Telmisartan 20 A.T Treatment of hypertension (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Telmisartan

Ingredient

Composition information	Content
Telmisartan	20mg

Uses

indications

Telmisartan 20mg drug is indicated in the following cases:

Treatment of hypertension in adults.

Cardiovascular disease prevention: Reduce the risk of cardiovascular disease in adults:

Patients with a history of coronary heart disease, stroke, peripheral artery disease.

Patients with diabetes Type 2 with target organs.

Pharmacology

Telmisartan is a specific antagonist of Angiotensin II receptor (Type AT1) in smooth and adrenal smooth muscles.

In the Renin-Anotensin system, Angiotensin II is made up of angiotensin I thanks to the catalyst of the enzyme transferring Angiotensin (ACE).

angiotensin II is a vascular contraction, stimulating synthetic adrenal shells and releasing aldosteron, stimulating heart. Aldosteron reduces sodium excretion and increases potassium excretion in the kidneys.

Telmisartan blocks selectively the attachment of angiotensin II into the AT1 receptor in the blood vessel and adrenal glands, causing vasodilation and reducing the effects of aldosteron.

The AT2 receptor is also found in many tissues, but it is unclear whether this receptor has nothing to do with cardiovascular stability. Telmisartan has a strong affinity for AT1 receptor, 3,000 times higher than the AT2 receptor.

Unlike angiotensin enzyme inhibitors - a group of drugs widely used to treat hypertension, Angiotensin II receptor antagonists do not inhibit bradykinin chemistry, so they do not cause persistent dry cough - an unwanted effect when treated with ACE inhibitors.

Therefore, Angiotensin II receptor antagonists are used for people who have to stop using ACE inhibitors because of persistent cough.

In humans, the dose of 80 mg Telmisartan inhibits almost completely acting causing hypertension of angiotensin II. Telmisartan dose is over 80 mg/day (to 160 mg/day) does not increase the effectiveness of treatment of Telmisartan.

Inhibition effect (hypotension) is maintained for 24 hours and still measures 48 hours after drinking. After taking the first dose, the effect of reducing blood pressure manifests itself slowly within the first 3 hours. Typically, the maximum reduction of arterial blood pressure reached 4-8 weeks after the beginning of treatment.

Prolonged effects when long -term treatment. In humans hypertension, Telmisartan reduces systolic and diastolic blood pressure without changing the heart frequency.

Telmisartan's anti -hypertension effect is equivalent to other anti -hypertension drugs.

When stopping treatment of Telmisartan suddenly, the blood pressure again gradually again for a few days as not yet treated, but there is no strong increase in the phenomenon.

Dynamic pharmacokinetics

absorption: Telmisartan is quickly absorbed, although the absorption has changed. Absolute oral bioavailability is 50%. When taken with food area under the curve of plasma concentrations over time (AUC) Telmisartan may decrease from 6% when using 40 mg to 19% when using 160 mg. Telmisartan's plasma concentrations are hungry and drink with food after 3 hours is equivalent. AUC decreases less, so it has little effect on treatment effects.

Distribution: 99.5% Telmisartan attaches to plasma proteins, mainly on albumin and alpha 1-acid glycoprotein. The distribution volume is about 500 liters.

Metabolism: Telmisartan is metabolized by a reaction conjugated with glucuronid metabolites without pharmacological effects.

Elimination: Telmisartan is eliminated under the second -level dynamic equation. The final sale time is over 20 hours, the drug is eliminated in the form of constant biliary tract into the feces, only very small amount (less than 2%) discharged through the urine.

Before taking Telmisartan 20 A.T Treatment of hypertension (10 blisters x 10 tablets)

How to use

use orally, drink once a day in the morning, with or without food.

Dosage

Dosage in case of hypertension:

The usual dosage is 40 mg x 1 time/day. May be effective at a dose of 20 mg/day in some patients.

Can increase the dose of Telmisartan to a maximum dose of 80 mg x 1 time/day to achieve target blood pressure.

In addition, Telmisartan can coordinate with thiazide diuretics such as hydrochlorothiazide, which can increase the effectiveness of hypotension. The maximum effect of hypotension reaches after 4 - 8 weeks of starting treatment, it should be noted when increasing the dose.

