Telpres Plus tabs 80mg + 12.5mg #28

Telpres Plus instruction

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Pharmacological properties

Telpres Plus is a combination of an angiotensin II receptor antagonist (Telmizartan) and a thiazide diuretic (hydrochlorothiazide). The combination of these ingredients has an additional antihypertensive effect, reducing blood pressure more than each of its components separately. Telpres Plus, when applied in therapeutic doses 1 time per day, effectively and slowly reduces blood pressure.
Telmisartan for oral use is an effective specific angiotensin II receptor antagonist (type AO1). Telmisartan with very high affinity replaces angiotensin II at its binding sites on the AO1 receptor subtype, which is responsible for the known activity of angiotensin II. Telmisartan has no partial agonistic effect on AO 1 receptor and selectively binds AO 1 receptor. The binding is long lasting. Telmisartan is not related to other receptors, including AO 2 and other, less described, AT receptors. The functional role of these receptors is not known, as well as the effect of possible excessive stimulation of angiotensin II, the level of which is increased under the influence of Telmisartan. Telmisartan reduces plasma aldosterone levels. Telmisartan does not inhibit renin in human blood plasma, does not block ion channels. Telmisartan does not inhibit ACE (ACE) (kininase II), it also destroys bradykinin. Thus, one should not expect an increase in adverse reactions associated with bradykinin.
In humans, telmisartan at a dose of 80 mg almost completely suppresses the increase in blood pressure caused by angiotensin II. The blocking effect lasts for 24 hours and remains significant for up to 48 hours.
After the first dose of Telmisartan, the antihypertensive activity gradually appears over 3:00. The maximum reduction in blood pressure appears after 4-8 weeks from the start of treatment and persists with prolonged therapy. The antihypertensive effect is maintained continuously for 24 hours after application, including during the last 4:00 before the next intake, established during ambulatory blood pressure monitoring. This is confirmed by the ratio of the concentration of Telmisartan before taking the next dose to C max, which is 80% after taking 40 and 80 mg of Telmisartan in clinical studies.
There was a dose-dependent effect on systolic blood pressure, but the data on diastolic pressure are inconsistent.
In patients with arterial hypertension, telmisartan reduces both systolic and diastolic pressure without affecting the pulse rate. The contribution of the diuretic and natriuretic action of the drug to its hypotensive activity has not yet been determined. The antihypertensive efficacy of telmisartan corresponds to that of other classes of antihypertensive drugs (demonstrated in studies comparing telmisartan with amlodipine, atenolol, enalapril, hydrochlorothiazide, and lisinopril).
With a sudden cessation of treatment with telmisartan, blood pressure gradually returns to the parameters that were before treatment for several days without the likelihood of withdrawal.
According to clinical studies, cases of dry cough were observed much less frequently with treatment with telmisartan than with treatment with ACE inhibitors.
The effect of Telmisartan on mortality and cardiovascular disease is unknown.
Hydrochlorothiazide is a thiazide diuretic. The mechanism of action of the antihypertensive effect of thiazide diuretics is still not fully understood. Thiazides affect the renal tubular mechanism of electrolyte reabsorption, thereby directly increasing the excretion of sodium and chlorine in approximately equivalent amounts. Due to the diuretic effect, hydrochlorothiazide reduces plasma volume, increases renin activity in plasma, increases aldosterone secretion with a consistent increase in urinary potassium and loss of bicarbonate and a decrease in serum potassium. Perhaps due to the blockade of renin-angiotensin, the simultaneous use of Telmisartan contributes to the reversible loss of potassium associated with hydrochlorothiazide. When using hydrochlorothiazide, the onset of diuresis occurs after 2:00, the maximum effect is achieved after 4:00, while the effect lasts for about 6-12 hours.
Epidemiological studies have shown that prolonged treatment with hydrochlorothiazide reduces the risk of cardiovascular morbidity and mortality.
The effect of the fixed telmisartan / hydrochlorothiazide combination on mortality and cardiovascular disease is unknown.

Indications for use

Arterial hypertension. As a combination with a fixed dose of the drug, Telpres Plus is used when taking Telmisartan as a monotherapy does not provide adequate blood pressure control.

