Telma 40mg Glenmark medicine for hypertension (1 blister x 10 tablets)

Dosage form Box of 1 blister x 10 tablets
Specifications Telmisartan

Ingredient

Composition information	Content
Telmisartan	40mg

Uses

Indications

Telma 40 is indicated in cases of mild and medium hypertension treatment.

Pharmacokology

Telmisartan is an Angiotensin II (ATI type) antagonistic drug that is effective when used orally. Telmisartan occupies Angiotensin II with strong affinity at the position of ATI receptor, receptor is responsible for all the known activities of Angiotensin II. Telmisartan does not show any partial transportation activity at the ATI receptor. Telmisartan selectively mounted on the ATI receptor. This cohesion lasts. Telmisartan does not show affinity for other receptors, including AT2 and other less AT characteristics. People do not know the function of these receptors as well as the effects of excessive stimulation they are when angiotensin II concentration increases due to telmisartan. Telmisartan reduces plasma aldosterone levels. Telmisartan does not inhibit human blood renin or ionic channels. Telmisartan does not inhibit the enzyme Angiotensin (Kininase U), yeast has the effect of breaking Bradykinin. Therefore, it is not possible to increase the side effects through Bradykinin intermediaries.

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

pharmacokinetic

absorption:

Telmisartan is quickly absorbed, although the absorption amount changes. Telmisartan's absolute bioavailability is about 50%. When taken with food, the area under the plasma concentration curve over time (AUC 9-∞) of Telmisartan can decrease from 6% (at 40 mg) to about 19% (at a dose of 160 mg). During the period after 3 hours, plasma concentrations are equivalent whether Telmisartan is hungry or with food.

Distribution:

Telmisartan combines most of the plasma proteins (> 99.5%), mainly with albumin and alpha-1 acid Glycoprotein. The average distribution volume is about 500 l.

Metabolism:

Telmisartan metabolizes by a reaction with glucuronid. Metabolic substances have no pharmacological effects.

Elimination:

Telmisartan is destroyed dynamic under the level 2 equation, the last waste sale time is over 20 hours. Maximum concentration in plasma (CMAX) and in a smaller range, the area under the curve of plasma concentrations over time (AUC) increases not commensurate with the dose. There is no clinically related evidence of Telmisartan's accumulation when taking the recommended dose. Plasma concentrations in women are higher than that of plasma concentrations in men, but there is no difference in efficiency.

After drinking (and intravenous injection), Telmisartan is almost completely eliminated through feces, mostly in the form of unchanged. The total amount of secretion through the urine is

Before taking Telma 40mg Glenmark medicine for hypertension (1 blister x 10 tablets)

How to use

Telmisartan tablets are used by oral route once a day and should be taken with water, can be the same or not with food.

Be cautious before storing or using this drug.

Telmisartan needs to be stored in a closed vessel because the drug has a moisture absorption. The pill should be used immediately after removing the blister.

Dosage

Treatment of idiopathic hypertension:

The usual effective dose is 40 mg once a day. Some patients may be effective at 20 mg/day. In the case of target blood pressure that has not been achieved, the dose may be increased to 80 mg once daily. In addition, Telmisartan can also be used in combination with thiazid diuretics such as hydrochlorothiazid, which has the effect of lowering blood pressure along with telmisartan. When increasing the dose, it is advisable to pay attention to the maximum lowering effect of general pressure achieved after 4 to 8 weeks of treatment.

Cardiovascular disease prevention:

recommended dose is 80 mg once daily. It is not known whether the dose below 80 mg is effective in reducing cardiovascular disease.

When starting treatment with Telmisartan to reduce cardiovascular disease, recommend monitoring of blood pressure, and if necessary, the dose can be adjusted to achieve lower blood pressure.

Special patient groups

Patients with renal failure:

Experience is limited for patients with severe or dialysis. The initial dosage recommends less than 20 mg for these patients.

For patients with mild to moderate renal impairment, it is not necessary to change the dosage.

