Drug/Small Molecule:
telmisartan

2D structure

Overview

Generic Names: BIBR 277; BIBR 277SE; telmisartan
Trade Names: Micardis; Micardis HCT; Pritor
Brand Mixtures: Micardis Plus (Hydrochlorothiazide + Telmisartan)
PharmGKB Accession Id: PA451605

Description

Telmisartan is an angiotensin II receptor antagonist (ARB) used in the management of hypertension. Generally, angiotensin II receptor blockers (ARBs) such as telmisartan bind to the angiotensin II type 1 (AT1) receptors with high affinity, causing inhibition of the action of angiotensin II on vascular smooth muscle, ultimately leading to a reduction in arterial blood pressure. Recent studies suggest that telmisartan may also have PPAR-gamma agonistic properties that could potentially confer beneficial metabolic effects. (source: Drug Bank)

Indication

For the treatment of hypertension. (source: Drug Bank)

ATC Therapeutic Category

  • C09CA:Angiotensin II antagonists, plain

Pharmacology, Interactions, and Contraindications

Mechanism Of Action

Telmisartan interferes with the binding of angiotensin II to the angiotensin II AT<sub>1</sub>-receptor by binding reversibly and selectively to the receptors in vascular smooth muscle and the adrenal gland. As angiotensin II is a vasoconstrictor, which also stimulates the synthesis and release of aldosterone, blockage of its effects results in decreases in systemic vascular resistance. Telmisartan does not inhibit the angiotensin converting enzyme, other hormone receptors, or ion channels. (source: Drug Bank)

Pharmacology

Telmisartan is an orally active nonpeptide angiotensin II antagonist that acts on the AT<sub>1</sub> receptor subtype. New studies suggest that telmisartan may also have PPARγ agonistic properties that could potentially confer beneficial metabolic effects. This observation is currently being explored in clinical trials. Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). Angiotensin II is the principal pressor agent of the renin-angiotensin system, with effects that include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation, and renal reabsorption of sodium. Telmisartan works by blocking the vasoconstrictor and aldosterone secretory effects of angiotensin II. (source: Drug Bank)

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Minimally metabolized by conjugation to form a pharmacologically inactive acylglucuronide; the glucuronide of the parent compound is the only metabolite that has been identified in human plasma and urine. The cytochrome P450 isoenzymes are not involved in the metabolism of telmisartan. (source: Drug Bank)

Protein Binding

Highly bound to plasma proteins (&gt;99.5%), mainly albumin and a1-acid glycoprotein. Binding is not dose-dependent. (source: Drug Bank)

Absorption

Absolute bioavailability depends on dosage. Food slightly decreases the bioavailability (a decrease of about 6% is seen when the 40-mg dose is administered with food). (source: Drug Bank)

Toxicity

Intravenous LD<sub>50</sub> in rats is 150-200 mg/kg in males and 200 to 250 mg/kg in females. Acute oral toxicity is low: no deaths and no changes occurred in rats or dogs at 2000 mg/kg, the highest dose tested. Limited data are available with regard to overdosage in humans. The most likely manifestations of overdosage with telmisartan would be hypotension, dizziness and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation. (source: Drug Bank)

Isomeric SMILES Code:

CCCC1=NC2=C(N1CC3=CC=C(C=C3)C4=CC=CC=C4C(=O)O)C=C(C=C2C)C5=NC6=CC=CC=C6N5C (source: Drug Bank)

The following genes are in curated knowledge about this drug.

  Gene Relationship Evidence
No phenotype data Genotype Data Available Literature annotations available Not annotated
SLCO1B3
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  •   
  • FA
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Publications
Phenotype data available Genotype Data Available Literature annotations available Has annotations
UGT1A1
  •   
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  • PK
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Publications

A list of non-curated publications that mention this drug along with other genes is available.

Drug Targets

Gene Description
AGTR1 Uncurated Annotation (source: Drug Bank)

A list of non-curated publications that mention this drug along with other drugs is available.

