Cilzec: Dosage must be individualized. The usual starting dose is 40 mg once daily. Blood pressure response is dose-related over the range of 20-80 mg.
Special Populations: Patients with depletion of intravascular volume should have the condition corrected or telmisartan tablets should be initiated under close medical supervision. Patients with biliary obstructive disorders or hepatic insufficiency should have treatment started under close medical supervision.
Most of the antihypertensive effect is apparent within 2 weeks and maximal reduction is generally attained after 4 weeks. When additional blood pressure reduction beyond that achieved within 80 mg of telmisartan tablets is required, a diuretic may be added.
No initial dosing adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis. Patients on dialysis may develop orthostatic hypotension; their blood pressure should be closely monitored.
Cilzec Plus: Cilzec Plus should be taken once daily with liquid, with or without food in patients whose blood pressure is not adequately controlled by telmisartan alone. Individual dose titration with each of the 2 components is recommended before changing to the fixed dose combination. When clinically appropriate, direct change from monotherapy to the fixed combination may be considered.
To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy. The side effects (see Warnings) of telmisartan are generally rare and apparently independent of dose; those of hydrochlorothiazide are a mixture of dose-dependent phenomena (primarily hypokalemia) and dose-independent phenomena (eg, pancreatitis), the former much more common than the latter. Therapy with any combination of telmisartan and hydrochlorothiazide will be associated with both sets of dose-independent side effects. Cilzec Plus (telmisartan and hydrochlorothiazide) tablets may be administered with other antihypertensive agents.
Patients with Renal Impairment: The usual regimens of Cilzec Plus, once daily may be followed as long as the patient's creatinine clearance is >30 mL/min. In patients with more severe renal impairment, loop diuretics are preferred to thiazides, so Cilzec Plus tablets are not recommended.
Patients with Hepatic Impairment: Cilzec Plus tablets are not recommended for patients with severe hepatic impairment. Patients with biliary obstructive disorders or hepatic insufficiency should have their treatment started under close medical supervision using the 40/12.5 mg combination.
Administration: Cilzec: Telmisartan tablets may be administered with other antihypertensive agents. Telmisartan may be taken with or without food.