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Why it's used

Hydrochlorothiazide/Telmisartan is a prescription medicine that is used to treat an essential high blood pressure condition in patients who are suffering from the state of uncontrolled blood pressure while having therapy with telmisartan alone. Hydrochlorothiazide works by eliminating the excess amounts of sodium, chloride and potassium salts from the kidney and telmisartan works by preventing the activity of certain natural substances that tighten the blood vessels which results in decreased blood pressure.
Angiotensin 2 Receptor Blocker
Hydrochlorothiazide+Telmisartan belongs to the Angiotensin 2 Receptor Blocker class of medicines. Angiotensin II receptor blockers are used for the treatment of high blood pressure and heart failure. These medicines act by relaxing the blood vessels and makes it easier for your heart to pump blood.

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How to use

Follow directions on the product label, information guide, and provided by your doctor before using Hydrochlorothiazide+Telmisartan. Eat this medicine as per your doctor's instructions.
Hydrochlorothiazide+Telmisartan is eaten with or without food.

Typical Dosage

The typical adult dose of Hydrochlorothiazide+Telmisartan is 40 mg/12.5 mg-80 mg/12.5 mg once daily. The maximum dose for adults of Hydrochlorothiazide+Telmisartan is 80/25 mg once daily per day. Hydrochlorothiazide+Telmisartan is typically used at the same time every day. It takes 2 hours for this medicine to start its action.
Hydrochlorothiazide+Telmisartan is to be used for longer periods of time. Use of Hydrochlorothiazide+Telmisartan may be prescribed for the long-term to control the high blood pressure conditions in patients with creatinine clearance less than 30 ml/min.

Talk to Your Doctor

Tell your doctor if you develop new or worsening symptoms. Talk to your doctor if inflammation of the connective tissues (systemic lupus erythematosus), and unexpected skin lesions. If you have any kidney disease, No dose adjustment is needed for patients with moderate kidney problems, and the use of Hydrochlorothiazide+Telmisartan should be avoided in patient with severe kidney problems. If you have issues with the health of your liver, 40 mg/12.5 mg/day dose should be used in a patients with abnormal functioning of the liver and the use of Hydrochlorothiazide+Telmisartan should be avoided in a patient with severe kidney problems.
Taking a high dose of this medicine is known to increase the chances of side-effects.

Use in Children

The safety and effectiveness of using this medicine in children has not been established. Safety and effectiveness of Hydrochlorothiazide+Telmisartan have not been evaluated in children under the age of 18 years.

Avoid Alcohol

Avoid drinking alcohol with Hydrochlorothiazide+Telmisartan.

Lab Tests

Your doctor may require that certain tests be performed before using Hydrochlorothiazide/Telmisartan. The doctor may ask you to have Sodium test. Blood sodium levels should be maintained before starting treatment with this medicine.

Storage

Store Hydrochlorothiazide/Telmisartan at 25°C (77°F), away from moisture, and away from sunlight. Keep this medicine away from children and pets.
Medicines may be given for uses other than those listed in the medicine guide. Do not use Hydrochlorothiazide/Telmisartan for symptoms for which it was not prescribed. Do not give Hydrochlorothiazide/Telmisartan to others who may have similar symptoms as you. Self-medication can cause harm.

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How to take Hydrochlorothiazide+Telmisartan

The dose and frequency of using Hydrochlorothiazide+Telmisartan will depend on the following factors:
  • age of the patient
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys

Hydrochlorothiazide+Telmisartan Dosage

Dosage for high blood pressure

Adult (Patients whose blood pressure is not controlled by telmisartan 40 mg or 80 mg)
  • Recommended: 40 mg telmisartan/12.5 mg hydrochlorothiazide - 80 mg telmisartan/12.5 mg hydrochlorothiazide once daily
  • Maximum: 80 mg telmisartan/25 mg hydrochlorothiazide mg once a day

Minimum Age

18 years

Forms

Tablet
Strength: 40 mg/12.5 mg, 80 mg/12.5 mg and 80 mg/25 mg

Missed Dose

Take the missed dose as soon as you remember. Do not take a second dose to make up for the dose that you may have missed. Just continue with the next dose.