Hepatoostatic human failure:

Telma is contraindicated in patients severe liver failure .

For patients with hepatic impairment from mild to medium, the dose does not exceed 40 mg once daily.

Elderly patients:

Unnecessary dose adjustment.

Children and teenagers:

Not yet established Telma's safe and effective parameters for children and adolescents at the age of 18 and there is no specific recommendation.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose? Dizziness due to slow heart rate, increased serum creatinine and acute renal failure have also been reported.

Treatment: Telmisartan cannot be removed by hemorrhage. Patients should be closely monitored and treated based on symptoms and support. Overdose management depends on the time after swallowing and the severity of the symptoms. Proposed measures include induction causing vomiting and/ or gastric lavage. Activated carbon can be helpful in treating overdose. The electrolyte in serum and creatinine should be monitored regularly. If hypotension occurs, patients need to be placed on their backs and salt quickly.

What to do when forgetting a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Side Effects

When using Telma 40 , you may experience unwanted effects (ADR).

Uncommon, 1/1000

Infections and parasitic infections: Urinary tract infections include cystitis, upper respiratory tract infections including sore throat and sinusitis.

Blood disorders and lymphatic systems: Anemia .

Disorders of metabolism and nutrition: Hemorrhage.

Mental disorders: insomnia, depression.

neurological disorders: unconscious. Cardiovascular: slow heart rate, hypotension, hypotension.

Respiratory, chest and mediastinum disorders: Difficulty breathing, cough.

Gastrointestinal disorders: abdominal pain, diarrhea , indigestion, flatulence, vomiting.

musculoskeletal and connective tissue disorders: back pain (such as sciatica), muscle spasms, muscle pain.

Renal and urinary disorders: renal failure including acute renal failure.

Body and on -site: chest pain, weakness.

Rare, 1/10000

Infections and parasitic infections: Blood infections include death.

Blood disorders and lymphatic systems: eosinophilia, thrombocytopenia.

Immune system disorders: Anaphylaxis, hypersensitivity.

Disorders of metabolic and nutrition: Hypoglycemia (in patients with diabetes).

Mental disorders: Anxiety.

Neurological disorders: Sleep.

visual disorders: vision disorders.

cardiovascular: tachycardia.

Digestive disorders: Dry mouth , stomach discomfort, taste disorder.

Hepatic disorders: abnormal liver function;

musculoskeletal and connective tissue disorders: joint pain, limb pain, tendon pain (symptoms like tendonitis).

Body and on -site: Influenza disease.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Telma 40 contraindicated in the following cases:

Hypersensitivity to any active ingredient or excipient of the drug.

The three months and the last three months of pregnancy.

Biliary obstruction disorders.

Severe liver failure.

Concentrated use of Telmisartan with products containing Aliskiren is contraindicated in patients with diabetes or kidney failure (GFR

Precautions when using

Hepatic failure:

Do not use Telmisartan for patients with cholestasis, bile congestion disorders or severe liver failure, because Telmisartan is almost excreted through bile. The clearance of the liver in patients with liver failure may be impaired when using Telmisartan. Telmisartan should only be used carefully in patients with mild and medium liver failure.

Hypertension due to kidney stenosis (kidney pressure):

There is a risk of severe hypotension and renal failure when the patient has narrowed kidney narrowing on both sides or the nest of the kidney artery on one side and the function is treated with drugs that affect the renin-angiotensin-irtosteron system.

kidney failure and kidney transplantation:

When Telmisartan is used in patients with impaired renal function, periodic monitoring of serum and creatinin levels should be monitored. There is no case related to the use of Telma in recent kidney transplant patients.

Reducing internal blood volume:

Symptomic hypotension, especially after the first Telmisartan dose, can occur in patients with volume impaired and/or sodium due to strong diuretic treatment, limiting salt in food, diarrhea, vomiting. These cases must be treated before using Telma. Intelligence of volume and/or sodium should be adjusted before using Telmisartan.

