Telmisartan

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Mar 07, 2024

Warnings

Telmisartan (Micardis) Risks, Warnings, and Complications

Telmisartan can cause serious health problems in some people. Talk to your doctor or pharmacist about other options for lowering blood pressure if you are at a high risk of complications from telmisartan use. Some of the risks of taking telmisartan include:

RISK DURING PREGNANCY: Telmisartan should not be used during pregnancy. This medication is harmful to the unborn baby and can cause serious birth defects if taken in the second or third trimester (last 6 months of pregnancy). Before starting telmisartan, tell your doctor if you are pregnant, could be pregnant, or are planning a pregnancy in the near future. There are other safer options to control blood pressure during pregnancy.
HYPOTENSION: Telmisartan can cause hypotension (low blood pressure) with symptoms such as lightheadedness, dizziness, and fainting. The risk of this happening is higher if you are also taking other medications that lower blood pressure, such as diuretics (water pills) or if you are salt or volume-depleted (dehydrated). This side effect usually goes away with time. Tell your doctor if the symptoms of low blood pressure persist. They may change your dose or switch you to a different blood pressure medicine.
HYPERKALEMIA: Telmisartan can cause hyperkalemia (increased blood levels of potassium in the body). Risk factors include renal impairment (reduced kidney function), heart failure, dialysis, and taking potassium supplements, potassium-containing salt substitutes, potassium-sparing diuretics, and other drugs that can increase blood levels of potassium. High potassium levels in the body can cause symptoms such as nausea, tingling sensations, and muscle weakness. Keep all your medical and lab appointments while on telmisartan. Your healthcare provider may order regular blood tests to check potassium levels.
IMPAIRED HEPATIC FUNCTION: People with impaired hepatic function (reduced liver function) or biliary obstruction may not be able to clear telmisartan from the body. Tell your doctor if you have a history of liver or biliary problems. Your provider may start you on a lower dose of telmisartan and increase the dose slowly.
IMPAIRED RENAL FUNCTION: In people with severe congestive heart failure, kidney dysfunction, or renal artery stenosis, telmisartan, other ARBs, and blood pressure medications called angiotensin-converting enzyme (ACE) inhibitors can cause worsening kidney problems. There is an increased risk of this happening if you are taking other medications that can cause kidney injury. Your provider may order blood tests to make sure your kidneys are healthy before prescribing telmisartan. Tell your doctor immediately if you develop reduced urine output or swelling while on telmisartan.

Precautions Before Starting Telmisartan (Micardis)

Tell your doctor if you have ever had allergic reactions to telmisartan, any of the active or inactive ingredients in telmisartan tablets, or any other drugs. Your pharmacy can give you a list of ingredients.

Give your doctor a complete medical history. Telmisartan may not be safe for people with certain medical conditions such as heart failure, heart disease, bile duct blockage, kidney disease, or liver disease.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. This can help avoid possible drug interactions.

Specifically, tell your doctor if you are taking a medication called aliskiren (Tekturna, Tekturna HCT, Tekamlo, Amturnide), which is prescribed to patients with diabetes (high blood sugar). You should not take telmisartan and aliskiren together.

Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy, or are breast-feeding. Talk to your doctor about appropriate birth control while on this blood pressure medicine.

Precautions During Use of Telmisartan (Micardis)

Keep all your medical and laboratory appointments during treatment with telmisartan. Your doctor may want to adjust your dose and monitor you for side effects.

Telmisartan can cause drowsiness, dizziness, and lightheadedness. Do not drive or operate heavy machinery until you know how this medicine affects you.

Tell your doctor if you develop diarrhea, vomiting, excessive sweating, or dehydration during treatment with telmisartan. This can lead to low blood pressure, which can cause lightheadedness and fainting.

If your doctor has recommended a low-sodium or low-salt diet, follow it carefully. Do not use potassium supplements or salt substitutes that contain potassium without talking to your healthcare provider first.

Stop taking telmisartan and tell your doctor as soon as possible if you become pregnant while on telmisartan. Check with your doctor before breastfeeding while on telmisartan. It is unknown if telmisartan passes into breast milk.

Tell all your doctors you are on telmisartan before any surgery, including dental procedures.

Telmisartan (Micardis) Drug Interactions

Certain medicines can affect how telmisartan works. Possible interactions between telmisartan and other medicines can increase the potential risks of severe adverse effects. Your doctor may prescribe doses lower than usual, switch you to a different medication, and/or monitor you carefully for side effects if there are known interactions between telmisartan and your other medicines.

You should not take a medication called aliskiren (Tekturna, Tekturna HCT, Tekamlo, Amturnide) at the same time as telmisartan.

The following medications can also have interactions with telmisartan:

Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve)
Selective COX-2 inhibitors such as celecoxib (Celebrex)
Angiotensin-converting enzyme (ACE) inhibitors such as captopril (Captoten, in Capozide), benazepril (Lotensin, in Lotrel), enalapril (Vasotec), lisinopril (in Prinzide), fosinopril, moexipril (Univasc, in Uniretic), quinapril (Accupril, in Accuretic, in Quinaretic), trandolapril (Mavik, in Tarka), perindopril (Aceon), and ramipril (Altace)
Heart medications such as digoxin (Lanoxin)
Diuretics or water pills such as spironolactone (Aldactone, in Aldactazide)
Psychiatric medications such as lithium (Lithobid)
Potassium supplements

The above list may not include all the possible interactions of telmisartan. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription and over-the-counter medicines.

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