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 blood pressure reduction. This medication offers a well-tolerated therapeutic option with a once-daily dosing regimen that supports adherence and consistent 24-hour hemodynamic control.

Features

• Active ingredient: Telmisartan
• Available in 20 mg, 40 mg, and 80 mg film-coated tablets
• Once-daily oral administration
• High selectivity for the angiotensin II type 1 (AT1) receptor
• Long half-life (~24 hours) supporting sustained pharmacodynamic effect
• Bioavailability approximately 42%; not affected by food intake
• Hepatic metabolism via conjugation; primarily excreted in feces

Benefits

• Provides effective and sustained 24-hour blood pressure control with single daily dosing
• Reduces risk of stroke, myocardial infarction, and cardiovascular mortality in patients unable to take ACE inhibitors
• Demonstrates placebo-like tolerability profile in clinical trials
• May offer metabolic benefits including potential improvement in insulin sensitivity
• Suitable for use in a broad range of hypertensive patients, including those with type 2 diabetes
• Compatible with combination therapy approaches when additional blood pressure reduction is required

Common use

Micardis is primarily prescribed for the management of essential hypertension. It may be used as monotherapy or as part of combination treatment regimens with other antihypertensive classes such as thiazide diuretics or calcium channel blockers. In patients with high cardiovascular risk and intolerance to ACE inhibitors, telmisartan has demonstrated cardiovascular protective effects. Some evidence supports its use in patients with diabetic nephropathy, though this represents an off-label application requiring careful clinical consideration.

Dosage and direction

The recommended initial 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 receiving high-dose diuretics), initiate therapy with 20 mg once daily. May be taken with or without food. Tablets should be swallowed whole with a glass of water. Dosage adjustment is recommended in patients with severe hepatic impairment (Child-Pugh class C), with a maximum recommended dose of 40 mg daily. No initial dosage adjustment is necessary for elderly patients or those with mild to moderate renal impairment.

Precautions

Monitor renal function periodically, particularly in patients with renal artery stenosis, severe congestive heart failure, or volume depletion. Use with caution in patients with hepatic impairment due to increased systemic exposure. Avoid use during pregnancy due to risk of fetal injury and death. Hypotension may occur in volume- or salt-depleted patients. Monitor serum potassium levels, especially in patients with renal impairment, diabetes, or those concomitantly using potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium. Not recommended for use in children under 18 years due to insufficient safety and efficacy data.

Contraindications

Hypersensitivity to telmisartan or any component of the formulation. Concomitant use with aliskiren in patients with diabetes. Second and third trimester of pregnancy. Severe hepatic impairment (Child-Pugh class C) when used at doses exceeding 40 mg. Bilateral renal artery stenosis or stenosis to a solitary kidney.

Possible side effects

Common adverse reactions (≥1% and more frequent than placebo) include: upper respiratory tract infection, back pain, sinusitis, diarrhea, and pharyngitis. Serious but less frequent adverse events may include: symptomatic hypotension, hyperkalemia, renal impairment, angioedema, and increased liver enzymes. Rare cases of rhabdomyolysis have been reported. Laboratory abnormalities may include elevated serum creatinine, BUN, and uric acid levels.

Drug interaction

Increased risk of hyperkalemia with potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other drugs that may increase serum potassium. NSAIDs may reduce antihypertensive effect and increase risk of renal impairment. Enhanced hypotensive effect with other antihypertensive agents. Lithium levels may increase when coadministered with telmisartan. Digoxin peak and trough concentrations may be increased. Ramipril coadministration may increase telmisartan exposure.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule to ensure consistent blood pressure control.

Overdose

The most likely manifestation of overdose would be hypotension and tachycardia. Bradycardia could occur from parasympathetic stimulation. If overdose occurs, implement supportive measures with careful monitoring of vital signs and electrolyte balance. Telmisartan is not removed by hemodialysis. Treatment should be symptomatic and supportive, with volume expansion using normal saline for hypotension.

Storage

Store at room temperature (15-30°C or 59-86°F) in the original container. Protect from moisture. Keep tightly closed. Do not use after the expiration date printed on the packaging. Keep out of reach of children and pets. Do not store in bathroom cabinets where moisture levels may fluctuate.

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 treatment decisions should be made based on individual patient characteristics and under medical supervision. The prescribing physician should be familiar with the complete prescribing information before initiating therapy.

Reviews

Clinical trials demonstrate that Micardis provides effective blood pressure reduction with favorable tolerability. In the ONTARGET study involving 25,620 patients, telmisartan was non-inferior to ramipril in reducing cardiovascular events with better tolerability. The PRISMA studies confirmed its efficacy in 24-hour blood pressure control, particularly during the early morning surge period. Real-world evidence supports maintained efficacy and persistence rates superior to some other antihypertensive classes. Patient satisfaction surveys indicate high acceptance due to once-daily dosing and low incidence of side effects such as cough.