Angiotensin II receptor antagonist
"Kinzal" redirects here. For other uses, see
Kinzhal .
Telmisartan
Pronunciation
Trade names Micardis, Actavis, others
AHFS /
Drugs.com
Monograph
MedlinePlus
a601249
License data
Pregnancy category
Routes of administration
By mouth
Drug class
Angiotensin II receptor antagonist
ATC code
Legal status
Bioavailability 42–100%
Protein binding >99.5%
Metabolism Minimal liver (
glucuronidation )
Elimination half-life 24 hours
Excretion Feces 97%
2-(4-{[4-Methyl-6-(1-methyl-1H -1,3-benzodiazol-2-yl)-2-propyl-1H -1,3-benzodiazol-1-yl]methyl}phenyl)benzoic acid
CAS Number
PubChem
CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (
EPA )
ECHA InfoCard
100.149.347
Formula C 33 H 30 N 4 O 2
Molar mass 514.629 g·mol−1 3D model (
JSmol )
O=C(O)c1ccccc1c2ccc(cc2)Cn3c4cc(cc(c4nc3CCC)C)c5nc6ccccc6n5C
InChI=1S/C33H30N4O2/c1-4-9-30-35-31-21(2)18-24(32-34-27-12-7-8-13-28(27)36(32)3)19-29(31)37(30)20-22-14-16-23(17-15-22)25-10-5-6-11-26(25)33(38)39/h5-8,10-19H,4,9,20H2,1-3H3,(H,38,39)
Y Key:RMMXLENWKUUMAY-UHFFFAOYSA-N
Y
(verify)
Telmisartan , sold under the brand name Micardis among others, is a
medication used to treat
high blood pressure ,
heart failure , and
diabetic kidney disease .
[2] It is a reasonable initial treatment for high blood pressure.
[2] It is taken by mouth.
[2] Versions are available as the combination
[3]
telmisartan/hydrochlorothiazide , telmisartan/cilnidipine
[4] and telmisartan/
amlodipine .
[2]
Common side effects include
upper respiratory tract infections , diarrhea, and back pain.
[2] Serious side effects may include
kidney problems ,
low blood pressure , and
angioedema .
[2] Use in
pregnancy may harm the baby and use when
breastfeeding is not recommended.
[5] It is an
angiotensin II receptor antagonist and works by blocking the effects of
angiotensin II .
[2]
Telmisartan was patented in 1991 and came into medical use in 1999.
[6] It is available as a
generic medication .
[7] In 2021, it was the 217th most commonly prescribed medication in the United States, with more than 1 million prescriptions.
[8]
[9]
Medical uses
Telmisartan is used to treat
high blood pressure ,
heart failure , and
diabetic kidney disease .
[2] It is a reasonable initial treatment for high blood pressure.
[2]
[10] : 146
Contraindications
Telmisartan is contraindicated during
pregnancy . Like other drugs affecting the
renin–angiotensin system (RAS), telmisartan can cause
birth defects ,
stillbirths , and
neonatal deaths . It is not known whether the drug passes into the breast milk.
[11] Also it is contraindicated in bilateral
renal artery stenosis in which it can cause
kidney failure .
Side effects
Side effects are similar to other angiotensin II receptor antagonists and include
tachycardia and
bradycardia (fast or slow heartbeat),
hypotension (low blood pressure) and
edema (swelling of arms, legs, lips, tongue, or throat, the latter leading to breathing problems).
Allergic reactions may also occur.
[11]
Interactions
Due to its mechanism of action, telmisartan increases blood
potassium levels. Combination with potassium preparations or
potassium-sparing diuretics could cause
hyperkalaemia (excessive potassium levels). Combination with
NSAIDs , especially in patients with impaired kidney function, has a risk of causing (usually reversible)
kidney failure .
[12]
Pharmacology
Mechanism of action
Telmisartan is an angiotensin II receptor blocker that shows high affinity for the
angiotensin II receptor type 1 (AT1 ), with a binding affinity 3000 times greater for AT1 than
AT2 .
In addition to blocking the
renin–angiotensin system , telmisartan acts as a selective modulator of
peroxisome proliferator-activated receptor gamma (PPAR-γ), a central regulator of
insulin and
glucose metabolism. It is believed that telmisartan's dual mode of action may provide protective benefits against the vascular and renal damage caused by
diabetes and
cardiovascular disease (CVD).
[13]
Telmisartan's activity at the
peroxisome proliferator-activated receptor delta (PPAR-δ) receptor has prompted speculation around its potential as a sport doping agent as an alternative to
GW 501516 .
[14] Telmisartan activates PPAR-δ receptors in several tissues.
[15]
[16]
[17]
[18]
Also, telmisartan has a
PPAR-γ agonist activity.
[10] : 171
Pharmacokinetics
The substance is quickly but to varying degrees absorbed from the gut. The average
bioavailability is about 50% (42–100%). Food intake has no clinically relevant influence on the kinetics of telmisartan.
Plasma protein binding is over 99.5%, mainly to
albumin and
alpha-1-acid glycoprotein .
[12] It has the longest half-life of any
angiotensin II receptor blocker (ARB) (24 hours)
[19]
[13] and the largest
volume of distribution among ARBs (500 liters).
[20]
[21] Less than 3% of telmisartan is inactivated by
glucuronidation in the liver, and over 97% is eliminated in unchanged form via
bile and faeces.