Overdose

What to do if you overdose on Hydrochlorothiazide+Telmisartan?
Monitoring for electrolyte imbalance and creatinine level along with supportive therapy and treatment according to the symptoms (symptomatic) should be considered in the case of overdose. If ingestion is recent, the harmful effects can be reduced by using activated charcoal, inducing emesis or by cleaning out the contents of the stomach (gastric lavage). Overdose effect of telmisartan cannot be removed from the blood by artificial blood purifying technique (hemodialysis). If low blood pressure occurs, the patient should be placed in a horizontal position and salt or volume replacements should be given as soon as possible.
Symptoms of an overdose of Hydrochlorothiazide+Telmisartan
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Hydrochlorothiazide/Telmisartan, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Hydrochlorothiazide+Telmisartan

Before you use Hydrochlorothiazide+Telmisartan, tell your doctor of your medical and health history including the following:
  • anuria
  • difficulty in breathing
  • exposure to thoracic surgery
  • genetic problems
  • gout
  • heart failure
  • high blood sugar levels
  • increased production of aldosterone hormone
  • inflammation of the connective tissues
  • liver or kidney problems
  • low potassium levels or high calcium levels
  • neonates with a history of exposure to Hydrochlorothiazide+Telmisartan
  • obstruction in the blood flow of the heart
  • skin cancer
  • sulfonamide or penicillin allergy
  • thickening of heart muscles
  • use of lithium-containing drugs, diuretics, laxatives, angiotensin-converting enzyme inhibitors, potassium tablets, amphotericin tablets, penicillin, sleeping tablets, pain killer, corticosteroids, nonsteroidal anti-inflammatory agents, calcium supplements, beta blockers, anticholinergics, amantadine, cyclosporin,heparin sodium, heart medicines, cholestyramine, colestipol, noradrenaline, muscle relaxing medicines
  • volume depletion
Allergic reactions may occur in patients with a history of difficulty in breathing while using hydrochlorothiazide. Use of hydrochlorothiazide may cause optic nerve damage (angle-closure glaucoma) in patients with a history of sulfonamide or penicillin allergy. Hydrochlorothiazide+Telmisartan may cause reduced urination and low blood pressure in neonates with a history of in-utero exposure. Patients with thickened heart muscles may experience the severe condition of decreased blood pressure, which may lead to heart attack and stroke.
Before you use Hydrochlorothiazide+Telmisartan, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Discuss with your doctor if you are allergic to telmisartan, hydrochlorothiazide, or sulphonamide-derived substances.
Before having any surgery, discuss with your doctor and dentist about medicines you use including prescription medicines, non-prescription medicines, and herbal supplements.
The use of Hydrochlorothiazide/Telmisartan may change liver function parameters. Hydrochlorothiazide+Telmisartan may cause an increase in liver enzymes and in bilirubin levels.
The use of this medicine may change hemoglobin and hematocrit. Hydrochlorothiazide+Telmisartan or telmisartan may cause a decrease in hemoglobin and hematocrit levels.
The use of Hydrochlorothiazide/Telmisartan may change kidney parameters. Hydrochlorothiazide may cause a decrease in magnesium and increase in calcium levels. Monitoring of the potassium, uric acid, and creatinine levels should be considered in patients with an abnormality in the functioning of the kidney. Increased levels of creatinine were also observed in patients suffering from high blood pressure.
The use of this medicine may change cholesterol. Hydrochlorothiazide+Telmisartan or hydrochlorothiazide may cause an increase in cholesterol levels.
The use of this medicine may change blood pressure. Hydrochlorothiazide+Telmisartan or telmisartan may cause either increase or decrease the condition of blood pressure.