Dosage and administration

Adults

Telpres Plus should be taken in patients in whom blood pressure is not sufficiently controlled when using Telmisartan alone. Before switching to a fixed-dose combination, the dose of each component should be individually determined. According to clinical indications, direct replacement of monotherapy with fixed combination therapy is possible.
Telpres Plus can be prescribed to patients whose blood pressure is not sufficiently controlled when using Telmisartan or hydrochlorothiazide separately, or to patients who have previously achieved an improvement in condition when using Telmisartan and hydrochlorothiazide separately.
Telpres Plus 40 mg / 12.5 mg can be administered once a day to patients whose blood pressure is not sufficiently controlled with the use of Telpres 40 mg tablets.
Telpres Plus 80 mg / 12.5 mg can be administered once a day to patients whose blood pressure is not sufficiently controlled with the use of Telpres 80 mg tablets.

Special patient groups

Patients with impaired renal function
It is recommended to monitor kidney function.
Patients with impaired liver function
For patients with mild to moderate hepatic impairment, the daily dose of Telpres Plus should not exceed 40 mg / 12.5 mg.
Telpres Plus is not prescribed to patients with severely impaired liver function. Thiazides should be used with caution in patients with impaired liver function.
Telpres Plus tablets are taken 1 time per day with a liquid, regardless of the meal.

Security measures before using the drug

Telpres Plus should be stored in an airtight blister pack, because the tablets are very hygroscopic. Take pills out of the blister immediately before use.
Children. The safety and efficacy of using Telpres Plus for children (under 18 years of age) have not been established; therefore, this category of patients should not be used.

Contraindications for Telpres Plus

Hypersensitivity to any of the components of the drug.
Hypersensitivity to other substances that are derived from sulfonamide (since hydrochlorothiazide is a derivative of sulfonamide).
Pregnancy or pregnancy planning (see the sections “Peculiarities of Use” and “Use during Pregnancy or Breastfeeding”).
Cholestatic and biliary obstructive disorders.
Severe abnormal liver function.
Anuria, severe renal impairment (creatinine clearance less than 30 ml / min).
Refractory hypokalemia / hyponatremia, hypercalcemia.
Breastfeeding
Symptomatic hyperuricemia (gout).
Children's age (up to 18 years).
The simultaneous use of Telmisartan and aliskiren in the middle of their products is contraindicated in patients with diabetes mellitus or renal insufficiency (GFR <60 ml / min / 1.73 m 2).