[2]
[12]
History
Society and culture
Telmisartan is available as a
generic medication .
[7]
References
^
"FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)" . nctr-crs.fda.gov .
FDA . Retrieved 22 October 2023 .
^
a
b
c
d
e
f
g
h
i
j
"Telmisartan Monograph for Professionals" . Drugs.com . American Society of Health-System Pharmacists. Retrieved 3 March 2019 .
^ Golwala D.
"Formulation and Evaluation of Mouth Dissolving Tablets of Telmisartan" . Inventi Journals . Retrieved 18 July 2020 . [
permanent dead link ]
^
"Cilacar T" . Medical Dialogues. Retrieved 23 February 2021 .
^
"Telmisartan Pregnancy and Breastfeeding Warnings" . Drugs.com . Retrieved 3 March 2019 .
^ Fischer J, Ganellin CR (2006).
Analogue-based Drug Discovery . John Wiley & Sons. p. 471.
ISBN
9783527607495 .
^
a
b British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 178.
ISBN
9780857113382 .
^
"The Top 300 of 2021" . ClinCalc .
Archived from the original on 15 January 2024. Retrieved 14 January 2024 .
^
"Telmisartan - Drug Usage Statistics" . ClinCalc . Retrieved 14 January 2024 .
^
a
b Opie LH, Gersh BJ (2009). Drugs for the heart (seventh ed.). Saunders.
ISBN
978-1-4160-6158-8 .
^
a
b Drugs.com:
Micardis
^
a
b
c Haberfeld, H, ed. (2015). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag.
^
a
b Benson SC, Pershadsingh HA, Ho CI, Chittiboyina A, Desai P, Pravenec M, et al. (May 2004).
"Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARgamma-modulating activity" . Hypertension . 43 (5): 993–1002.
doi :
10.1161/01.HYP.0000123072.34629.57 .
PMID
15007034 .
^ Sanchis-Gomar F, Lippi G (March 2012).
"Telmisartan as metabolic modulator: a new perspective in sports doping?" . Journal of Strength and Conditioning Research . 26 (3): 608–10.
doi :
10.1519/JSC.0b013e31824301b6 .
PMID
22130396 .
^
Cytoplasmic and Nuclear Receptors: Advances in Research and Application: 2011 Edition . ScholarlyEditions. 2012. pp. 21–.
ISBN
978-1-464-93110-9 . Retrieved 2 April 2013 .
^ Feng X, Luo Z, Ma L, Ma S, Yang D, Zhao Z, et al. (July 2011).
"Angiotensin II receptor blocker telmisartan enhances running endurance of skeletal muscle through activation of the PPAR-δ/AMPK pathway" . Journal of Cellular and Molecular Medicine . 15 (7): 1572–81.
doi :
10.1111/j.1582-4934.2010.01085.x .
PMC
3823201 .
PMID
20477906 .
^ He H, Yang D, Ma L, Luo Z, Ma S, Feng X, et al. (April 2010).
"Telmisartan prevents weight gain and obesity through activation of peroxisome proliferator-activated receptor-delta-dependent pathways" . Hypertension . 55 (4): 869–79.
doi :
10.1161/HYPERTENSIONAHA.109.143958 .
PMID
20176998 .
^ Li L, Luo Z, Yu H, Feng X, Wang P, Chen J, et al. (March 2013).
"Telmisartan improves insulin resistance of skeletal muscle through peroxisome proliferator-activated receptor-δ activation" . Diabetes . 62 (3): 762–74.
doi :
10.2337/db12-0570 .
PMC
3581229 .
PMID
23238297 .
^ Pritor prescribing information
^ Stangier J, Su CA, Roth W (2000). "Pharmacokinetics of orally and intravenously administered telmisartan in healthy young and elderly volunteers and in hypertensive patients". The Journal of International Medical Research . 28 (4): 149–67.
doi :
10.1177/147323000002800401 .
PMID
11014323 .
S2CID
33299699 .
^ Gosse P (September 2006).
"A review of telmisartan in the treatment of hypertension: blood pressure control in the early morning hours" . Vascular Health and Risk Management . 2 (3): 195–201.
doi :
10.2147/vhrm.2006.2.3.195 .
PMC
1993985 .
PMID
17326326 .
Further reading
Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, et al. (April 2008). "Telmisartan, ramipril, or both in patients at high risk for vascular events". The New England Journal of Medicine . 358 (15). Massachusetts Medical Society: 1547–59.
doi :
10.1056/nejmoa0801317 .
hdl :
2437/81925 .
PMID
18378520 .
Yusuf S, Teo K, Anderson C, Pogue J, Dyal L, Copland I, et al. (September 2008).
"Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial" . Lancet . 372 (9644): 1174–83.
doi :
10.1016/S0140-6736(08)61242-8 .
PMID
18757085 .
S2CID
5203511 . Retrieved 26 November 2019 .
ATR Tooltip Angiotensin receptor Combinations:
PPARα Tooltip Peroxisome proliferator-activated receptor alpha
PPARδ Tooltip Peroxisome proliferator-activated receptor delta
PPARγ Tooltip Peroxisome proliferator-activated receptor gamma Non-selective
CAR Tooltip Constitutive androstane receptor
PXR Tooltip Pregnane X receptor