Use when Pregnant

Hydrochlorothiazide+Telmisartan is not safe for use in women who are pregnant. If you are pregnant or planning to become pregnant, you should discuss the impact on the fetus with your doctor before you start using this medicine. Use of Hydrochlorothiazide+Telmisartan during the second and third trimesters of pregnancy may cause injury to the developing fetus such as low blood pressure, abnormal body growth, nonpassage of urine, decreased functioning of the kidney, high potassium levels, and deficiency of amniotic fluid. Thiazides may cross the placenta, and cause birth defects such as low levels of thrombocytes, jaundice, and other side effects.

If Breastfeeding

Hydrochlorothiazide/Telmisartan should be used while breastfeeding only when required. This medicine is excreted in breast milk and may cause serious side effects in infants.

If trying to Conceive

Consult with your doctor on the use of Hydrochlorothiazide+Telmisartan, if you are trying to conceive. Hydrochlorothiazide and telmisartan has no effect on the fertility of female and male.

Alcohol

Avoid drinking alcohol with Hydrochlorothiazide+Telmisartan. Consumption of alcohol may cause further lowers blood pressure, dizziness, and fainting.

Seizures

Hydrochlorothiazide+Telmisartan can make you feel sleepy. Be careful, especially while driving, while using heavy machinery, or when doing any activity that needs you to be completely alert. The consumption of alcohol with Hydrochlorothiazide+Telmisartan can worsen the sleepiness. Hydrochlorothiazide+Telmisartan may cause seizures in some people. Hence, you should discuss with your doctor before performing any activities where a loss of consciousness may cause harm to you or others.

Increase in Risk

This medicine may increase your sensitivity to sunlight and make you prone to sunburn. If this happens, limit your time outdoors to prevent sunburn. Use a sunscreen and cover your skin.

Long-term Use

Long term use of hydrochlorothiazide may cause a decreased level of potassium in the blood and increases the risk of the different type of cancer.

