramipril, it leads to an increase of 2.5 times AUC0-24 and CMAX of Ramipril and Ramiprilate. Unknown clinical involvement of this observation.

Increased serum and recovery lithium concentration has been recorded when shared with lithium with angiotensin enamel inhibitors. In some cases, it has also been reported when used with Angiotensin II receptor antagonists including micardis. Therefore, lithium concentration should be monitored in serum when shared with two drugs.

Concentrated with nonsteroidal anti-inflammatory drugs (such as ASA at doses for anti-inflammatory effects, COX-2 inhibitors and non-selective nonsteroidal anti-inflammatory drugs) are likely to cause acute renal failure on patients with dehydration. The drugs acting on the Renin - Angiotensin system like Telmisartan may have a synergistic effect. Patients with simultaneous use of nonsteroidal anti -inflammatory drugs and micardis should be fully rehydrated and monitor kidney function from the beginning of combination treatment.

The anti -hypertension effect of drugs such as Telmisartan is reduced due to the inhibition of vasodilic prostaglandin that has been reported during treatment in combination with nonsteroidal anti -inflammatory drugs.