BLACK BOX WARNING
- fetal toxicity
telmisartan
Brand: Micardis
⚠ BBW Prototype: losartan
Drug Class: angiotensin II receptor blocker (ARB)
Drug Family: antihypertensive
Subclass: AT1 receptor antagonist with PPAR-gamma partial agonism
Organ Systems: cardiovascular
Mechanism of Action
Long-acting AT1 receptor antagonist; partial PPAR-gamma agonism may improve insulin sensitivity.
AT1 receptorPPAR-gamma (partial)
Indications
- hypertension
- cardiovascular risk reduction (ONTARGET)
Contraindications
- pregnancy
- aliskiren in DM
Adverse Effects
Common
- dizziness
- back pain
- sinusitis
Serious
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 42-58% bioavailability; food reduces Cmax by 6-20% |
| Distribution | highly lipophilic; large Vd |
| Metabolism | conjugation (not CYP); not metabolized to active form |
| Excretion | fecal >97% (minimal renal) |
| Half-life | 24 hours |
| Onset | 1-3 hours |
| Peak | 0.5-1 hour |
| Duration | 24+ hours |
| Protein Binding | >99.5% |
| Vd | 500 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| digoxin | increases digoxin peak concentration by 49% | moderate |
| warfarin | slight increase in INR | minor |
Nursing Considerations
- Longest half-life ARB — once-daily dosing robust
- Almost exclusively fecal excretion — no renal dose adjustment
- Monitor digoxin levels if co-administered
Clinical Pearls
- Longest half-life of all ARBs (24+ hours)
- ONTARGET trial: non-inferior to ramipril for CV risk reduction in high-risk patients
- Partial PPAR-gamma agonism may provide metabolic benefits
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.