Hydrochlorothiazide+Telmisartan Side-effects

The following side-effects may commonly occur when using Hydrochlorothiazide/Telmisartan. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
Rarely, the use of Hydrochlorothiazide/Telmisartan may cause the following side-effects:
  • abnormal electrocardiography (ECG)
  • abnormal liver function
  • abscess
  • acid reflux (gastroesophageal reflux)
  • back pain
  • brain related blood vessel disorder
  • burning or prickling sensation
  • chest pain
  • decreased appetite
  • decreased haemoglobin
  • disease of lung tissue (interstitial lung disease)
  • drug-induced skin reactions
  • dry mouth
  • earache
  • electrolyte imbalance
  • excessive sweating
  • face swelling
  • fatigue
  • feeling of discomfort
  • fluid builds up in the body
  • flushing
  • frequent urination (micturition frequency)
  • fungal infection
  • gas formation
  • hives
  • inability in a man to achieve orgasm (impotence/erectile dysfunction)
  • increased liver enzyme
  • indigestion
  • infection
  • inflammation of salivary glands (sialadenitis)
  • inflammation of the airways of the lungs (bronchitis)
  • inflammation of the kidney
  • inflammation of the lining of the intestines (gastroenteritis/enteritis)
  • influenza-like illness
  • insomnia
  • irregular heartbeat
  • irritation and swelling of the nose (rhinitis)
  • itchy inflammation of the skin (eczema)
  • joint pain
  • kidney dysfunction
  • lack of energy
  • leg cramps
  • leg pain
  • leg swelling
  • light-headedness
  • loss of consciousness
  • loss of volume of fluid from the body
  • low level of eosinophils in the blood
  • lower limb swelling
  • middle ear infection (otitis media)
  • migraine
  • muscle cramps
  • muscle pain
  • muscle spasms
  • nervousness
  • non-specific gastrointestinal disorders
  • pain in limb
  • painful swelling and inflammation of the joint (arthritis)
  • piles (hemorrhoid)
  • poor distance vision (acute myopia)
  • presence of excess sugar in the urine (glycosuria)
  • red or purple discolored spots on the skin
  • redness of the skin (erythema)
  • restlessness
  • ringing in the ears (tinnitus)
  • severe pain, redness and tenderness in joints (gout)
  • severe skin itching
  • shortness of breath (asthma)
  • skin cancer (Non-melanoma skin cancer including basal cell carcinoma and Squamous cell carcinoma)
  • skin rash
  • stomach discomfort
  • stomach pain
  • swelling of the lower legs or hands
  • swelling of the skin due to allergic reaction
  • tendon pain
  • toothache
  • vertigo
  • vision deficiency (xanthopsia)
  • visual disturbance
  • weakness
  • wear and tear on the joints (arthrosis)
The following severe side-effects may also occur when using Hydrochlorothiazide/Telmisartan:
  • Symptoms: inflammation of the pharynx (pharyngitis), inflammation or swelling of the sinuses (sinusitis), difficulty in breathing (dyspnea), respiratory distress including inflammation of the lung tissue and excess fluid in the lungs, bleeding from the nasal cavity (epistaxis) upper respiratory tract infection
    If this happens, contact your doctor as soon as possible.
  • Metabolism and nutrition disorders
    Symptoms: low level of potassium in the blood, high uric acid in the blood, low levels of sodium in the blood, high potassium in the blood, low blood sugar, high blood sugar, high calcium level in the blood, deficiency of chloride (hypochloraemic alkalosis), eating disorder (anorexia), high cholesterol in the blood (hypercholesterolaemia) increased triglycerides
    If this happens, contact your doctor as soon as possible.
  • Mental and nervous system disorders
    Symptoms: anxiety, depression drowsiness
    If this happens, contact your doctor as soon as possible.
  • Eye disorders
    Symptoms: blurred vision, optic nerve damage (acute angle-closure glaucoma) inflammation or infection of the eyeball (conjunctivitis)
  • Heart and blood vessel disorders
    Symptoms: rapid heart rate, increased and decreased heartbeat, low blood pressure, low blood pressure on quickly standing up, slow heart rate, inflammation of the blood vessels (vasculitis necrotizing/skin vasculitis), high blood pressure, congestive heart failure heart attack
    If this happens, contact your doctor as soon as possible.
  • Stomach and intestinal disorders
    Symptoms: diarrhea, constipation, vomiting, stomach inflammation (gastritis) pancreas inflammation (pancreatitis)
    If this happens, contact your doctor as soon as possible.
  • Skin disorders (possibly fatal)
    Symptoms: swelling of the lower layer of the skin, sun allergic reaction, life-threatening drug-induced skin reaction, skin allergic reaction caused by infection (erythema multiforme), life-threatening skin reaction (Stevens-Johnson Syndrome) redness and peeling of the skin (exfoliative dermatitis)
    If this happens, stop taking Hydrochlorothiazide+Telmisartan and contact your doctor as soon as possible.
  • Immune system disorders
    Symptoms: allergic reaction, life-threatening allergic reaction (anaphylactic reactions) inflammation of the connective tissues (lupus-like syndrome/exacerbation or activation of systemic lupus erythematosus)
    If this happens, stop taking Hydrochlorothiazide+Telmisartan and contact your doctor as soon as possible.
  • Kidney and urinary disorders
    Symptoms: increased blood creatinine levels, increased blood creatine phosphokinase levels, abnormal functioning of the kidney, acute kidney failure urinary tract infection including inflammation of the bladder (cystitis)
Your doctor has prescribed this medicine because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious cases of side-effects. This page does not contain a complete list of all possible side-effects.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Heart Problems

Patients with heart problems such as weak heart muscles (ischemic cardiopathy) or blood vessel-related heart disease are at an increased risk while using Hydrochlorothiazide+Telmisartan. These patients may experience an excessive decrease in blood pressure, which may lead to heart attack and stroke. Precaution should be taken in patients with obstruction in the blood flow of the heart (aortic and mitral valve stenosis) and thickening of the heart muscles (Hypertrophic cardiomyopathy).

