DOSAGE AND ADMINISTRATION
The usual starting dose of telmisartan is 40 mg once a day; blood
pressure response is dose related over the range of 20-80 mg. Patients
with depletion of intravascular volume should have the condition corrected
or telmisartan tablets should be initiated under close medical supervision
(see
WARNINGS, Hypotension in Volume-Depleted
Patients
). Patients with biliary obstructive
disorders or hepatic insufficiency should have treatment started under
close medical supervision (see
PRECAUTIONS
).
Hydrochlorothiazide
is effective in doses of 12.5 mg to 50 mg once daily.
To minimize dose-independent side effects, it is usually
appropriate to begin combination therapy only after a patient has
failed to achieve the desired effect with monotherapy. The side effects
(see
WARNINGS
) of telmisartan are generally rare and apparently independent of
dose; those of hydrochlorothiazide are a mixture of dose-dependent
phenomena (primarily hypokalemia) and dose-independent phenomena (e.g.,
pancreatitis), the former much more common than the latter. Therapy
with any combination of telmisartan and hydrochlorothiazide will be
associated with both sets of dose-independent side effects.
Micardis® HCT (telmisartan and hydrochlorothiazide)
tablets may be administered with other antihypertensive agents.
MICARDIS HCT tablets may be administered
with or without food.
Replacement Therapy
The combination may be substituted for the
titrated components.
Dose Titration by ClinicalEffect
MICARDIS HCT tablets
are available as tablets containing either telmisartan 40 mg and hydrochlorothiazide
12.5 mg, or telmisartan 80 mg and hydrochlorothiazide 12.5 mg or 25
mg. A patient whose blood pressure is not adequately controlled with
telmisartan monotherapy 80 mg (see above) may be switched to MICARDIS
HCT tablets, telmisartan 80 mg/hydrochlorothiazide 12.5 mg once daily,
and finally titrated up to 160/25 mg, if necessary.
A patient whose blood pressure is inadequately controlled
by 25 mg once daily of hydrochlorothiazide may be switched to MICARDIS
HCT (telmisartan 80 mg/hydrochlorothiazide 12.5 mg or telmisartan
80 mg/hydrochlorothiazide 25 mg) tablets once daily. The clinical
response to MICARDIS HCT tablets should be subsequently evaluated
and if blood pressure remains uncontrolled after 2-4 weeks of therapy,
the dose may be titrated up to 160/25 mg, if necessary. Those patients
controlled by 25 mg hydrochlorothiazide but who experience hypokalemia
with this regimen, may be switched to MICARDIS HCT (telmisartan 80
mg/hydrochlorothiazide 12.5 mg) tablets once daily, reducing the dose
of hydrochlorothiazide without reducing the overall expected antihypertensive
response.
Patients with Renal Impairment
The usual regimens of therapy with Micardis®
HCT (telmisartan and hydrochlorothiazide) tablets may be followed
as long as the patient’s creatinine clearance is >30 mL/min. In patients
with more severe renal impairment, loop diuretics are preferred to
thiazides, so MICARDIS HCT tablets are not recommended.
Patients with HepaticImpairment
MICARDIS HCT
tablets are not recommended for patients with severe hepatic impairment.
Patients with biliary obstructive disorders or hepatic insufficiency
should have treatment started under close medical supervision using
the 40/12.5 mg combination (see
PRECAUTIONS
).
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