Telmisartan

Angiotensin II receptor blocker (ARB)

ATC code: C09CA07

Brand names: Micardis

Updated 19 Aug 2026 · Methodology

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Anti-aging and longevity

Not recommended

Telmisartan is an ARB with additional partial PPARγ agonist activity. It is prescribed for hypertension and for secondary CV prevention in high-risk patients ( 2023, SEH-LELHA, 2017). In anti-aging and longevity communities, telmisartan is promoted as a partial PPARγ agonist with metabolic effects in healthy normotensives. In people with normal blood pressure, no clinical studies of prophylactic use for metabolic purposes exist. The drug can cause dizziness, hyperkalemia, and teratogenicity. If telmisartan was prescribed to a healthy person, consider seeking a second opinion.

Sources

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Selectively blocks AT1 receptors of angiotensin II. Longest T1/2 among ARBs (~24 hours) provides stable 24-hour BP control. Additionally, partial PPARγ agonism (improves glucose metabolism).

Safety

Contraindications

Hypersensitivity to telmisartan
2nd and 3rd trimester of pregnancy
Severe hepatic impairment, cholestasis
Biliary obstruction
Co-administration with aliskiren in patients with diabetes or moderate-to-severe renal impairment

Serious adverse effects

Angioedema
Acute kidney injury
Hyperkalaemia with arrhythmia
Severe hypotension

Common adverse effects

Dizziness
Hyperkalaemia
Back pain
Upper respiratory tract infections

Pregnancy: can you take Telmisartan?

EMA summary of product characteristics (section 4.6): angiotensin II receptor blockers are not recommended in the first trimester and are contraindicated in the second and third trimesters; there are insufficient data on telmisartan in pregnant women, and animal studies have shown reproductive toxicity. Evidence on teratogenicity after first-trimester exposure to ACE inhibitors is inconclusive, but a small increase in risk cannot be excluded, and similar risks may exist for angiotensin II receptor blockers. Unless continued treatment is considered essential, patients planning a pregnancy should switch to an antihypertensive with an established safety profile in pregnancy; once pregnancy is diagnosed, telmisartan is stopped immediately and, if appropriate, alternative therapy is started. Second- and third-trimester exposure causes fetal toxicity (reduced renal function, oligohydramnios, delayed skull ossification) and neonatal toxicity (renal failure, hypotension, hyperkalaemia). After exposure from the second trimester onwards, an ultrasound of fetal kidneys and skull is advised, and infants whose mothers took these drugs are watched closely for hypotension.

Breastfeeding: can you take Telmisartan?

Compatibility not established. Hale L4. No data on human milk transfer. Highly protein-bound with large Vd and long half-life. AEMPS prefers other antihypertensives during breastfeeding (labetalol, nifedipine, enalapril).

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Drug–drug interactions

9 pairs found. Sorted from critical to minor.

MajorCaptoprilACE inhibitor

Mechanism

Dual RAAS blockade (ACE-I + ARB). The ONTARGET trial showed increased hyperkalaemia, hypotension, and acute kidney injury without outcome improvement. Contraindicated in most clinical situations.

Symptoms

Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.

Management

The combination is not prescribed. Choose one: ACE-I (captopril) if tolerated, ARB (telmisartan) if there is a dry cough.

Sources

Pair details →Captopril →

MajorCo-trimoxazoleSulfonamide-trimethoprim combination

Mechanism

Trimethoprim in co-trimoxazole blocks the epithelial sodium channel (ENaC) like amiloride – potassium retention. With an ARB (telmisartan): additive hyperkalaemia.

Symptoms

Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.

Management

During co-trimoxazole therapy, check potassium 3 days after start. In older patients and chronic kidney disease, prefer alternative antibiotics (nitrofurantoin, fosfomycin).

Sources

BMJ: Co-trimoxazole, sudden death and RAS blockers — Fralick 2014 (2014)

Pair details →Co-trimoxazole →

MajorEnalaprilAngiotensin-converting enzyme inhibitors (ACEi)

Mechanism

Dual RAAS blockade – increased hyperkalaemia, hypotension, and acute kidney injury without outcome improvement (ONTARGET).

Symptoms

Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.

Management

The combination is not prescribed. Choose one: ACE-I (enalapril) if tolerated, ARB (telmisartan) if there is a dry cough.