Abnormality in the Functioning of the Kidney

Patients with an abnormality in the functioning of the kidney or with narrowing of kidney arteries (renal artery stenosis) are at increased risk when using Hydrochlorothiazide+Telmisartan. Use of Hydrochlorothiazide+Telmisartan may cause reduced urination or blood pressure, kidney failure, high levels of nitrogen-containing compounds (azotemia), creatinine, blood urea nitrogen, and other fatal conditions. Precaution should be taken in patients with severe kidney disease while using thiazides. Hydrochlorothiazide+Telmisartan should not be used in patients with the severe abnormality in the function of the kidney. Also, monitoring of the creatinine, potassium, or uric acid levels should be considered in these patients.

Dual Blockade of the Renin-Angiotensin-Aldosterone System

Patients using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, ramipril or aliskiren are at an increased risk while using Hydrochlorothiazide+Telmisartan. Such patients are at an increased risk of low blood pressure, low potassium level, and decreased functioning of the kidney. Using telmisartan with ramipril may increase the exposure of ramipril. Avoid the combined use of angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, ramipril or aliskiren. If necessary the combination therapy should be used under medical supervision. Also, monitoring of the functioning of the kidney, and electrolytes should be considered.

Increased Production of Aldosterone

These patients do not respond to blood pressure lowering drugs. Hydrochlorothiazide+Telmisartan should not be used in patients with increased production of aldosterone (primary hyperaldosteronism).

Increased Level of Calcium

Thiazides may cause increased levels of calcium by decreasing the urinary excretion. Increased levels of calcium may be due to increased production of parathyroid hormone (hyperparathyroidism). Thiazides should be stopped before performing a parathyroid function test.

Electrolyte Imbalance

Patients receiving diuretic therapy are at an increased risk. Hydrochlorothiazide may cause decrease in potassium, sodium and chloride levels (hypochloremic alkalosis ). Symptoms of electrolyte imbalance may include lack of energy, thirst, dryness of mouth, and restlessness, etc. Periodic examination of the electrolytes should be performed. Electrolyte determination by urine and blood test should be performed when the patient receives fluids parentally or on the occurrence of excessive vomiting.

Decreased Levels of Potassium

Patients with liver cell damage (cirrhosis of the liver), diuresis, taking corticosteroids/adrenocorticotrophic hormone, using Hydrochlorothiazide+Telmisartan for long-term or receiving inadequate electrolytes are at increased risk. These patients may experience thiazide-induced low level of potassium which may cause abnormal heart rate and increased response of the heart to the harmful effect of the digitalis.

Increased Levels of Potassium

Patients with kidney failure, heart failure, high blood sugar levels, or taking Hydrochlorothiazide+Telmisartan are at increased risk. Telmisartan may oppose diuretics induced low levels of potassium, which may lead to increased levels of potassium in the blood. Precaution should be taken in patients using Hydrochlorothiazide+Telmisartan with potassium-sparing diuretics, potassium-containing salt substitutes or potassium supplements.

Decreased Levels of Sodium and Chloride

Patients taking Hydrochlorothiazide+Telmisartan are at increased risk. Hydrochlorothiazide may increase the level of bicarbonate (metabolic alkalosis) and decrease the level of chloride in the blood. Patients suffering from fluid build up in the body may experience low levels of sodium in the body. Chloride replacement therapy should be considered in patients suffering from metabolic alkalosis. Water restriction, replacement therapy or salt intake should be considered according to the patient's condition.

Decreased Levels of Magnesium

Patients taking Hydrochlorothiazide+Telmisartan are at increased risk. Thiazides may increase the urinary elimination of magnesium, which may result in decreased levels of magnesium in the body.

Increased Mortality in Infants

A fetus is at increased risk when pregnant women use this medicine. The use of Hydrochlorothiazide+Telmisartan during the second and third trimesters of pregnancy may lead to fetal and neonatal injury, including reduced functioning of the kidney, low blood pressure, deficiency of amniotic fluid, abnormalities of the skull and lung, insufficiency to produce urine, kidney failure, increased levels of potassium and other fatal conditions. Management of high blood pressure is essential during pregnancy to improve the outcomes for the fetus and mother. Discontinue the use of Hydrochlorothiazide+Telmisartan immediately after diagnosis of pregnancy.

