Telmisartan + hydrochlorothiazide
Class: Angiotensin II receptor blocker (ARB) + thiazide diuretic
Manufacturer: Micro Labs Limited (India)
Dosage Form: Tablets
Similar Brands:
Uses:
Treatment of essential hypertension (high blood pressure) in adults when blood pressure is not adequately controlled by telmisartan monotherapy or when combination therapy is appropriate (previously stabilized on separate components). Reduces risk of cardiovascular events (e.g., heart attack, stroke) in high-risk patients. Lowers BP by relaxing vessels and removing excess fluid/salt. Not first-line for all—used when single agents insufficient.
Dosage:
Oral, once daily (same time each day), with or without food; swallow whole with water.
Adults: 1 tablet daily (e.g., 40 mg/12.5 mg or 80 mg/12.5 mg based on prior response—start with lower if needed). Max typical: 80 mg telmisartan/25 mg hydrochlorothiazide (higher HCTZ variants may exist).
Liver impairment: Max 40 mg/12.5 mg daily.
Renal impairment: Caution/monitor (avoid if severe).
Elderly/volume-depleted: Start low to avoid hypotension.
Continue as prescribed; regular BP/electrolyte/kidney checks required.
Adults: 1 tablet daily (e.g., 40 mg/12.5 mg or 80 mg/12.5 mg based on prior response—start with lower if needed). Max typical: 80 mg telmisartan/25 mg hydrochlorothiazide (higher HCTZ variants may exist).
Liver impairment: Max 40 mg/12.5 mg daily.
Renal impairment: Caution/monitor (avoid if severe).
Elderly/volume-depleted: Start low to avoid hypotension.
Continue as prescribed; regular BP/electrolyte/kidney checks required.
Not for children/adolescents.
Side Effects:
Common (up to 1 in 10): Dizziness (especially standing), fatigue/weakness, headache, nausea, diarrhea, back/muscle pain, upper respiratory infections (e.g., cold/sinusitis), increased urination (diuretic effect).
Uncommon (up to 1 in 100): Low potassium (hypokalemia), high potassium (hyperkalemia), orthostatic hypotension, anxiety, vertigo, tachycardia, dry mouth, abdominal discomfort, erectile dysfunction, elevated creatinine/uric acid.
Rare/Serious (seek immediate care): Angioedema (swelling of face/lips/tongue—may be fatal), sepsis-like severe infection, anaphylaxis, severe skin reactions (e.g., toxic epidermal necrolysis), acute kidney failure, electrolyte imbalances (e.g., low sodium/potassium leading to cramps/irregular heartbeat), gout flares, photosensitivity.
Uncommon (up to 1 in 100): Low potassium (hypokalemia), high potassium (hyperkalemia), orthostatic hypotension, anxiety, vertigo, tachycardia, dry mouth, abdominal discomfort, erectile dysfunction, elevated creatinine/uric acid.
Rare/Serious (seek immediate care): Angioedema (swelling of face/lips/tongue—may be fatal), sepsis-like severe infection, anaphylaxis, severe skin reactions (e.g., toxic epidermal necrolysis), acute kidney failure, electrolyte imbalances (e.g., low sodium/potassium leading to cramps/irregular heartbeat), gout flares, photosensitivity.
Warnings & Precautions:
Monitor electrolytes (potassium/sodium), kidney function, BP regularly—risk of hyperkalemia (especially with potassium supplements/diuretics) or dehydration/hypotension.
Caution in renal artery stenosis, heart failure, liver disease, diabetes (may affect blood sugar), gout history, SLE (may worsen).
Avoid in severe renal/hepatic impairment, anuria, or untreated low potassium/high calcium.
Surgery/anesthesia: Inform doctor (hypotension risk).
Black patients: May be less effective.
Not for self-adjustment—doctor may check kidneys/BP/electrolytes if combined with ACE inhibitors/aliskiren.
Caution in renal artery stenosis, heart failure, liver disease, diabetes (may affect blood sugar), gout history, SLE (may worsen).
Avoid in severe renal/hepatic impairment, anuria, or untreated low potassium/high calcium.
Surgery/anesthesia: Inform doctor (hypotension risk).
Black patients: May be less effective.
Not for self-adjustment—doctor may check kidneys/BP/electrolytes if combined with ACE inhibitors/aliskiren.
Pregnancy & Lactation:
Pregnancy: Contraindicated >3 months (fetal harm/death possible—renal damage, oligohydramnios); avoid early pregnancy—stop immediately if pregnant; use effective contraception/alternative.
Lactation: Not recommended (hydrochlorothiazide excreted in milk—risk to infant); consult doctor for alternatives.
Lactation: Not recommended (hydrochlorothiazide excreted in milk—risk to infant); consult doctor for alternatives.
Drug Interactions:
Potassium-raising agents (supplements, salt substitutes, potassium-sparing diuretics, ACE inhibitors/ARBs): Hyperkalemia risk—monitor.
Lithium: Increased toxicity—avoid/monitor.
NSAIDs (e.g., ibuprofen): Reduced antihypertensive effect + renal risk.
Other antihypertensives: Additive hypotension.
Diuretics (high doses): Excessive fluid loss/low BP.
Aliskiren: Avoid in diabetes/impaired kidneys.
Digoxin: Possible increased levels.
Alcohol/CNS depressants: Enhanced dizziness.
Lithium: Increased toxicity—avoid/monitor.
NSAIDs (e.g., ibuprofen): Reduced antihypertensive effect + renal risk.
Other antihypertensives: Additive hypotension.
Diuretics (high doses): Excessive fluid loss/low BP.
Aliskiren: Avoid in diabetes/impaired kidneys.
Digoxin: Possible increased levels.
Alcohol/CNS depressants: Enhanced dizziness.
Contraindications:
Hypersensitivity to telmisartan, hydrochlorothiazide, sulfonamides, or components.
Severe renal/hepatic impairment, anuria, untreated electrolyte imbalances (low potassium/high calcium).
Pregnancy (>3 months) or with aliskiren in diabetes/impaired kidneys.
Concomitant aliskiren in certain patients.
Severe renal/hepatic impairment, anuria, untreated electrolyte imbalances (low potassium/high calcium).
Pregnancy (>3 months) or with aliskiren in diabetes/impaired kidneys.
Concomitant aliskiren in certain patients.
Price: Ksh 2,110.71/- (Arbitel 80 H 30s), 1900/-
Notes:
The variants available in the Kenyan market are;
Arbitel-H 40/12.5 mg (telmisartan 40 mg + hydrochlorothiazide 12.5 mg) or 80/12.5 mg (telmisartan 80 mg + hydrochlorothiazide 12.5 mg).