Telmisartan

MICARDIS

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Pronunciation: tel-mi-SAR-tan (mye-KAR-dis)

Telmisartan ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Telmisartan ballicule

Telmisartan MICARDIS mascot mnemonic cartoon — Visual mnemonic: Telmisartan mascot
**“Tell me Sartan (what) My card is”**

What it isAngiotensin II receptor blocker with partial PPAR-gamma activity; hypertension and cardiovascular risk reduction.

Why this oneThe longest half-life of the ARBs, so it forgives a late dose, and it has outcome data in high-risk patients.

What limits itHyperkalemia and the hemodynamic creatinine rise. Contraindicated in pregnancy.

Telmisartan molecular structure (skeletal formula) — Molecular structure: Telmisartan

FDA-approved for

hypertension (1998)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity — discontinue as soon as pregnancy is detected.

FDA dosing	Population	Start	Target	Max
Hypertension	Adults	40 mg QD	40–80 mg QD	80 mg QD
Cardiovascular risk reduction	Adults unable to take ACE inhibitors	80 mg QD	80 mg QD	80 mg QD

Titration Most antihypertensive effect within 2 wk; maximal by 4 wk

Renal No initial dosage adjustment (including hemodialysis); monitor for orthostatic hypotension on dialysis

Hepatic Biliary obstruction or hepatic insufficiency: initiate at low dose, titrate slowly

Instructions

Take orally once daily, with or without food
Correct volume/salt depletion before starting
When initiating for CV risk reduction, monitor BP and adjust other BP-lowering meds as needed

Available strengths

tab 20, 40, 80 mg

Contraindications

Do not co-administer with aliskiren in patients with diabetes

Cautions

Fetal toxicity — discontinue when pregnancy detected
Hypotension in volume/salt-depleted patients — correct first
Hyperkalemia (esp. renal impairment, heart failure, K-sparing agents)
Avoid concomitant ACE inhibitor + ARB (renal dysfunction, hypotension, hyperkalemia)

Adverse reactions

Back pain, sinusitis, diarrhea (hypertension); intermittent claudication, skin ulcer (CV risk trials)

Pregnancy Can cause fetal harm (2nd/3rd trimester RAS effects) — discontinue when pregnancy detected

Lactation Do not breastfeed during treatment (risk of hypotension, hyperkalemia, renal impairment in infant)

Cost

Telmisartan (MICARDIS)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
20 mg	tab	30 qd	$3.17	offered
40 mg	tab	30 qd	$4.51	offered
80 mg	tab	30 qd	$4.90	offered

Generic entry2014

⚠ BOXED WARNING

Fetal toxicity; discontinue as soon as pregnancy is detected

Principal riskHyperkalemia and acute kidney injury

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, fetal toxicity and increased lithium exposure.

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Memory aids: interaction avatars

OATP substrate

Box: minimal PK interactions

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