Interaction with other drugs and other types of interactions

Interaction studies were conducted only with the participation of adults.
Lithium. With simultaneous use of lithium with ACE inhibitors registered a reversible increase in the concentration of lithium in the serum and increase its toxicity. Such rare interactions have also been reported with the use of angiotensin II receptor antagonists (including telmisartan / hydrochlorothiazide). The simultaneous use of lithium and Telpres Plus is not recommended. If the effectiveness of such a combination is proven, recommended careful monitoring of the level of lithium in the blood serum.
Drugs associated with potassium loss and hypokalemia (for example, other diuretics, potassium excretion, laxatives, corticosteroids, ACTH (ACTH), amphotericin, carbenoxolone, penicillin G sodium, salicylic acid and derivatives)
When using these drugs together with the telmisartan / hydrochlorothiazide combination, it is recommended to monitor plasma potassium levels.
These drugs can enhance the effect of hydrochlorothiazide on the level of potassium in the blood plasma.
Drugs that can increase sodium and cause hyperkalemia (for example, drugs that inhibit the renin-angiotensin system, potassium-saving diuretics, potassium supplements, potassium-containing, cyclosporin or other drugs such as sodium heparin)
When using these drugs together with a combination of telmisartan / hydrochlorothiazide, it is recommended to monitor the level of potassium in the blood plasma. Given the experience of using other drugs that inhibit the renin-angiotensin system, the simultaneous use of these drugs can lead to an increase in the level of potassium in the blood serum and therefore is not recommended.
Drugs that cause impaired serum potassium
It is recommended to monitor the level of potassium in the serum and ECG when using the drug Telpres Plus with drugs that cause a violation of the level of potassium in the blood serum (for example, with digitalis glycosides, antiarrhythmic drugs), and drugs that stimulate paroxysmal tachycardia of the torsades de pointes type ( including some antiarrhythmic drugs), hypokalemia, which is a provoking factor for torsades de pointes:
    antiarrhythmic drugs of class Ia (for example quinidine, hydroquinidine, disopyramide)
    class III antiarrhythmic drugs (for example, amiodarone, sotalol, dofetelid, ibutilide)
    some antipsychotic drugs (for example, thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, sultopridom, amisulpride, tiaprid, pimozide, haloperidol, droperidol)
    others (for example bepridil, cisapride, difemanil, erythromycin IV, halofantrine, mizolastine, pentamidine, sparfloxacin, terfenadine, vincamine iv).
Digitalis glycosides. Hypokalemia or hypomagnesemia caused by thiazides contribute to the occurrence of cardiac arrhythmias caused by digitalis.
Digoxin. With simultaneous use of telmisartan with digoxin, an increase in mean values ​​of peak (49%) and minimal (20%) concentrations of digoxin in plasma was noted.
At the beginning of therapy, during dose adjustment and with the cancellation of therapy with telmisartan, it is necessary to control the level of digoxin in order to maintain the level within the therapeutic limits.
Other antihypertensive drugs
Telmisartan may increase the hypotensive effect of other antihypertensive drugs.
It was reported that double blockade of renin-angiotensin- (RAAS) using a combination of ACE inhibitors, angiotensin II receptor blockers or aliskiren is associated with a higher frequency of side effects such as hypotension, hyperkalemia and reduced renal function (including acute renal failure) compared to using a single raas-acting agent.
Antidiabetic drugs (oral medication and insulin)
It may be necessary to adjust the dose of antidiabetic agents.
Metformin should be used with caution because of the risk of lactic acidosis caused by possible functional renal failure, while using hydrochlorothiazide.
Kolestiraminovaya and cholestipol resin. The absorption of hydrochlorothiazide is impaired in the presence of anion exchange resins.
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs (in particular, acetylsalicylic acid in anti-inflammatory doses, COX-2 inhibitors, non-selective NSAIDs) can reduce the diuretic, natriuretic and hypotensive effects of thiazide diuretics and the antihypertensive effect of angiotensin II receptor antagonists. In some patients with impaired renal function (in patients with dehydration or elderly patients with impaired renal function), the simultaneous use of angiotensin II receptor antagonists and agents that suppress COX can cause deterioration of renal function, including acute renal failure, which is usually reversible. Therefore, the combination should be used with caution, especially in elderly patients. After initiation of therapy with a combination of drugs and periodically later, patients need to ensure adequate hydration and to carefully monitor renal function.
In one study, the simultaneous use of telmisartan and ramipril resulted in a 2.5-fold increase in AUC 0-24 and C max ramipril and ramiprilat.
The clinical significance of this observation remains unknown.
Vasopressor amines (eg norepinephrine)
The action of vasopressor amines can be reduced.
Nondepolarized skeletal muscle relaxants (for example, tubocurarine)
The effect of skeletal muscle nondepolarizing muscle relaxants can be enhanced by hydrochlorothiazide.
Drugs used to treat gout (for example, probenecid, sulfinpirazon, and allopurinol)
It may be necessary to adjust the dose of drugs that promote the excretion of uric acid, since hydrochlorothiazide may increase serum uric acid levels. May require an increase in the dose of probenecid or sulfinpyrazone. The simultaneous use of thiazide may increase the incidence of hypersensitivity reactions to allopurinol.
Calcium salts. Thiazide diuretics may increase serum calcium levels due to decreased excretion. If necessary, the appointment of calcium supplements should be monitored calcium levels in the serum and adjust the dose accordingly.
β-blockers and diazoxide. The hyperglycemic effect of β-blockers and diazoxide can be enhanced by thiazides.
Anticholinergic drugs (for example, atropine, biperidine) can increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility and the degree of gastric emptying.
Amantadine. Thiazides increase the risk of side effects, amantadine.
Cytotoxic drugs (for example cyclophosphamide, methotrexate)
Thiazides can reduce the renal excretion of cytotoxic drugs and enhance their myelosuppressive effect.
Based on pharmacological properties, it is expected that baclofen and amifostine may enhance the hypotensive effect of all antihypertensive drugs, including telmisartan.
In addition, orthostatic hypotension may be enhanced by the use of alcohol, barbiturates, narcotic drugs or antidepressants.
Salicylates When high doses of salicylates are used, hydrochlorothiazide may increase their toxic effects on the central nervous system.
Methyldopa Individual cases of hemolytic anemia have been reported with simultaneous use of hydrochlorothiazide and methyldopa.
Cyclosporine. With the simultaneous use of cyclosporin, hyperuricemia may increase and the risk of complications such as gout may increase.
The effect of drugs on laboratory test results
Through its effect on calcium metabolism, thiazides can influence the results of the evaluation of the function of the parathyroid glands.
Carbamazepine. Considering the risk of symptomatic hyponatremia, it is necessary to carry out clinical and biological monitoring.
Iodine-containing contrast agents. In the case of diuretic-induced dehydration, the risk of developing acute renal failure increases, mainly when using high doses of iodine-containing contrast media. Patients need rehydration prior to the introduction of iodine-containing drugs.
Amphotericin B (for parenteral administration), corticosteroids, ACTH and stimulant laxatives. Hydrochlorothiazide increases electrolyte imbalance, mainly hypokalemia.

