Before and during the treatment with Telmisartan-Richter, blood pressure control, renal function, potassium content in blood serum should be monitored. Transient arterial hypotension is not a contraindication for further treatment with Telmisartan-Richter after stabilization of arterial pressure. In the case of repeated occurrence of severe arterial hypotension, the dose should be reduced or the drug should be withdrawn. In the presence of renal failure, treatment is carried out with caution under the control of serum creatinine concentration.
Liver failure
Telmisartan-Richter should not be used in patients with cholestasis, obstruction of the biliary tract or acute liver failure (see "Contraindications"), since telmisartan, mainly, is excreted with bile. It is assumed that these patients reduced the hepatic clearance of telmisartan.Telmisartan-Richter should be used with extreme caution in patients with mild or moderate hepatic impairment.
Renovascular hypertension
In the treatment of drugs acting on the renin-angiotensin-aldosterone system (RAAS), in patients with bilateral renal artery stenosis and stenosis of the artery of a single kidney, the risk of severe arterial hypotension and renal failure increases.
Renal failure and kidney transplantation
When using the drug Telmisartan-Richter in patients with impaired renal function, periodic monitoring of the potassium and serum levels of creatinine is recommended. The clinical experience of using the preparation Telmisartan-Richter in patients who have recently undergone kidney transplantation is absent.
Reduction of the volume of circulating blood (OSHO)
In patients with reduced BCC and / or sodium content due to previous diuretic therapy, restriction of salt intake, diarrhea, or vomiting, symptomatic arterial hypotension may occur, especially after the first administration of Telmisartan-Richter.Such conditions should be eliminated before it is received. The deficiency of fluid and / or sodium should be eliminated before the start of taking Telmisartan-Richter.
Double blockade of the oenine-angiotensin-aldosterone system
As the effects of inhibition of RAAS were observed: the occurrence of arterial hypotension, syncope, hyperkalemia and impaired renal function (including acute renal failure) in predisposing patients, especially when used in combination with drugs also acting on this system. Double blockade of RAAS, for example, with the addition of an ACE inhibitor (angiotensin converting enzyme) to an angiotensin II receptor antagonist, is not recommended for patients with already controlled blood pressure and should be limited to individual cases with enhanced monitoring of renal function.
Other diseases characterized by RAAS stimulation
In patients whose vascular tone and renal function depend primarily on RAAS activity (eg, patients with chronic heart failure or kidney disease, including renal artery stenosis), the use of drugs acting on this system such as telmisartan, was associated with the emergence of acute arterial hypotension, hyperaemia, oliguria, or rarely - with acute renal failure (see section "Side effect").
Primary aldosteronism
Patients with primary aldosteronism, as a rule, do not respond to treatment with antihypertensive drugs, the effect of which is manifested by inhibition of RAAS. In this regard, the use of the drug Telmisartan-Richter in these cases is not recommended.
Stenosis of the aortic and mitral valve, hypertrophic obstructive cardiomyopathy
As with other vasodilators, special precautions are indicated for patients with aortic and mitral stenosis or hypertrophic obstructive cardiomyopathy.
Hyperkalemia
The use of drugs acting on RAAS can cause hyperkalemia.
For elderly patients, patients with renal insufficiency, patients with diabetes mellitus and also with arterial hypertension and coronary heart disease (CHD), patients receiving concomitant medication therapy that may cause an increase in potassium content,and / or patients with concomitant disease, hyperkalemia can be fatal.
Before considering the possibility of concomitant use of drugs acting on RAAS, it is necessary to evaluate the benefit-risk relationship.
The main risk factors that should be considered are:
- Diabetes mellitus, renal failure, age (patients older than 70 years).
- Combination with one or more drugs acting on RAAS and / or an increase in serum potassium. Drugs or therapeutic classes of drugs that can cause hyperkalemia include salt substitutes containing potassium, potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, non-steroidal anti-inflammatory drugs (NSAIDs, including selective COX-2 inhibitors), heparin, immunosuppressants (ciclosporin or tacrolimus) and trimethoprim.
- Intercurrent diseases, especially dehydration, acute heart failure, metabolic acidosis, impaired renal function, severe deterioration of the kidneys (eg, infectious diseases), cytolysis syndrome (eg, acute limb ischemia, rhabdomyolysis, severe trauma).
For patients at risk, regular monitoring of serum potassium is recommended (see section "Interaction with other drugs").
Lactose
This preparation contains lactose monohydrate. Patients with rare hereditary diseases, such as galactose intolerance, Lappa lactase deficiency or impaired glucose-galactose absorption, should not take this medication.
Racial differences
As noted for angiotensin-converting enzyme (ACE) inhibitors, Telmisartan-Richter and other angiotensin II receptor antagonists appear to be less effective in lowering arterial pressure in patients of the Negroid race than in representatives of other races, possibly due to a greater predisposition to decreased renin activity in the population patients of the Negroid race, patients with diabetes mellitus and also with arterial hypertension and ischemic heart disease.
Other
As with the use of other antihypertensive drugs, excessive reduction in blood pressure in patients suffering from ischemic cardiopathy, or patients with sugardiabetes and also with arterial hypertension and coronary artery disease can lead to the development of myocardial infarction or cerebral circulation disorders.