Micardis HCT and/or Equivalents
|Drug||Related Drug Names|
|Micardis HCT 80mg/12.5mg and/or Equivalents||Micardis Plus, Telmisartan/ HCTZ, Teva-Telmisartan/ HCTZ|
|Micardis HCT 80mg/25mg and/or Equivalents||Micardis Plus, Telmisartan/ HCTZ, Teva-Telmisartan/ HCTZ|
Micardis HCT (telmisartan/hydrochlorothiazide)
Micardis HCT Description
Micardis HCT is an angiotensin II receptor antagonist. It prevents the action of angiotensin II, a hormone in the blood that narrows the blood vessels. When its operation is prevented, the blood vessels dilate again, the blood pressure drops and the risks associated with a high blood pressure (eg. strokes) are avoided. So it is highly recommended for the treatment of arterial hypertension.
The peptide hormone angiotensin II is largely under the influence of angiotensin converting enzyme (ACE) - of angiotensin I, which also influences the receptor subtype AT 1 in blood pressure. Different pharmacological mechanisms are involved. Angiotensin II causes vasoconstriction, increases the general activity of the sympathetic nervous system, leads to increased reabsorption in the kidneys and promotes the secretion of aldosterone in the adrenal glands. Micardis HCT, like most other angiotensin II receptor antagonists, is a benzimidazole derivative. It selectively inhibits the angiotensin II receptor subtype AT 1 and lowers blood pressure.
Micardis HCT acts as efficiently as other commonly used antihypertensives. In comparison with other angiotensin II receptor antagonists, Micardis HCT has the longest half-life and possibly a lower interaction potential, because of its gradual degradation in the liver via the cytochrome P450 system. There is still no study result to show that Micardis HCT or any other angiotensin II receptor antagonists are able to reduce the mortality in hypertensive patients. Angiotensin II receptor antagonists are much less documented than ACE inhibitors and should be reserved for use, by principle, only if ACE inhibitor is not tolerated.
Micardis HCT is rapidly absorbed and maximum plasma levels are reached in less than an hour. The bioavailability is dose-dependent, because the first-pass effect is saturable between 40 and 60%. Simultaneously ingested food can reduce the minimal absorption. Its elimination from the body is about 98% of the original content. Micardis HCT is coupled with glucuronic acid and bile to be excreted by faeces. An enterohepatic circulation does not seem to exist. The half-life is of approximately 24 hours.
Micardis HCT Dosage
a.) Typical Dosage Recommendation
In clinical studies, Micardis HCT has been compared to placebo and various other antihypertensive drugs. Most studies included men and women of all ages, and an inclusion criterion was mild to moderate arterial hypertension (diastolic blood pressure values between 95 and 114 mm Hg).
In two placebo-trolled studies, the antihypertensive efficacy of Micardis HCT was documented. Doses ranging from 20 to 80 mg per day (not very strong) were given. The dose-response relationship, above 80 mg per day exhibited no additional antihypertensive effect. In a six-week double-blind study, 222 people were either given placebo or Micardis HCT (40 or 80 mg once a day) or losartan (50 mg daily). The average blood pressure was lower with Micardis HCT, as shown in a reduced 14/9 mm Hg (40 mg) and 16/10 mm Hg (80 mg) blood pressure levels. According to a published study, Micardis HCT (40 to 80 mg/day) was as good as atenolol (50 to 100 mg/day).
The only official indication for Micardis HCT is arterial hypertension. Micardis HCT is available in any drug store as tablets of 40 and 80 mg. Although some people have already benefited from a dose of 20 mg / day, the tablets should not be divided because of its physicochemical properties. Doses are to be administered once per day. As a starting dose, 40 mg is generally prescribed. The maximum effect is expected in the course of 4 weeks. If necessary, the dose can be doubled to 80 mg. Micardis HCT is well combined with any thiazide diuretic, such as indapamide or cyclopenthiazide. It is not to be used in cases with severe renal insufficiency. For hepatic dysfunction and pre-existing gastrointestinal diseases, it is recommended to reduce the dose depending on the severity. As with all angiotensin II receptor antagonists, Micardis HCT is contraindicated in pregnancy because it may cause renal damage in the fetus.
b.) Missing a Dose
The missed dose can be taken up to a few hours behind schedule. However, if it’s about time for the next dosage, don’t take an added dose. Leave out the missed dose and go ahead with the subsequent one.
Micardis HCT can result in a significant increase in digoxin levels. Therefore, the digoxin levels should be monitored when therapy is started or stopped with Micardis HCT. It is also taken into consideration that angiotensin II receptor antagonists may increase lithium levels. So any dosage of Micardis HCT should be preceded by lithium content of the patient’s body.
Micardis HCT Warnings
Micardis HCT should not be used in the following cases:
• If patient is hypersensitive to Micardis HCT or any other component of the drug • People who are pregnant or breastfeeding • Patients with severe liver and gastrointestinal problems
Micardis HCT Side Effects
The most common side effects are:
- Symptoms of infection (including the urinary tract or upper respiratory tract)
- Abdominal pain
- gastrointestinal disorders
- Skin disorders (eczema)
- Arthralgia (joint pain)
- back pain
- leg cramps or leg pain
- muscle pain or chest pain
- Flu-like symptoms
Treatment with Micardis HCT also showed side effects such as:
- diarrhea and infections
These side effects were quite similar to the ones observed in case of placebo as well. Very few patients complained of cough. According to studies, rare cases of angioedema have been observed. However, these side effects are much less frequent than ACE inhibitors and other angiotensin II receptor antagonists. In animal experiments, Micardis HCT sometimes caused gastric erosions and ulcers, but no such effect was seen in humans.
Drug Interactions With Micardis HCT
Major Drug Interactions with Micardis HCT:
- Aldactazide (Spironolactone/Hydrochlorothiazide)
- Aldactone (spironolactone)
- Midamor (amiloride)
- Moduret (Amiloride/Hydrochlorothiazide)
- Cordarone (amiodarone)
- Anzemet (Dolasetron)
- K-10 (Potassium Chloride)
- Prepulsid (cisapride)
- Clinimix E Sulfite Free (parenteral nutrition solution w/electrolytes)
- Demi-Cof (chlorpheniramine/codeine/phenylephrine/potassium iodide)
- Tikosyn (dofetilide)
- Effer-K (citric acid/potassium bicarbonate)
- Ed K+10 (potassium chloride)
- Fleet Enema (Enemol)
- Freamine III with Electrolytes (parenteral nutrition solution w/electrolytes)
- Gen-K (potassium chloride)
- Geodon (ziprasidone)
- Glu-K (potassium chloride)
- Inapsine (droperidol)
- Maxzide (triamterene/HCTZ)
- Uniphyl (theophylline)
- Zanaflex (Tizanidine)
The simultaneous use of Micardis HCT with potassium-sparing diuretics and potassium supplements or potassium containing salt substitutes is not advised. Angiotensin II antagonists reduce the potassium loss associated with these agents, which may lead to a significant increase in serum potassium levels. Analogously, the associated use of Micardis HCT and lithium is not recommended because it can lead to an increase in serum lithium concentrations and toxicity. NSAIDs (nonsteroidal anti-inflammatory drugs) may reduce the effect of angiotensin II antagonists.
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Notice: The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.