Preventive cardiovascular disease: The recommended dose is 80 mg x 1 time/day. The effectiveness of the use of lower doses of more than 80 mg Telmisartan in preventing cardiovascular disease has not been proven, should monitor the patient's blood pressure when using the drug and can adjust the dose of antihypertensive drugs if necessary.

Patients with severe renal impairment or dialysis are recommended for 20 mg x 1 time/day. For patients with mild and moderate renal failure, do not need to adjust the dose.

Severe liver failure: Contraindications. Patients with mild and moderate liver failure should not be used more than 40 mg x 1 time/day.

Elderly patients: No dose adjustment.

Children and teenagers are less than 18 years old: Safety and effectiveness have not been proven.

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 using overdose?

Symptoms: Hypotension, tachycardia, increased blood creatinine, slow heart rate, dizziness, cable kidney failure has been reported.

Treatment: Telmisartan is not eliminated by blood separation. Patients should be closely monitored and treated symptoms and support. Treatment of drug side treatment at the time of taking the drug and the severity of the symptoms.

Proposal: Causes vomiting, gastrointestinal, can use activated carbon when treating overdose. Need to monitor electrolytes, serum creatinine, if under pressure, the patient should be on the back, quickly compensate for salt and the volume of circulation.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Telmisartan 20mg, you may experience unwanted effects (ADR).

rarely, 1/1000

Respiratory: cough, shortness of breath, sore throat.

Cardiovascular: Hypotension, hypotension. Electrolyte: hyperkalemia.

Infections: Urinary tract infections, cystitis, upper respiratory infections such as sinusitis, sore throat.

Blood and lymphatic disorders: Anemia.

nerve: insomnia, depression.

Systemic: dizziness, slow heartbeat, fainting.

Skin: itching, rash, increased sweating.

digestion: diarrhea, indigestion, flatulence, vomiting.

rare, 1/10000

Bacterial infection: Hemorrhage can be fatal.

blood: acidic leukemia, thrombocytopenia.

Immune disorders: Anaphylaxis, hypersensitivity reaction. Metabolism: Hypoglycemia in diabetes patients.

Mental: Mental disorders, Dreaming status.

Eyes, ears: visual disorders, hearing.

skin: angioedema. kidney: Acute renal failure.

Instructions on how to handle ADR

Notify the doctor immediately the unwanted effects when using the drug.

Warnings

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

contraindicated

Telmisartan medicine 20mg contraindicated in the following cases:

Hypersensitivity to the active ingredient or any ingredient of the drug.

3 months between and the last 3 months of pregnancy.

Lactating women.

Colecular disorders. Severe liver failure.

Coordinate with Aliskiren in patients with diabetes or renal failure (GFR

Caution when using

Hepatic failure: Telmisartan is completely eliminated through bile. Should not be used for patients with bile stasis, bile congestion or severe liver failure. These patients can reduce the clearing of Telmisartan in the liver. Drugs can only be used carefully for patients with mild and medium liver failure.

Hyperglythic hypertension due to kidney disease: There is a risk of excessive hypotension and renal impairment when the patient has narrowed kidney stenosis on both sides or one side treated with drugs on the Renin-Anotensin-Lostosteron system.

Renal failure and kidney transplantation: When using Telmisartan for kidney failure, periodic monitoring of potassium and serum creatinine. There is no experience using Telmisartan in new kidney transplant patients.

Intravascular volume decline: lower dosage hypotension in patients with reduced intravascular volume and/or sodium reduction due to strong diuretic treatment, diet to limit salt, diarrhea or vomiting. The patient should be treated before using Telmisartan.

Other pathologies stimulate the renin-ankiotensin-aldosteron system: In patients with kidney function and vascular tone depending heavily on the operation of the renin-angiotensin-aldosteron system (for example, patients with severe congestive heart failure or renal disease including kidney stenosis). Blood, urinary discharge or acute renal failure.

