Telmisartan Stella 40mg medicine for hypertension, cardiovascular prevention (3 blisters x 10 tablets)
Dosage form Box of 3 blisters x 10 tablets
Specifications Telmisartan
Ingredient
| Composition information | Content |
| Telmisartan | 40mg |
Uses
Indications
Telmisartan Stella 40mg is indicated in the following cases:
Telmisartan reduces aldosteron levels in plasma. Telmisartan does not inhibit renin in human plasma or ionic channels. Telmisartan does not inhibit Angiotensin (Kinase II) enzyme, this enzyme also has the effect of degenerative Bradykinin. Therefore, there is no unwanted effect caused by indirect Bradykinin.
In humans, the dose of 80mg Telmisartan inhibits almost completely hypertension of Angiotensin II. The inhibitory effect is maintained for more than 24 hours and is still valid for up to 48 hours.
After the starting dose of Telmisartan, the hypotension effect will slowly become clearly within 3 hours. Hypotension effects usually reach maximum after 4 - 8 weeks of treatment and is maintained during long -term treatment.
pharmacokinetic
absorption
Telmisartan is rapidly absorbed through the gastrointestinal tract. Absolute oral bioavailability depends on bureaucracy and reaches about 42% after a dose of 40 mg and 58% after a dose of 160mg. Telmisartan's peak concentration in plasma reaches about 0.5 -1 hours after drinking.
Distribution
Telmisartan is connected to plasma proteins more than 99%.
Elimination
The drug is excreted almost entirely in the biliary tract into the feces, mainly in a constant form. Telmisartan's final waste time is about 24 hours.
Before taking Telmisartan Stella 40mg medicine for hypertension, cardiovascular prevention (3 blisters x 10 tablets)
How to use
Telmisartan Stella 40mg is used by oral and without meals. Should take the medicine immediately after removing the pill from the blister.
Dosage
Hypertension treatment
Usually effective dose is 40mg/time/day. Some patients may be effective at a dose of 20mg/time/day. In the absence of target blood pressure, Telmisartan may increase to maximum of 80mg/time/day. In addition, Telmisartan can be used in conjunction with thiazid diuretics such as hydrochlorothiazid, which has been shown to lower the effect of hypotension with Telmisartan. When considering increasing the dose, it should be noted that the maximum hypotension effect is usually achieved after starting 4 - 8 weeks of treatment.
Cardiovascular Prevention
The recommended dose is: 80mg/time/day. It is not known whether the Telmisartan dose is less than 80mg, which is effective in reducing cardiovascular mortality. When starting to treat Telmisartan to reduce cardiovascular mortality, recommend careful monitoring of blood pressure and if needed to adjust the dose to achieve lower blood pressure.kidney failure
Data on severe kidney failure or dialysis is limited, the starting dose should be 20mg/time/day. There is no need to adjust the patient to medium mild renal impairment.
Hepatic failure
If mild to medium liver failure, daily dose must not exceed 40mg x 1 time/day monotherapy and also combined with hydrochlorothiazid. Contraindicated in combination with thiazid diuretics in patients with severe liver failure.
Elderly
No dose adjustment.
Children under 18 years old
The safety and effectiveness of Telmisartan has not been determined. Recommended use of appropriate cell format when using Telmisartan dose 20mg.
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?
Symptoms: The most typical manifestations of Telmisartan overdose are hypotension and tachycardia; Slow heart rate, dizziness, increased serum creatinine and acute renal failure have also been reported.
Management: Telmisartan is not removed by hemorrhage. Patients should be closely monitored and treated symptoms and support. The treatment depends on the time after taken and the severity of the symptoms. Proposal measures include vomiting and/or gastric lavage. Activated carbon can be helpful in treating overdose. Regular monitoring of electrolytes in serum and creatinine. If hypotension occurs, patients need to be placed in a lying position, quickly compensate for salt and water.
What to do when forgetting 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.
Side Effects
When using Telmisartan Stella 40mg, you may experience unwanted effects (ADR).
