Telmisartan And Hydrochlorothiazide

Do not co-administer aliskiren with telmisartan and hydrochlorothiazide in patients with diabetes. Avoid use in patients with renal impairment (GFR <60 mL/min).

Dual blockade of renin-angiotensin system associated with increased risks of hypotension, hyperkalemia, and renal impairment without additional cardiovascular benefit.

Telmisartan increases digoxin peak plasma concentration by 49% and trough concentration by 20%. Monitor digoxin levels when initiating, adjusting, and discontinuing telmisartan.

Drug Interactions Telmisartan Aliskiren: Do not co-administer aliskiren with telmisartan and hydrochlorothiazide tablets in patients with diabetes. Avoid use of aliskiren with telmisartan and hydrochlorothiazide tablets in patients with renal impairment (GFR <60 mL/min). Because lithium should not be used with diuretics, the use of lithium with telmisartan and hydrochlorothiazide is not recommended.

Increases in serum lithium concentrations and lithium toxicity have been reported with concomitant use of thiazide diuretics or angiotensin II receptor antagonists, including telmisartan.

COX-2 inhibitors may result in deterioration of renal function and reduce the diuretic, natriuretic, and antihypertensive effects similar to NSAIDs.

NSAIDs may result in deterioration of renal function, including possible acute renal failure, and may attenuate the antihypertensive effect of ARBs. NSAIDs reduce diuretic, natriuretic, and antihypertensive effects.

May result in deterioration of renal function including acute renal failure in elderly, volume-depleted, or renally compromised patients. Attenuates antihypertensive effect and reduces diuretic efficacy.

Co-administration increases ramipril and ramiprilat exposure (2.3-2.4 fold Cmax, 1.5-2.1 fold AUC) while decreasing telmisartan levels. Additive pharmacodynamic effects may occur.

Drug Interactions Telmisartan Aliskiren: Do not co-administer aliskiren with telmisartan and hydrochlorothiazide tablets in patients with diabetes. Avoid use of aliskiren with telmisartan and hydrochlorothiazide tablets in patients with renal impairment (GFR <60 mL/min). Digoxin : When telmisartan was co-administered with digoxin, median increases in digoxin peak plasma concentration (49%) and in trough concentration (20%) were observed.

Cholestyramine reduces absorption of thiazides, potentially decreasing their efficacy.

Colestipol reduces absorption of thiazides, potentially decreasing their efficacy.

Telmisartan slightly decreased mean warfarin trough plasma concentration, but this did not result in a change in INR.

7.4 Dual Blockade of the Renin-Angiotensin-Aldosterone System and Changes in Renal Function Dual blockade of the renin-angiotensin-aldosterone system (RAS) with angiotensin blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and renal impairment.

Other Drugs : Co-administration of telmisartan did not result in a clinically significant interaction with acetaminophen, amlodipine, glibenclamide, simvastatin, hydrochlorothiazide or ibuprofen.

Other Drugs : Co-administration of telmisartan did not result in a clinically significant interaction with acetaminophen, amlodipine, glibenclamide, simvastatin, hydrochlorothiazide or ibuprofen.

Other Drugs : Co-administration of telmisartan did not result in a clinically significant interaction with acetaminophen, amlodipine, glibenclamide, simvastatin, hydrochlorothiazide or ibuprofen.