Potassium or potassium supplements:

Angiotensin II receptor antagonists like Telmisartan, reducing the loss of potassium caused by diuretics. Potassium diuretics such as Spirinolacton, Eplerenon, Triamteren or Amilorid, Potassium Supplements, or replacement salts containing potassium can lead to a significant increase in serum potassium content. If indicated to use simultaneously due to the acknowledgment of hypokalemia, caution should be used carefully and regularly monitor serum potassium.

lithium:

Increased lithium and toxic lithium concentration has been reported during simultaneous use of lithium with angiotensin transfer inhibitors, and with angiotensin II receptor antagonists, including telmisartan. If the combination use is necessary, careful monitoring of serum lithium concentration.

Must be cautious when using simultaneously.

Steroid anti -inflammatory drugs:

NSAID can reduce the effect of hypotension of Angiotensin II receptor antagonistic drugs.

In some patients with damaged renal function (for example, patients with dehydration or elderly patients with damaged kidney function), the combination of the use of Angiotensin II receptor antagonists and cyclo-oxygenase inhibitors can lead to further impairment of renal function, including acute renal insufficiency, often recovered. Therefore, the combination should be used carefully, especially in the elderly. Patients need to be adequate water and need to consider to monitor kidney function after starting treatment simultaneously and periodically later.

Diuretics (thiazid diuretics or diuretics:

Pre -dosage treatments such as Furosemid (diuretics) and hydrochlorothiazid (thiazid diuretics) can lead to loss of fluid, and the risk of hypotension when starting with Telmisartan.

Need to consider carefully when using simultaneously.

Other antihypertensive drugs:

Telmisartan's hypotension effect can be increased by simultaneous use of other antihypertensive drugs.

Clinical test data shows the double inhibition of the Renin-Angiotensin-Aldosteron (RAAS) system through the use of a combination of ACE inhibitors. Angiotensin II or Aliskiren receptor inhibitors are linked with a higher frequency of side effects such as hypotension, hyperkalemia and reduced kidney function (including acute renal failure) compared to using a single -acting substance on RAAS.

Based on its pharmacological properties, it can be expected that the following drugs can increase the hypotension effects of hypotension drugs including telmisartan: Baclofen, amifostin. Moreover, hypotension can get worse due to alcohol, sedative, sleeping pills or antidepressants.

corticosteroid (systemic line):

Reducing the effect of hypotension.

The ability to drive and operate machinery

Be cautious because dizziness insomnia can sometimes occur when using antihypertensive therapy like Telmisartan.

Pregnancy

should not use Angiotensin II receptor receptor drug during pregnancy. Unless the continued treatment with angiotensin II is considered necessary, patients who have a plan to become pregnant should be transferred to alternative hypotension treatments with safety records that have been proven to use during pregnancy. When diagnosed with pregnancy, it is recommended to immediately stop treating Angiotensin II receptor antagonistic drugs and start using alternative treatments if appropriate.

Breastfeeding period

Because there is no information related to Telma's use during breastfeeding, Telma is not recommended.

Medicinal interaction

Telmisartan is not metabolized by the isoenzyme cytochrom P450 (CYP), so there is little risk of hindering the metabolism of metabolic drugs through this enzyme system.

digoxin: plasma digoxin concentration changes when used with telmisartan. However, there is no notice of interaction in large research designs on Telmisartan in heart failure patients, of which more than one -third of the patients are using digoxin. However, it is necessary to monitor the concentration of Digoxin in the serum and need to change the dose of digoxin when recommending the dosage of treatment with Telmisartan

Warfarin: Telmisartan has little effect on Warfarin concentration in hematomas observed on 12 healthy volunteers but there are no significant changes in statistics on the INR after using Telmisartan.

Other drugs: Telmisartan does not affect pharmacokinetics in a stable state when used with amlodipine, glibenclamid, ibuprofen, paracetamol and hydrochlorothiazide.

Storage

Store less than 300C, avoid light and moisture.

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