Common, ADR> 1/100
Uncommon, 1/1000 Rare, 1/10000 Mental: Anxiety. Liver: abnormal/liver dysfunction. Skin and subcutaneous tissue: angioedema (sometimes death), eczema, erythema, urticaria, drug rash, skin rash due to poisoning. Other: hyperuricemia, liver enzyme, hypertreatin phosphokinase, hemoglobin decrease. 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
Telmisartan Stella 40 mg is contraindicated in the following cases:
Concomitance Telmisartan use with preparations containing Aliskiren in patients with diabetes or kidney failure (GFR glomerular filtration speed
Precautions when used
pregnancy: Angiotensin II receptor antagonistic drugs should not be started during pregnancy. Unless the continuation of the Angiotensin II receptor antagonist is considered necessary, patients who have a plan to become pregnant should turn to replacement hypotension therapy that has been shown to be safe when used during pregnancy. When being diagnosed with pregnancy, it is advisable to stop treating with antagonistic drugs Angiotensin II immediately, and if appropriate, should start replacement therapy.
Hepatic failure: Because Telmisartan is excreted mainly through bile, does not use Telmisartan for patients with cholestasis, bile congestion disorders or severe liver failure. These patients can reduce the clearing of Telmisartan in the liver. Telmisartan should be used for patients with mild to moderate liver failure.
Hypergank hypertension due to kidney blood vessel disease: Increased risk of severe hypotension and renal failure when patients with kidney stenosis on both sides or one sides are treated with drugs that influence the renin-angiotensin-irtosteron system.
Renal failure and kidney transplantation: When using Telmisartan for patients with renal function, periodic monitoring of potassium and serum creatinine should be monitored. No experience using Telmisartan for new kidney transplant patients.
Reducing intravascular blood capacity: Hypotension can occur, especially after the first dose in patients with inner volume reduction and/or sodium reduction due to strong diuretic treatment, salt, diarrhea or vomiting diet.
Double-Renin-Anotensin-Aldosteron (RAAS) Renin-Aldosteron (RAAS): There is evidence that simultaneously used with Angiotensin (ACE), Angiotensin II or Aliskiren receptor blockers, increases the risk of hypotension, hyperkalate and reducing kidney function (including acute kidney failure). Due to the Dual RAAS system, it is not recommended to simultaneously use ACE inhibitors, Angiotensin II or Aliskiren receptor blockers. If double clutches are considered necessary, only use simultaneously under the supervision of the doctor and regularly monitor the kidney, electrolyte and blood pressure. ACE inhibitors and Angiotensin II receptor blockers should not be used simultaneously in patients with diabetic kidney disease.
Other pathologies stimulate the renin-angiotensin-aldosteron system: In patients with vascular tone and renal function depending mainly on the activity of the renin-angiotensin-aldosteron system (such as patients with severe congestion or kidney disease including kidney stenosis), treatment with other drugs that affect the renin-angiotensin-standosterone system will cause acute blood pressure, increase nitrogen, nitrogen nitrogen, nitrogen nitrogen, nitrus nitrogen, nitrus Blood, urinary or rare kidney failure.
Increasing primary aldosteron: Patients with primary hygiene increases are often not responding to antihypertensive drugs that act on the inhibition of the renin-angiotensin system. Therefore, it is not recommended to use Telmisartan for these patients.
Mitrous valve stenosis and aortic valve, obstructive hypertrophy of myocardial disease: Similar to other vasodilators, special attention should be paid to patients with patients with aortic stenosis or mitral stenosis or hypertrophic heart muscle.
Patients with diabetes are treated with insulin or anti -diabetes drugs: Patients with hypoglycemia when treated with Telmisartan. Therefore, in these patients, considering monitoring appropriate blood glucose; Need to adjust insulin dose or anti -diabetes drugs when used simultaneously.
Telmisartan can cause porphyrin metabolism disorders, so they only use when there are no other safer drugs to replace and be cautious in severe hypertension patients.
Hyperbonia
On the elderly, patients with renal impairment, patients with diabetes, patients treated simultaneously with other drugs that may increase potassium concentration and/or other patients with other diseases, increased potassium can be fatal.
Main risk factors for hyperkalemia:
Diseases, especially dehydration, acute heart loss, metabolic acidosis, worsening kidney function, suddenly worsening kidney condition (such as infections), cell diseases (acute ischemic anemia, prolonged trauma). Advice to strict monitoring serum potassium in patients at risk.
Sorbitol: Telmisartan Stella 40 mg contains sorbitol, which can affect the bioavailability of other drugs when taken at the same time. Should be cautious about the added effect when taking pills containing sorbitol (or fructose) simultaneously with a diet with sorbitol (or fructose). Do not use this medication for patients with fructose intolerant genetic disorders.