Sources

Pair details →Enalapril →

MajorIbuprofenNon-steroidal anti-inflammatory drugs (NSAIDs)

Mechanism

Similar to losartan + ibuprofen. NSAIDs reduce renal blood flow; the ARB (telmisartan) lowers glomerular pressure. The combination causes acute kidney injury.

Symptoms

Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and in chronic kidney disease.

Management

Avoid prolonged combination. If ibuprofen is needed for a short course, use the minimum effective dose for 5–7 days with pantoprazole cover and creatinine monitoring. For chronic analgesia: paracetamol or celecoxib.

Sources

Pair details →Ibuprofen →

MajorSpironolactonePotassium-sparing diuretics (mineralocorticoid receptor antagonists)

Mechanism

Additive hyperkalaemia. Both drugs retain potassium: spironolactone directly blocks aldosterone receptors; telmisartan (ARB) reduces aldosterone synthesis.

Symptoms

Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.

Management

The telmisartan SmPC () lists potassium-sparing diuretics, spironolactone included, under combinations that are not recommended. If the combination is needed, check serum potassium often. It is most often used in heart failure with reduced ejection fraction, where a mineralocorticoid receptor antagonist is part of core therapy ( 2021). Per the spironolactone SmPC, check potassium and creatinine within the first week after starting or increasing the dose, then monthly for 3 months, quarterly until the end of the first year and every 6 months after that. Stop spironolactone temporarily or permanently if potassium exceeds 5 mmol/L or creatinine exceeds 4 mg/dL (354 µmol/L). Do not give potassium supplements when potassium is above 3.5 mmol/L.

Sources

Pair details →Spironolactone →

ModerateAcetylsalicylic acidAntiplatelet agents (low dose) / NSAIDs (analgesic dose)

Mechanism

High aspirin doses (above 1 g/day) may reduce the ARB's antihypertensive effect via vasodilator prostaglandin suppression. Cardioprotective doses (75–100 mg) are clinically minor.

Symptoms

Gradual blood pressure rise at high aspirin doses. At cardioprotective doses, no significant changes.

Management

Cardioprotective aspirin doses (75–100 mg) are acceptable without adjustment. At high doses, monitor blood pressure and increase telmisartan if needed. Alternative analgesic: paracetamol.

Sources

Pair details →Acetylsalicylic acid →

ModerateAlprazolamBenzodiazepines. Short-to-medium-acting anxiolytics

Mechanism

Additive hypotension. Benzodiazepines have weak hypotensive effect; the main one comes from the ARB. In most patients, clinically minor.

Symptoms

Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk. Morning weakness possible at standard doses.

Management

No dose adjustment usually needed. In older patients on starting telmisartan, check standing/sitting BP at one week. With pronounced morning hypotension, move alprazolam from night to morning or switch to buspirone.

Sources

FDA: Telmisartan tablet (Alembic Pharmaceuticals Limited) – Prescribing Information section 7 (2014)

Pair details →Alprazolam →

ModerateAmitriptylineTricyclic antidepressants (TCA)

Mechanism

Additive hypotension, especially orthostatic. Amitriptyline blocks α1-adrenoceptors; telmisartan is an ARB. Effects add up.

Symptoms

Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.

Management

On starting the combination, begin amitriptyline at 10 mg at bedtime. In older patients, do not exceed 25 mg/day. Check standing/sitting BP at 1–2 weeks. For neuropathic pain, alternatives: gabapentin or pregabalin.

Sources

FDA: Telmisartan tablet (Alembic Pharmaceuticals Limited) – Prescribing Information section 7 (2014)

Pair details →Amitriptyline →

ModerateDigoxinCardiac glycosides (digitalis)

Mechanism

Telmisartan moderately inhibits intestinal P-glycoprotein. Digoxin AUC rises by 20–50%, which may trigger toxicity, especially in older patients and in chronic kidney disease.

Symptoms

Nausea, vomiting, loss of appetite, confusion, yellow-green halos around lights, arrhythmia (bigeminy, AV block). Symptoms appear earlier in older patients and chronic kidney disease.

Management

On telmisartan start, check digoxin levels at 1–2 weeks. In significant chronic kidney disease (clearance below 50 mL/min), reduce digoxin by 25%. In older patients, target 0.5–0.8 ng/mL. Alternatives: losartan or valsartan, with less effect on P-glycoprotein.

