MicardisPlus

How does it work?

This medicine contains two active ingredients, telmisartan and hydrochlorothiazide. Telmisartan is a type of medicine called an angiotensin II antagonist. This type of medicine works by blocking receptors known as angiotensin II receptors in the body. By blocking these receptors telmisartan prevents a compound called angiotensin II from working. Angiotensin II is produced naturally by the body and plays an important part in regulating blood pressure and fluid balance. It has two main actions. Firstly, it causes constriction (narrowing) of blood vessels and secondly, it reduces the production of urine by the kidneys. As telmisartan blocks angiotensin II receptors, it prevents the actions of angiotensin II, causing its effects to be reversed. As a result, the blood vessels widen and more urine is produced by the kidneys. The overall effect of this is a reduction in the pressure within the blood vessels and hence a drop in blood pressure. Hydrochlorothiazide is a type of medicine called a thiazide diuretic. Thiazide diuretics act in the kidneys, where they increase the production of urine. They work by causing the kidneys to increase the amount of salts, such as potassium and sodium, that are filtered out of the blood and into the urine. When these salts are filtered out of the blood by the kidneys, water is also drawn alongside. As hydrochlorothiazide increases the removal of salts from the blood, it also causes more water to be drawn out of the blood and into the urine. Removing water from the blood decreases the volume of fluid circulating through the blood vessels, which decreases the pressure within the blood vessels. Hydrochlorothiazide therefore lowers blood pressure. Telmisartan and hydrochlorothiazide have an additive effect on lowering blood pressure. They are used to treat high blood pressure in people whose blood pressure is not adequately controlled on telmisartan alone.

What is it used for?

High blood pressure with no known cause

Warning!

It is recommended that salt (electrolyte) levels in the blood should be monitored while taking this medicine.

If you experience any of the following symptoms while taking this medicine you should inform your doctor promptly, so that the amount of fluids and salts in your body can be checked: thirst, lethargy, confusion, weakness, drowsiness, muscle cramps, scanty production of urine, abnormal heart rhythm, seizures, nausea and vomiting.

As diuretics cause your kidneys to produce more urine, you may prefer to take this medicine in the morning rather than before going to bed, as this will reduce the likelihood of you needing to get up in the night to visit the toilet. Seek further advice from your doctor or pharmacist.

If you need a test to assess the functioning of your parathyroid gland your doctor may ask you to stop taking this medicine beforehand, as it may interfere with the test results.

Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting.

People with decreased kidney function should have their potassium levels and kidney function monitored while taking this medicine.

The safety and efficacy of this medicine in children and adolescents under 18 years of age has not been established.

Dizziness and weariness may occasionally occur during treatment with blood pressure lowering medicines. If you are affected, caution is required when driving or operating machinery.

Use with caution in

Decreased kidney function

Decreased liver function

Diabetes

Gout

Heart disease caused by inadequate blood flow to the heart

Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy)

History of allergies

History of asthma

Long-term inflammation of skin and some internal organs (systemic lupus erythematosus)

Narrowing of one of the valves in the heart

Narrowing of the artery which supplies blood to the kidneys (renal artery stenosis)

Narrowing of the main artery coming from the heart (aortic stenosis)

People with low fluid volume or salt levels in the body, eg due to diuretic therapy, low-sodium diet, diarrhoea or vomiting

Severe heart failure

Not to be used in

Allergy to medicines from the sulphonamide group, eg the antibiotic sulphamethoxazole

Blockage of the bile duct (biliary obstruction)

Breastfeeding

Failure of the normal flow of bile from the liver to the intestines

High levels of calcium in the blood (hypercalcaemia)

Inherited intolerance to fructose in the diet

Low potassium blood levels that cannot be corrected (refractory hypokalaemia)

Second and third trimesters of pregnancy

Severely decreased kidney function

Severely decreased liver function

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine should not be used in pregnancy, particularly in the second and third trimesters, as it may affect the growth and development of the foetus or have adverse effects on foetal tissues. Seek medical advice from your doctor.

This medicine may decrease the quantity of breast milk produced and may also be present in breast milk, therefore it should not be taken by breastfeeding mothers. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Abdominal pain

Constipation

Diarrhoea

Impotence

Indigestion (dyspepsia)

Balance problems involving the inner ear (vertigo)

Low blood potassium level (hypokalaemia)

Cold or flu-like symptoms

Back pain

Dizziness

Eczema

Anxiety

Pain in the muscles and joints

Urinary tract infection

Raised cholesterol levels

Respiratory tract infections

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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