Sodium ion: The maximum daily dose of this drug (80 mg) contains 3,864 mg of sodium ions (in the form of NaOH). This amount is equivalent to about 0.2% of the maximum amount of sodium ion daily for adults.
Gastric ulcer, duodenum can be active or other stomach disease (increased the risk of stomach - intestinal bleeding).
Mild to moderate kidney function.
Other caution:
like any hypertension, excessive decrease in blood pressure in patients with ischemia can lead to myocardial infarction or stroke.
The ability to drive and operate machinery
Use caution when driving and operating machinery because of the dizziness or dizziness due to Telmisartan's hypotension.
Pregnancy
The drug has a direct impact on the renin-angiotensin system, when taking the medication in the middle and the last 3 months of pregnancy can cause damage and even the developing fetus. When detecting pregnancy, Telmisartan must be stopped as soon as possible.
Breastfeeding period
It is unknown whether Telmisartan is excreted in human milk in humans or not, but has seen Telmisartan present in the milk of mice. Because of the ability to cause unwanted effects for breastfeeding, deciding to stop breastfeeding or stop taking the drug, weighing the importance of the drug for the mother.
Drug interaction
Drug interaction
Digoxin: When Telmisartan is used simultaneously with digoxin, the concentration of digoxin in plasma increases an average of 49% and the base concentration increases average by 20%. Monitor Digoxin concentration to maintain concentration in the therapeutic range at the beginning of treatment, dose adjustment, and stop using Telmisartan.
Like drugs that act on the Renin-Anotensin-Aldosteron system, Telmisartan may cause hyperkalemia. This risk can be increased in the case of combining treatment with other drugs that also cause hyperkalemia (salt-containing substances containing potassium, potassium diuretics, ACE inhibitors, Angiotensin II receptor anti-receptor drugs, nonsteroidal anti-inflammatory drugs (including selective COX-2 inhibitors), heparin, immunosuppressants (cyclosporin or tacrolimus) and tacrolimus) trimethoprim).
There is no recommendation to simultaneously
Diuretics keep potassium or potassium supplements: Angiotensin II antagonists like Telmisartan, reducing potassium loss of diuretics. Potassium diuretics such as spironolacton, eplerenon, triamteren or amilorid, potassium supplements, or salt -containing salt substitutes can lead to significant increase in serum potassium levels. If indicated simultaneously due to hypokalemia, caution should be used carefully and regularly monitor serum potassium concentration.
Lithi: Increased lithe healing lithium concentration and toxicity increased have been reported during simultaneous use of lithium with ACE inhibitors and angiotensin II receptor antagonists, including telmisartan. If you need to use simultaneously, recommend careful monitoring of serum lithium concentration.
Precautions when using simultaneously
Non-steroid anti-inflammatory drugs: NSAID drugs (such as acetylsalicylic acid in the anti-inflammatory regimen, selective inhibitors of COX-2 and non-selective NSAID drugs) can reduce the effect of lowering the blood pressure of Angiotensin II receptor antagonists. In some patients with renal function damage (such as dehydrated patients or elderly patients with renal function damage), simultaneous use of Angiotensin II receptor antagonists and cyclo-olyenase inhibitors can lead to worse renal function impairment, including acute renal failure, but often recover. Therefore, cautious when used simultaneously, especially in the elderly. Patients should be fully rehydrated and should consider monitoring kidney function after starting treatment simultaneously and periodically later. In a simultaneous study of Telmisartan and Ramipril, it led to an increase of 2.5 times AUC0-24 and CMAX of Ramipril and Ramiprilat. The clinical relevance of this observation is not known.
Diuretics (thiazid diuretics or diuretics): Previous treatment with high -dose diuretic such as Furosemid (diuretics) and hydrodorothiazid (thiazid diuretics) can lead to dehydration and increase the risk of excessive blood pressure when starting treatment with Telmisartan.
Note when using simultaneously
Other hypotension drugs: Telmisanan's hypotension increases when used simultaneously with other anti -hypertension drugs. Drugs like Baclofen, Amifostin may increase the hypotension of hypotension drugs including Telmisartan. Moreover, hypotension can be worse due to alcohol, sedative, addictive sleeping pills or antidepressants.
corticosteroid (systemic effect): Reducing hypotension effect.
Tyeum of drugs
Due to the absence of studies on the correlation of the drug, not mixing this drug with other drugs.
Storage
Store in closed packaging, dry place, avoid moisture.
Temperature does not exceed 30 ° C.
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