DRUG INTERACTIONS
Aliskiren: Do not co-administer
aliskiren with MICARDIS in patients with diabetes. Avoid use of aliskiren
with MICARDIS in patients with renal impairment (GFR <60 mL/min).
Digoxin
: When MICARDIS was co-administered with digoxin, median increases
in digoxin peak plasma concentration (49%) and in trough concentration
(20%) were observed. Therefore, monitor digoxin levels when initiating,
adjusting, and discontinuing telmisartan for the purpose of keeping
the digoxin level within the therapeutic range.
Lithium
: Reversible
increases in serum lithium concentrations and toxicity have been reported
during concomitant administration of lithium with angiotensin II receptor
antagonists including MICARDIS. Therefore, monitor serum lithium levels
during concomitant use.
Non-Steroidal Anti-Inflammatory Agents including Selective
Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors):
In patients who are elderly, volume-depleted (including those on
diuretic therapy), or with compromised renal function, co-administration
of NSAIDs, including selective COX-2 inhibitors, with angiotensin
II receptor antagonists, including telmisartan, may result in deterioration
of renal function, including possible acute renal failure. These effects
are usually reversible. Monitor renal function periodically in patients
receiving telmisartan and NSAID therapy.
The antihypertensive effect of angiotensin II receptor
antagonists, including telmisartan may be attenuated by NSAIDs including
selective COX-2 inhibitors.
Ramipril and Ramiprilat
: Co-administration
of telmisartan 80 mg once daily and ramipril 10 mg once daily to healthy
subjects increases steady-state Cmax and AUC
of ramipril 2.3- and 2.1-fold, respectively, and Cmax and AUC of ramiprilat 2.4- and 1.5-fold, respectively. In contrast,
Cmax and AUC of telmisartan decrease by 31%
and 16%, respectively. When co-administering telmisartan and ramipril,
the response may be greater because of the possibly additive pharmacodynamic
effects of the combined drugs, and also because of the increased exposure
to ramipril and ramiprilat in the presence of telmisartan. Concomitant
use of MICARDIS and ramipril is not recommended.
Other Drugs
: Co-administration
of telmisartan did not result in a clinically significant interaction
with acetaminophen, amlodipine, glyburide, simvastatin, hydrochlorothiazide,
warfarin, or ibuprofen. Telmisartan is not metabolized by the cytochrome
P450 system and had no effects
in vitro
on cytochrome P450 enzymes, except for some inhibition
of CYP2C19. Telmisartan is not expected to interact with drugs that
inhibit cytochrome P450 enzymes; it is also not expected to interact
with drugs metabolized by cytochrome P450 enzymes, except for possible
inhibition of the metabolism of drugs metabolized by CYP2C19.
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