Dual-Renin-Anotensin-Aldosteron System: When using the enzyme inhibitors (ACEI) with Angiotensin II or Aliskiren receptor antagonists, increases the risk of hypotension, hypoglycemia and reducing kidney function. Do not use Telmisartan simultaneously with enzyme inhibitors or Aliskiren. In case of really need to use simultaneously, it is necessary to monitor blood pressure, electrolytes and kidney function.

Increasing primary aldosteron: In general, patients with raw hyperlemen increases will not respond to hypertension medications that affect the inhibition of the renin-angiotensin system. Therefore, Telmisartan 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 hyperpigmentation: When treated with drugs that affect the renin-angiotensin-aldosteron system that can cause hyperkalemia. People over 70 years old, patients with renal impairment, diabetes, patients are treated simultaneously with many other drugs that may increase the level of potassium and/or other patients with other diseases, increased potassium can cause death. Before using simultaneously, the drugs affect the renin-analiotensin-aldosteron system, so the ratio should be evaluated between harmful risks and treatment benefits.

Other caution: Through observations of angiotensin, Telmisartan transfer inhibitors and other Angiotensin receptor antagonists showing poor hypotension in black people compared to those with other colored people, maybe due to higher black hypertension with lower renoc.

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

The drug can cause dizziness, drowsiness, caution when driving and operating machinery.

Pregnancy

Not used for pregnant women. If you suspect pregnancy, you should change the medication to treat hypertension, when you are pregnant, you must stop this medication.

Lactation period

Contraindications to use Telmisartan during breastfeeding because it is not known whether Telmisartan is excreted in breast milk or not, but Telmisartan is excreted by mouse milk. Because there is the ability to cause side effects for breastfeeding, should decide to stop breastfeeding or stop the drug, so consider the importance of the drug for the mother.

Drug interaction

digoxin: Concentrated with Telmisartan increases the concentration of Digoxin in serum, so when starting, adjusting or stopping Telmisartan, it is necessary to monitor Digoxin levels to ensure the concentration in the therapy range

The risk of hyperkalemia increases when combining Telmisartan with other drugs that can cause hyperkalemia such as alternative salts containing potassium, potassium-saving diocesia, enzyme inhibitors, other Angiotensin II receptor anti-receptor drugs, nonsteroidal anti-inflammatory drugs (including COX-2 inhibitors), heparin, cyclosporin, tacrolimus, trimethoprim. Trimethoprim. Particularly high risks in case of combination with potassium -saving diuretic or replacement salts containing potassium.

It is not recommended to combine telmisartan with the following drugs:

Potassium -saving diuretic: The combination of Telmisartan with potassium -saving diuretic drugs such as Spironolacton, Eplerenon, Triamteren, or Amilorid, potassium salts can significantly increase potassium potassium. If used at the same time, serum potassium must be monitored.

Lithi: simultaneously use Angiotensin II receptor antagonist with lithium increases lithium concentration and lithium toxicity. When necessary to use should carefully monitor serum lithium concentration.

When used in combination must be cautious with the following drugs:

Steroid anti -inflammatory drugs may reduce the lowering effect of Telmisartan. In some patients with damaged kidney function (elderly patients, patients who are conventional), the simultaneous use of Angiotensin II receptor resistant drugs and COX inhibitors will impair more renal function, which can cause acute kidney failure and recovery. Therefore should be careful when combining these drugs, especially in the elderly. Patients need to be fully rehydrated and monitor kidney function immediately after the beginning of this combination and periodic.

thiazid diuretics, diuretics: When using Telmisartan with strong diuretic such as: Furosemid, hydrochlothiazide can reduce the volume of circulatory, increase the risk of lowering blood pressure.

The effect of hypotension of Telmisartan increases when used simultaneously with other hypertension drugs.

Double-sealing sealing of the renin-ankiotensin-aldosteron system when using the enzyme inhibitors (ACEI), Aliskiren increases the risk of hypotension, hypotension and reduced kidney function.

Steroid anti -inflammatory reduces the hypotension of Telmisartan.

In addition, the following drugs can also increase the hypotension effect of Telmisartan such as Baclofen, Amifostin. Moreover, hypotension can be worse by alcohol, sedative, antidepressants.

Storage

In a dry place, temperature ≤ 30oC, avoid light.

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