Micardis (telmisartan) is an angiotensin II receptor blocker (ARB) indicated for the treatment of hypertension in adults. It may be used alone or in combination with other antihypertensive agents. By selectively blocking the binding of angiotensin II to the AT1 receptor, Micardis inhibits the vasoconstrictive and aldosterone-secreting effects of angiotensin II, leading to relaxation of blood vessels and reduction in blood pressure. This mechanism offers a well-tolerated, once-daily dosing option for long-term management of high blood pressure, contributing to reduced risk of associated cardiovascular events.

Features

• Active ingredient: Telmisartan
• Available in tablet strengths: 20 mg, 40 mg, 80 mg
• Administration: Oral, once daily
• Onset of action: Within 3 hours post-dose
• Peak plasma concentration: Achieved within 0.5–1 hour
• Half-life: Approximately 24 hours
• Bioavailability: 42–58%
• Protein binding: >99.5%
• Excretion: Primarily via feces (97%) as unchanged drug

Benefits

• Provides sustained 24-hour blood pressure control with once-daily dosing
• Reduces systolic and diastolic blood pressure effectively across diverse patient populations
• Demonstrates a favorable side effect profile with low incidence of cough compared to ACE inhibitors
• May offer additional metabolic benefits, including potential improvement in insulin sensitivity
• Supports long-term cardiovascular risk reduction when used as part of a comprehensive treatment plan
• Compatible with many other antihypertensive agents for combination therapy when needed

Common use

Micardis is primarily prescribed for the management of essential hypertension. It is suitable for first-line treatment or as an add-on therapy when monotherapy does not achieve target blood pressure levels. In some regions, it may also be indicated to reduce cardiovascular morbidity in patients with manifest atherothrombotic cardiovascular disease or diabetes mellitus with documented target organ damage, though specific indications vary by country and regulatory approval.

Dosage and direction

The recommended starting dose is 40 mg once daily. Dosage may be increased to 80 mg once daily if blood pressure remains uncontrolled. In volume-depleted patients (e.g., those on high-dose diuretics), initiation with 20 mg is recommended. Micardis may be taken with or without food. Tablets should be swallowed whole with a glass of water. Dose adjustment is generally not required in elderly patients but may be necessary in those with severe renal impairment or hepatic dysfunction. For patients with mild to moderate hepatic impairment, the maximum recommended dose is 40 mg daily.

Precautions

Use with caution in patients with:

• Renal artery stenosis
• Impaired renal function
• Hepatic impairment
• Aortic or mitral valve stenosis
• Hypertrophic obstructive cardiomyopathy
• Primary hyperaldosteronism Monitor renal function and electrolytes periodically, particularly in patients with pre-existing renal impairment or those receiving concomitant diuretics. Avoid use during pregnancy due to potential fetal harm. Symptomatic hypotension may occur in volume-depleted patients; correct volume depletion prior to administration. Use caution when driving or operating machinery until response to treatment is known.

Contraindications

• Hypersensitivity to telmisartan or any component of the formulation
• Second and third trimester of pregnancy
• Concomitant use with aliskiren in patients with diabetes or renal impairment (GFR <60 mL/min/1.73 m²)
• Severe hepatic impairment (Child-Pugh class C)
• Bilateral renal artery stenosis or stenosis to a solitary kidney

Possible side effects

Common (≥1/100 to <1/10):

• Upper respiratory tract infection
• Back pain
• Sinusitis
• Diarrhea
• Pharyngitis

Uncommon (≥1/1,000 to <1/100):

• Dizziness
• Hypotension
• Vertigo
• Bradycardia
• Tachycardia
• Edema
• Anxiety
• Insomnia
• Increased sweating
• Pruritus
• Rash
• Muscle cramps
• Myalgia
• Hyperkalemia
• Increased serum creatinine
• Eosinophilia

Rare (<1/1,000):

• Angioedema
• Syncope
• Urticaria
• Hepatic enzyme increased
• Erectile dysfunction
• Thrombocytopenia

Drug interaction

Significant interactions include:

• Other antihypertensive agents: Additive hypotensive effects
• Potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium: Increased risk of hyperkalemia
• Lithium: Increased lithium concentrations and toxicity
• NSAIDs: May reduce antihypertensive effect and increase risk of renal impairment
• Digoxin: Increased digoxin peak plasma concentration
• Ramipril: Combination not recommended due to increased risk of adverse effects
• Aliskiren: Contraindicated in patients with diabetes or renal impairment

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is nearly time for the next dose, skip the missed dose and continue with the regular dosing schedule. Do not take a double dose to make up for a missed dose.

Overdose

Symptoms: The most likely manifestation of overdose is hypotension and tachycardia. Bradycardia could occur if vagal stimulation occurs. Management: Supportive treatment with intravenous normal saline is recommended. Telmisartan is not removed by hemodialysis. Monitor vital signs and electrolyte balance closely. Symptomatic treatment should be instituted as required.

Storage

Store at room temperature (15–30°C/59–86°F). Keep in the original container to protect from moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Dosage and indications may vary by country and specific patient circumstances. The prescribing physician should be consulted for specific recommendations based on individual patient characteristics.

Reviews

Clinical trials and post-marketing surveillance demonstrate that Micardis is generally well-tolerated and effective for blood pressure control. In the ONTARGET trial, telmisartan showed non-inferiority to ramipril in reducing cardiovascular events with better tolerability. Real-world evidence supports its efficacy in diverse populations, including elderly patients and those with metabolic syndrome. Patient satisfaction surveys indicate high adherence rates due to once-daily dosing and low incidence of side effects. However, individual responses may vary, and some patients may require dose adjustment or combination therapy to achieve optimal blood pressure targets.