Names and pronunciation
(tel-mih-sar′tan) Micardis
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Drug reference
(tel-mih-sar′tan) Micardis
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Func. class.: Antihypertensive
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Chem. class.: Angiotensin II receptor (Type AT1) antagonist
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ACTION: Blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
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USES: Hypertension, alone or in combination; stroke, MI prophylaxis (>55 yr) in patients unable to take ACE inhibitors
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Unlabeled uses: Acute coronary syn- drome, stable coronary artery disease
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CONTRAINDICATIONS: Hyper- sensitivity
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Black Box Warning: Pregnancy Precautions: Pregnancy, breastfeeding, children, geriatric patients; hypersensi- tivity to ACE inhibitors; renal/hepatic dis- ease, renal artery stenosis, dialysis, HF, hyperkalemia, hypotension, hypovole- mia, African descent Black Box Warning: Pregnancy/breast- feeding: if pregnancy test is positive, stop treatment; can cause death to fetus; do not breastfeed • B/P, pulse standing, lying; note rate, rhythm, quality; if severe hypotension occurs, place in supine position; usually occurs during first few weeks of treat- ment • Baselines of renal, hepatic, electrolyte studies before therapy begins • Heart failure: edema in feet, legs daily; jugular venous distention; dyspnea, crackles; weight increase >5 lb per week Black Box Warning: To notify prescriber if pregnancy is planned or suspected; do not use in pregnancy, breastfeeding • To notify prescriber of all prescrip- tions, OTC products, and supplements taken; to rise slowly from sitting to pre- vent drop in B/P • Overdose: dizziness, bradycardia, or tachycardia
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SIDE EFFECTS CNS: Dizziness, insomnia, anxiety, headache, fatigue, syncope CV: Chest pain, edema, palpitations, bra dycardia, orthostatic hypotension GI: Diarrhea, dyspepsia, anorexia, vomiting META: Hyperkalemia MS: Myalgia, pain RESP: Cough, upper respiratory infec- tion, sinusitis, pharyngitis SYST: Angioedema
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INTERACTIONS Increase: digoxin peak/trough concentrations—digoxin Increase: antihypertensive action— diuretics, other antihypertensives, NSAIDs Increase: hyperkalemia—potassium-spar- ing diuretics, potassium salt substitutes, ACE inhibitors Decrease: antihypertensive effect— NSAIDs, salicylates Drug/Lab Test Increase: LFTs
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DOSAGE AND ROUTES Hypertension • Adult: PO 40 mg/day; range 20-80 mg/day Stroke, MI prophylaxis T • Adult >55 yr: PO 80 mg/day
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Available forms: Tabs 20, 40, 80 mg
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Administer: • Without regard to meals • Increased dose to African-American patients or consider alternative agent; B/P response may be reduced • Do not remove from blister pack until ready to use
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Assess:
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Evaluate: • Therapeutic response: decreased B/P
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To comply with dosage schedule, even if feeling better; to take at same time of day; that therapeutic effect may take 2-4 wk • To notify prescriber immediately of mouth sores, fever, swelling of hands or feet, swelling of face or lips, irregular heartbeat, chest pain, decreased urine output • Not to stop abruptly; increased B/P will occur • That excessive perspiration, dehydra- tion, vomiting, diarrhea may lead to fall in blood pressure; to consult prescriber if these occur • That product may cause dizziness, fainting, light-headedness; to avoid haz- ardous activities until response is known
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PHARMACOKINETICS Onset of antihypertensive activity 3 hr, peak 0.5-1 hr, extensively metabolized, terminal half-life 24 hr, protein binding 99.5%, excreted in feces >97%, B/P response is less in Black patients
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• Adult: PO 40 mg/day; range 20-80 mg/day Stroke, MI prophylaxis T
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• Adult >55 yr: PO 80 mg/day
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