Drug Interactions

Drug Description
amifostine Uncurated Annotation Telmisartan may increase the hypotensive effect of Amifostine. At chemotherapeutic doses of Amifostine, Telmisartan should be withheld for 24 hours prior to Amifostine administration. Use caution at lower doses of Amifostine. (source: Drug Bank)
amiloride Uncurated Annotation Telmisartan may increase the hyperkalemic effect of Amiloride. Monitor for increased serum potassium concentrations during concomitant therapy. (source: Drug Bank)
aspirin Uncurated Annotation Concomitant use of Telmisartan and Aspirin may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
celecoxib Uncurated Annotation Concomitant use of Telmisartan and Celecoxib may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
diclofenac Uncurated Annotation Concomitant use of Telmisartan and Diclofenac may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
diflunisal Uncurated Annotation Concomitant use of Telmisartan and Diflunisal may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
digoxin Uncurated Annotation Telmisartan may increase plasma Digoxin concentrations. Monitor Digoxin levels and adjust dose as required if Telmisartan is initiated, discontinued or dose changed. (source: Drug Bank)
drospirenone Uncurated Annotation Telmisartan may increase the hyperkalemic effect of Drospirenone. Monitor for increased serum potassium concentrations during concomitant therapy. (source: Drug Bank)
fenoprofen Uncurated Annotation Concomitant use of Telmisartan and Fenoprofen may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
flurbiprofen Uncurated Annotation Concomitant use of Telmisartan and Flurbiprofen may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
indomethacin Uncurated Annotation Concomitant use of Telmisartan and Indomethacin may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
ketoprofen Uncurated Annotation Concomitant use of Telmisartan and Ketoprofen may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
ketorolac Uncurated Annotation Concomitant use of Telmisartan and Ketorolac may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
lithium Uncurated Annotation Telmisartan may increase serum Lithium concentrations. Monitor serum Lithium levels during concomitant therapy to avoid Lithium toxicity. (source: Drug Bank)
lumiracoxib Uncurated Annotation Concomitant use of Telmisartan and Lumiracoxib may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
meloxicam Uncurated Annotation Concomitant use of Telmisartan and Meloxicam may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
nabumetone Uncurated Annotation Concomitant use of Telmisartan and Nabumetone may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
naproxen Uncurated Annotation Concomitant use of Telmisartan and Naproxen may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
oxaprozin Uncurated Annotation Concomitant use of Telmisartan and Oxaprozin may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
piroxicam Uncurated Annotation Concomitant use of Telmisartan and Piroxicam may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
potassium Uncurated Annotation Potassium may increase the hyperkalemic effect of Telmisartan. Monitor serum potassium levels during concomitant use. (source: Drug Bank)
potassium Uncurated Annotation Potassium Chloride may increase the hyperkalemic effect of Telmisartan. Monitor serum potassium levels during concomitant use. (source: Drug Bank)
rituximab Uncurated Annotation Telmisartan may increase the hypotensive effect of Rituximab. Telmisartan should be withheld prior to and throughout Rituximab administration. (source: Drug Bank)
spironolactone Uncurated Annotation Telmisartan may increase the hyperkalemic effect of Spironolactone. Monitor for increased serum potassium concentrations during concomitant therapy. (source: Drug Bank)
sulindac Uncurated Annotation Concomitant use of Telmisartan and Sulindac may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
tolmetin Uncurated Annotation Concomitant use of Telmisartan and Tolmetin may increase the risk of acute renal failure and hyperkalemia. Monitor renal function at the beginning and during treatment. (source: Drug Bank)
triamterene Uncurated Annotation Telmisartan may increase the hyperkalemic effect of Triamterene. Monitor for increased serum potassium concentrations during concomitant therapy. (source: Drug Bank)

Curated Information

The following diseases are in curated knowledge about this drug.

  Disease Relationship Evidence
No phenotype data No genotype data Literature annotations available Not annotated
Vascular Diseases
  • CO
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Publications

Non-Curated Information

A list of non-curated publications that mention this drug along with other diseases is available.

Additional Datasets

These datasets are minimally curated and are sorted alphabetically by title.

  1. Physicochemical determinants of human renal clearance

LinkOuts

Web Resource:
Wikipedia
DrugBank:
DB00966
KEGG Compound ID:
C07710
KEGG Drug ID:
D00627
PubChem Compound ID:
65999
PubChem Substance ID:
9912
IUPHAR Ligand ID:
592

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Non-Curated Publications

A list of non-curated publications that mention this drug is available.

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