Sources

Pair details →Digoxin →

Label mentions28 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

ModerateAcetylsalicylic acid
«Medicamentos antiinflamatorios no esteroideos (AINE): El tratamiento con AINE (es decir, ácido acetilsalicílico administrado en dosis propias de un tratamiento antiinflamatorio, inhibidores de la COX…»
AEMPS, section 4.5 · Open on CIMA
ModerateAINEclass named in the label
«La incidencia de hiperpotasemia depende de los factores de riesgo asociados. El riesgo aumenta en caso de combinarse los tratamientos anteriormente mencionados. El riesgo es particularmente alto en…»
AEMPS, section 4.5 · Open on CIMA
Moderateantidiabéticosclass named in the label
«Pacientes diabéticos tratados con insulina o antidiabéticos: En estos pacientes puede aparecer hipoglucemia bajo tratamiento con telmisartán. Por lo tanto, en estos pacientes se debe considerar una…»
AEMPS, section 4.4 · Open on CIMA
ModerateDigoxin
«Digoxina: Cuando se administró telmisartán conjuntamente con digoxina se observaron aumentos medios en el pico de la concentración plasmática (49 %) y en el valle de la concentración plasmática (20…»
AEMPS, section 4.5 · Open on CIMA
ModerateDigoxin
«DRUG INTERACTIONS: Digoxin: When telmisartan was co-administered with digoxin, median increases in digoxin peak plasma concentration (49%) and in trough concentration (20%) were observed. Therefore…»
FDA, section 7 · Open on DailyMed
Moderatediuréticos ahorradores de potasioclass named in the label
«La incidencia de hiperpotasemia depende de los factores de riesgo asociados. El riesgo aumenta en caso de combinarse los tratamientos anteriormente mencionados. El riesgo es particularmente alto en…»
AEMPS, section 4.5 · Open on CIMA
Moderatediuréticos del asaclass named in the label
«Diuréticos (tiazida o diuréticos del asa): A tener en cuenta en el uso concomitante.»
AEMPS, section 4.5 · Open on CIMA
ModerateEplerenone
«Diuréticos ahorradores de potasio o suplementos de potasio: Los bloqueantes de los receptores de la angiotensina II, tales como telmisartán, disminuyen la pérdida de potasio debida a los diuréticos…»
AEMPS, section 4.5 · Open on CIMA
Moderateinhibidores de la ECAclass named in the label
«La incidencia de hiperpotasemia depende de los factores de riesgo asociados. El riesgo aumenta en caso de combinarse los tratamientos anteriormente mencionados. El riesgo es particularmente alto en…»
AEMPS, section 4.5 · Open on CIMA
ModerateInsulin
«Pacientes diabéticos tratados con insulina o antidiabéticos: En estos pacientes puede aparecer hipoglucemia bajo tratamiento con telmisartán. Por lo tanto, en estos pacientes se debe considerar una…»
AEMPS, section 4.4 · Open on CIMA
Moderateinsulinaclass named in the label
«Pacientes diabéticos tratados con insulina o antidiabéticos: En estos pacientes puede aparecer hipoglucemia bajo tratamiento con telmisartán. Por lo tanto, en estos pacientes se debe considerar una…»
AEMPS, section 4.4 · Open on CIMA
ModerateLithium
«Litio: Uso concomitante que requiere precaución.»
AEMPS, section 4.5 · Open on CIMA
ModerateLithium
«DRUG INTERACTIONS: Lithium: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists…»
FDA, section 7 · Open on DailyMed
ModerateNSAIDsclass named in the label
«DRUG INTERACTIONS: Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors): In patients who are elderly, volume-depleted (including those on diuretic…»
FDA, section 7 · Open on DailyMed
ModerateSpironolactone
«Diuréticos ahorradores de potasio o suplementos de potasio: Los bloqueantes de los receptores de la angiotensina II, tales como telmisartán, disminuyen la pérdida de potasio debida a los diuréticos…»
AEMPS, section 4.5 · Open on CIMA
Moderatesuplementos de potasioclass named in the label
«Diuréticos ahorradores de potasio o suplementos de potasio: Los bloqueantes de los receptores de la angiotensina II, tales como telmisartán, disminuyen la pérdida de potasio debida a los diuréticos…»
AEMPS, section 4.5 · Open on CIMA
Moderatetiazidasclass named in the label
«Diuréticos (tiazida o diuréticos del asa): A tener en cuenta en el uso concomitante.»
AEMPS, section 4.5 · Open on CIMA
ModerateTriamterene
«Diuréticos ahorradores de potasio o suplementos de potasio: Los bloqueantes de los receptores de la angiotensina II, tales como telmisartán, disminuyen la pérdida de potasio debida a los diuréticos…»
AEMPS, section 4.5 · Open on CIMA
barbitúricosclass named in the label
«Además, la hipotensión ortostática puede agravarse por el alcohol, los barbitúricos, los narcóticos o los antidepresivos.»
AEMPS, section 4.5 · Open on CIMA
Ciclosporin
«Al igual que con otros medicamentos que actúan en el sistema renina-angiotensina-aldosterona, telmisartán puede provocar hiperpotasemia (ver sección 4.4). El riesgo puede aumentar en caso de…»
AEMPS, section 4.5 · Open on CIMA
Furosemide
«Diuréticos (tiazida o diuréticos del asa): Los tratamientos anteriores con altas dosis de diuréticos tales como furosemida (diurético del asa) e hidroclorotiazida (diurético tiazídico) pueden…»
AEMPS, section 4.5 · Open on CIMA
Hydrochlorothiazide
«Diuréticos (tiazida o diuréticos del asa): Los tratamientos anteriores con altas dosis de diuréticos tales como furosemida (diurético del asa) e hidroclorotiazida (diurético tiazídico) pueden…»
AEMPS, section 4.5 · Open on CIMA
inmunosupresoresclass named in the label
«Al igual que con otros medicamentos que actúan en el sistema renina-angiotensina-aldosterona, telmisartán puede provocar hiperpotasemia (ver sección 4.4). El riesgo puede aumentar en caso de…»
AEMPS, section 4.5 · Open on CIMA
Ramipril
«En un estudio, la administración conjunta de telmisartán y ramipril condujo a un aumento de hasta 2,5 veces de la AUC 0-24 y de la C max de ramipril y ramiprilato. Se desconoce la relevancia clínica…»
AEMPS, section 4.5 · Open on CIMA
Tacrolimus
«Al igual que con otros medicamentos que actúan en el sistema renina-angiotensina-aldosterona, telmisartán puede provocar hiperpotasemia (ver sección 4.4). El riesgo puede aumentar en caso de…»
AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

