Hydrochlorothiazide and telmisartan

Hydrochlorothiazide is a water pill (diuretic). Telmisartan is a type of medicine called an angiotensin II receptor blocker (often referred to as an ARB blocker).

Hydrochlorothiazide and telmisartan is a combination medicine used to treat high blood pressure (hypertension). Reducing blood pressure may decrease your risk of having a stroke or a heart attack.

Hydrochlorothiazide and telmisartan may also be used for reasons not mentioned in this medication guide.

Follow all instructions on your prescription label and read all medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed.

You can take this medicine with or without food.

Your blood pressure will need to be checked regularly.

Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than normal. You can easily become dehydrated while taking hydrochlorothiazide and telmisartan. This can lead to very low blood pressure, a serious electrolyte imbalance, or kidney failure.

If you need surgery or medical tests, inform the surgeon in advance that you are taking this medicine.

It may take up to 4 weeks for this medication to control your blood pressure. Continue using this medicine as directed, even if you feel fine. High blood pressure often does not have symptoms. You may need to take blood pressure medicine for the rest of your life.

Store at room temperature away from moisture and heat. Keep each tablet in its blister pack until you are ready to take it. Gently push the tablet through the foil to remove it.

Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant.

You should not use this medicine if you are unable to urinate.

If you have diabetes, do not use hydrochlorothiazide and telmisartan together with any medication that contains aliskiren (a blood pressure medicine).

You should not use hydrochlorothiazide and telmisartan if you are allergic to hydrochlorothiazide or telmisartan, or if you are unable to urinate.

If you have diabetes, do not use hydrochlorothiazide and telmisartan together with any medication that contains aliskiren (a blood pressure medicine).

You may also need to avoid taking hydrochlorothiazide and telmisartan with aliskiren if you have kidney disease.

Tell your doctor if you have ever had:

• kidney disease;
• liver disease;
• glaucoma;
• low or high levels of magnesium or potassium in your blood;
• asthma or allergies;
• lupus;
• diabetes; or
• an allergy to penicillin or sulfa drugs.

Do not use if you are pregnant. Stop using the medicine and tell your doctor right away if you become pregnant. Hydrochlorothiazide and telmisartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

You should not breastfeed while using this medicine.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

In rare cases, hydrochlorothiazide and telmisartan can cause a condition that leads to the breakdown of skeletal muscle tissue, which may result in kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have fever, unusual tiredness, or dark colored urine.

Also call your doctor at once if you have:

• eye pain, vision problems;
• a light-headed feeling, like you might pass out;
• jaundice (yellowing of the skin or eyes);
• swelling in your hands or feet, unusual weight gain;
• easy bruising, unusual bleeding; or
• signs of an electrolyte imbalance--dry mouth, increased thirst, drowsiness, confusion, feeling restless, vomiting, muscle pain or weakness, lack of energy, fast heartbeats, little or no urine, or a seizure.

Common side effects of hydrochlorothiazide and telmisartan may include:

• dizziness, feeling tired;
• nausea, diarrhea;
• back pain; or
• cold or flu symptoms.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Usual Adult Dose for Hypertension:

Hydrochlorothiazide 12.5 to 25 mg-Telmisartan 80 mg orally once a dayMaximum dose: Hydrochlorothiazide 25 mg-Telmisartan 160 mg orally once a dayComments:-This drug may be substituted for the individual titrated components.-If blood pressure remains uncontrolled by hydrochlorothiazide 25 mg orally once a day monotherapy, may switch to hydrochlorothiazide 12.5 to 25 mg-telmisartan 80 mg orally once a day. Reassess after 2 to 4 weeks; may increase up to hydrochlorothiazide 25 mg-telmisartan 160 mg orally once a day.-If blood pressure is controlled by hydrochlorothiazide 25 mg orally once a day monotherapy, but hypokalemia occurs, may switch to hydrochlorothiazide 12.5 mg-telmisartan 80 mg orally once a day.-If blood pressure remains uncontrolled by telmisartan 80 mg orally once a day monotherapy, may switch to hydrochlorothiazide 12.5 mg-telmisartan 80 mg orally once a day; may titrate up to hydrochlorothiazide 25 mg-telmisartan 160 mg orally once a day, if necessary.Use: Treatment of hypertension; not indicated for initial therapy.

Take the medicine as soon as you remember, but if it is close to the time for your next dose, skip the missed dose. Do not take two doses at the same time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include fast or slow heart rate, feeling light-headed, or fainting.

Hydrochlorothiazide may increase your risk of skin cancer. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Your doctor may want you to have skin examinations on a regular basis.

Do not use potassium supplements or salt substitutes, unless your doctor has told you to.

Drinking alcohol can further lower your blood pressure and may cause side effects.

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids.

If you also take cholestyramine or colestipol, do not take these medications within 4 hours before or 4 hours after you take hydrochlorothiazide and telmisartan.

Tell your doctor about all your other medicines, especially:

• any other heart or blood pressure medications;
• digoxin;
• lithium;
• a diuretic or "water pill";
• insulin or oral diabetes medicine;
• opioid pain medicine;
• a sleeping pill;
• steroid medicine or adrenocorticotrophic hormone (ACTH);
• a barbiturate such as butabarbital, phenobarbital, or secobarbital; or
• NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may affect hydrochlorothiazide and telmisartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.