Volume or Sodium Depleted Patients

Sodium or volume-depleted patients taking Hydrochlorothiazide+Telmisartan are at increased risk. Symptomatic low blood pressure may occur in these patients due to dietary or salt restriction, and diarrhea. The condition of the patients should be corrected before taking Hydrochlorothiazide+Telmisartan. Close supervision along with precaution should be recommended when starting Hydrochlorothiazide+Telmisartan therapy. On the occurrence of the low blood pressure, the patient should be placed in the supine position or infusion of normal saline in the veins should be given to the patients. In case of the temporary decrease in blood pressure, discontinuation of Hydrochlorothiazide+Telmisartan should be considered. Precaution should be taken in such patients.

Abnormality in the Functioning of the Liver

Patients with an abnormality in the functioning of the liver or in the bile flow (cholestasis), patients with blockage of the bile ducts (biliary obstructive disorders) or with severe liver failure are at increased risk when using Hydrochlorothiazide+Telmisartan. These patients may experience decreased elimination of telmisartan. Also, hydrochlorothiazide may cause a disturbance in the electrolyte or fluid balance in these patients, which may lead to liver coma. Precaution should be taken in patients with an abnormality in the functioning of the liver and using thiazides diuretics. Also, Hydrochlorothiazide+Telmisartan should not be given to patients with cholestasis, biliary obstructive disorders, or severe liver failure.

Allergic Reaction

Patients with a history of difficulty in breathing or allergy, and taking Hydrochlorothiazide+Telmisartan are at increased risk. Such patients may see an increased risk of development of symptoms such as purple or red-colored spots on the skin, increased sensitivity to sunlight, hives, swelling of the lower layer of the skin, respiratory distress including inflammation of the lung tissue (pneumonitis) and build up of excess fluid in the lungs and life-threatening allergic reactions (anaphylactic reactions). If this happens, stop taking Hydrochlorothiazide+Telmisartan and contact your doctor as soon as possible.

Eye Problems

Patients taking Hydrochlorothiazide+Telmisartan are at increased risk of developing eye problems. Hydrochlorothiazide may cause a rare and unpredictable reaction, which may result in poor distance vision (myopia) and optic nerve damage (angle-closure glaucoma). Symptoms such as decreased vision clarity or pain in eyes may occur within a few hours or weeks after starting the therapy. History of penicillin or sulphonamide allergy is the risk factor for developing optic nerve damage (angle-closure glaucoma). Use of hydrochlorothiazide should be stopped as early as possible. Surgical or medical treatment should be considered when the intraocular pressure remains uncontrolled.

Interactions with Hydrochlorothiazide+Telmisartan

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Hydrochlorothiazide/Telmisartan. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Anticoagulants

Your doctor's guidelines may need to be followed while taking this medicine along with Anticoagulants (warfarin or heparin), which are used to prevent blood clots. When Hydrochlorothiazide+Telmisartan is used with anticoagulants, it may decrease the level of the warfarin and increase the level of potassium in the blood. Patients should not use Hydrochlorothiazide+Telmisartan with heparin. If, necessary monitoring of the potassium levels should be considered.

Non-Steroidal Anti-Inflammatory Drugs

Hydrochlorothiazide/Telmisartan interacts with Non-Steroidal Anti-Inflammatory Drugs, (selective cyclooxygenase-2 Inhibitors), which are used to relieve pain. When telmisartan is used with non-steroidal anti-inflammatory drugs, it may cause damage to the functioning of the kidney (including kidney failure) in patients having abnormal functioning of the kidney, volume-depleted patients, and elderly patients. Take necessary precautions in patients using nonsteroidal anti-inflammatory drugs with telmisartan. Also, monitoring of the functioning of the kidney should be done in these patients. Patients should be observed for the therapeutic effects of the diuretics when using Hydrochlorothiazide+Telmisartan with non-steroidal anti-inflammatory drugs.