Digoxin
«Pharmacokinetic Drug Interactions: Telmisartan 20 to 49% NA»
FDA, section 7 · Open on DailyMed
Mycophenolate mofetil
«Medicamentos que afectan a la glucuronidación (por ejemplo, isavuconazol, telmisartán)»
AEMPS, section 4.5 · Open on CIMA
Mycophenolate mofetil
«DRUG INTERACTIONS: See FPI for drugs that may interfere with systemic exposure and reduce mycophenolate mofetil efficacy: antacids with magnesium or aluminum hydroxide, proton pump inhibitors, drugs…»
FDA, section 7 · Open on DailyMed

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Frequently asked

What is Telmisartan used for?

Telmisartan is evaluated for the following indications with varying evidence strength: Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Telmisartan?

Common side effects of Telmisartan (≥ 1 in 100): Dizziness, Hyperkalaemia, Back pain, Upper respiratory tract infections. See the Safety section for uncommon and serious reactions.

Is Telmisartan safe during pregnancy?

Is Telmisartan compatible with breastfeeding?

Who should not take Telmisartan?

Telmisartan is contraindicated in: Hypersensitivity to telmisartan; 2nd and 3rd trimester of pregnancy; Severe hepatic impairment, cholestasis; Biliary obstruction; Co-administration with aliskiren in patients with diabetes or moderate-to-severe renal impairment. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA
EMALabel dated 12/16/1998
FDA / DailyMedLabel dated 08/11/2026

Other drugs in this group

Telmisartan + Hydrochlorothiazide, Valsartan, Valsartan + Hydrochlorothiazide, Amlodipine + Olmesartan, Amlodipine + Olmesartan + Hydrochlorothiazide, Beetroot juice / dietary nitrate (Beta vulgaris), Enalapril + Hydrochlorothiazide, Losartan + Hydrochlorothiazide