Antimanic Agents

There may be an interaction of Hydrochlorothiazide+Telmisartan with Antimanic agents such as lithium, which is used to treat depression. The combined use of Hydrochlorothiazide+Telmisartan with lithium may increase the level of lithium in the body, which may lead to harmful effects of lithium. Hydrochlorothiazide+Telmisartan should not be used with lithium. If requires, careful monitoring of the lithium levels in the blood should be considered.

Cardiac Glycoside

Hydrochlorothiazide/Telmisartan may interact with Cardiac glycoside such as digoxin, which is used to treat heart failure. When telmisartan is used with digoxin, it may increase the level of digoxin in the body. Monitoring of the digoxin level should be considered while starting, adjusting or stopping telmisartan therapy.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Special instructions need to be followed while taking this medicine along with Angiotensin-Converting Enzyme (ACE) Inhibitors such as ramipril and ramiprilat, which are used to treat high blood pressure. The combined use of telmisartan with ramipril or ramiprilat may cause fatality related to heart disease, increase potassium levels in the blood, low blood pressure, loss of consciousness, kidney failure, and increase the exposure or levels of ramiprilat and ramipril. Therefore, patients should not use telmisartan with ramipril.

Nondepolarizing Skeletal Muscle Relaxants

Your doctor's guidelines may need to be followed while taking this medicine along with Nondepolarizing Skeletal Muscle Relaxants such as tubocurarine, which are used to reduce the tension of the muscles. When hydrochlorothiazide is used with nondepolarizing skeletal muscle relaxants, it may increase the effect of skeletal muscle relaxants.

Antibiotics

Hydrochlorothiazide/Telmisartan interacts with Antibiotics such as amphotericin and penicillin G, which are used to treat fungal and bacterial infections respectively. When hydrochlorothiazide or Hydrochlorothiazide+Telmisartan is used with amphotericin or penicillin G, it may cause a low level of potassium in the blood. Monitoring of the potassium levels in the blood should be considered in patients using Hydrochlorothiazide+Telmisartan with amphotericin or penicillin G.

Carbenoxolone and Salicylic Acid

Special instructions need to be followed while taking this medicine along with Carbenoxolone and Salicylic acid, which are used to treat mouth ulcers and acne respectively. The combined use of hydrochlorothiazide or Hydrochlorothiazide+Telmisartan with carbenoxolone or salicylic acid may cause a low level of potassium in the blood. Potassium levels should be monitored in patients using Hydrochlorothiazide+Telmisartan with carbenoxolone or salicylic acid.

Diuretics and Laxatives

There may be an interaction of Hydrochlorothiazide+Telmisartan with Diuretics and Laxatives, which are used to treat high blood pressure and constipation respectively. Using Hydrochlorothiazide+Telmisartan or hydrochlorothiazide with diuretics or laxatives may worsen the decreased level of potassium in the blood. Potassium levels should be monitored in patients using Hydrochlorothiazide+Telmisartan with diuretics and laxatives.

Prednisone and Adrenocorticotrophic Hormone

Hydrochlorothiazide/Telmisartan may interact with Corticosteroids (prednisone) and Adrenocorticotrophic Hormone, which are used to treat and regulate breathing problems and steroidal hormones respectively. Patients using hydrochlorothiazide or Hydrochlorothiazide+Telmisartan with prednisone or adrenocorticotropic hormone may see an increased risk of electrolyte depletion such as low potassium levels. Monitoring of the potassium levels in the blood should be considered in such patients.

Antihypertensive Agents and Potassium Supplements

Hydrochlorothiazide/Telmisartan may interact with Antihypertensive Drugs (such as angiotensin-converting enzyme inhibitors, beta blocker, or aliskiren) and Potassium Supplements, which are used to treat high blood pressure. When Hydrochlorothiazide+Telmisartan or telmisartan is used with antihypertensive drugs or potassium supplements, it may cause low blood pressure, loss of consciousness, kidney failure, or increased level of potassium in the blood. Patients should not use Hydrochlorothiazide+Telmisartan with antihypertensive or potassium supplements. If necessary, monitoring of the potassium levels should be considered.

Antidiabetics

Your doctor's guidelines may need to be followed while taking this medicine along with antidiabetic agents (oral agents, metformin, insulin), which are used to treat high blood sugar levels. Use of thiazides may cause metabolic condition resulting in glucose levels higher than normal, whereas low blood sugar may occur in patients using antidiabetic agents with telmisartan. Hydrochlorothiazide may cause kidney failure, which may increase the risk of lactate buildup in the body when used in combination with metformin. Monitoring of the blood glucose along with dose adjustment of antidiabetics should be considered. Precaution should be taken while using hydrochlorothiazide with metformin.

Digitalis Glycosides

Special instructions need to be followed while taking this medicine along with digitalis glycosides, which are used to treat heart failure. When thiazides are used with digitalis, it may decrease the level of potassium or magnesium, which may be a contributing factor in inducing abnormal heart rhythm. Monitoring of the potassium levels and electrography should be considered in patients using Hydrochlorothiazide+Telmisartan with digitalis glycosides.

Antipsychotics

Hydrochlorothiazide/Telmisartan interacts with antipsychotics (levomepromazine, sulpiride, and pimozide) which are used to treat mental disorders. When Hydrochlorothiazide+Telmisartan is used with antipsychotics, it may decrease the level of potassium in the blood. Periodic monitoring of blood potassium levels and electrocardiography is recommended in patients using Hydrochlorothiazide+Telmisartan with antipsychotics.

Antiarrhythmics

There may be an interaction of Hydrochlorothiazide+Telmisartan with Antiarrhythmics (quinidine, amiodarone, hydroquinidine) and calcium supplements, which are used to treat abnormal rhythms of the heart. When Hydrochlorothiazide+Telmisartan is used with antiarrhythmics, it may decrease the levels of potassium in the blood. Thiazides may increase the levels of calcium in the blood. Periodic monitoring of blood potassium levels and electrocardiography is recommended in patients using Hydrochlorothiazide+Telmisartan with antiarrhythmics. Also, monitoring of the calcium levels and dose adjustment should be considered when using calcium supplements with thiazides.

Bile Acid Sequestrants

Hydrochlorothiazide/Telmisartan may interact with colestipol and cholestyramine, which are used to lower cholesterol levels. When hydrochlorothiazide is used with colestipol or cholestyramine, it may decrease the absorption of hydrochlorothiazide.

Diazoxide and Noradrenaline

There may be an interaction of Hydrochlorothiazide+Telmisartan with diazoxide and noradrenaline, which are used to treat low blood sugar and low blood pressure respectively. Thiazides may increase the blood sugar lowering effect of diazoxide. The blood pressure lowering effect of noradrenaline may also get decreased.

Uricosuric Drugs

Hydrochlorothiazide/Telmisartan interacts with uricosuric drugs (probenecid, allopurinol or sulfinpyrazone), which are used to treat severe pain, redness and tenderness in joints (gout). The combined use of hydrochlorothiazide with uricosuric drugs may increase the level of uric acid in the blood and the occurrence of the allergic reaction. Dose adjustment of uricosuric drugs should be considered while using uricosuric drugs with hydrochlorothiazide.

Anticholinergic Agents

Special instructions need to be followed while taking this medicine along with anticholinergic agents (biperiden and atropine), which are used to treat decreased heartbeat and stomach or intestinal disorders. When thiazide-diuretics are used with anticholinergics, it may increase the bioavailability of thiazides.

Amantadine

Your doctor's guidelines may need to be followed while taking this medicine along with amantadine, which is used to treat respiratory infections. When thiazides are used with amantadine, it may increase the amantadine induced side effects.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Hydrochlorothiazide+Telmisartan is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Hydrochlorothiazide/Telmisartan .
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