Application features

Pregnancy. Angiotensin II receptor antagonist therapy should not be initiated during pregnancy. Until therapy with angiotensin II receptor antagonists is considered appropriate, patients planning a pregnancy should be switched to taking alternative antihypertensive drugs that have an established safety profile for use during pregnancy. When pregnancy is established, angiotensin II receptor antagonists should be stopped immediately and, if necessary, alternative therapy should be initiated.
Liver dysfunction. Telpres Plus should not be prescribed to patients with cholestasis, obstructive diseases of the bile ducts and severe liver failure, since telmisartan is excreted mainly from the bile. In such patients, a decrease in hepatic clearance of Telmisartan can be expected. In addition, Telpres Plus should be used with caution in patients with impaired liver function or progressive liver disease, since even minor changes in water and electrolyte balance can cause hepatic coma.
There is no clinical experience with Telpres Plus in patients with liver failure.
Renovascular hypertension. There is an increased risk of severe arterial hypotension and renal failure if patients with bilateral renal artery stenosis or renal artery stenosis of a single kidney are taking drugs that affect the renin-angiotensin-aldosterone system.
Kidney failure and kidney transplantation. Telpres Plus should not be used in patients with severe renal insufficiency (creatinine clearance less than 30 ml / min). There is no experience with the drug Telpres Plus for patients who have recently had a kidney transplant. Since the experience of using the drug Telpres Plus in patients with impaired mild to moderate renal function is small, it is recommended to periodically monitor the level of potassium, creatinine and uric acid in the blood serum. In patients with impaired renal function, azotemia associated with thiazide diuretics may occur.
Reduced bcc. Patients with sodium deficiency and / or circulating blood volume in the body through potent diuretic therapy, salt restriction in diet, diarrhea, or vomiting may experience symptomatic hypotension, especially after the first dose. Therefore, before the appointment of the drug Telpres Plus should be a correction of the above conditions.
Double renin-angiotensin-blockade (RAAS). There is evidence that the simultaneous use of ACE inhibitors, angiotensin II receptor blockers or aliskiren increases the risk of hypotension, hyperkalemia and reduces renal function (including acute renal failure).
Therefore, a double blockade of RAAS by the combined use of ACE inhibitors, angiotensin II receptor blockers or aliskiren is not recommended.
If a double blockade is considered absolutely necessary, it is carried out only under the supervision of a specialist and subject to continuous careful monitoring of the function of the kidneys, electrolytes and blood pressure.
ACE inhibitors and angiotensin II receptor blockers should not be given at the same time to patients with diabetic nephropathy.
In patients whose vascular tone and renal function depend mainly on renin-angiotensin-activity (for example, patients with severe congestive heart failure or kidney disease, including
With renal artery stenosis), treatment with drugs that affect this system can cause acute arterial hypotension, hyperazotemia, oliguria, and occasionally acute renal failure.
Primary aldosteronism. Patients with primary aldosteronism usually do not respond to antihypertensive drugs, the effect of which provides for the suppression of the renin-angiotensin system, therefore, the use of Telpres Plus is not recommended for such patients.

Aortic stenosis and mitral valve, obstructive hypertrophic cardiomyopathy. As with the use of other vasodilators, special care is required when treating patients suffering from aortic stenosis and mitral valve or obstructive hypertrophic cardiomyopathy.
Metabolic and endocrine effects. Thiazide treatment may decrease glucose tolerance. For patients with diabetes mellitus, dose adjustment of insulin or oral antidiabetic drugs may be required. During thiazide therapy, latent diabetes may occur. Thiazide diuretics are associated with increased cholesterol and triglyceride levels. However, the dose of 12.5 mg contained in the drug Telpres Plus does not have such an effect or this effect is only minimal. Some patients receiving thiazide drugs may develop hyperuricemia or overt gout.
Electrolyte imbalance. In any patient, it is treated with diuretics, at certain intervals it is necessary to determine the level of serum electrolytes.
Thiazides, including hydrochlorothiazide, can cause fluid or electrolyte imbalances (in particular, hypokalemia, hyponatremia, and hypochloraemic alkalosis). Symptoms of fluid electrolyte imbalance are dry mouth, thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle fatigue, arterial hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting.
Hypokalemia. Although hypokalemia may occur as a result of the use of thiazide diuretics, concomitant therapy with telmisartan may reduce the hypokalemia caused by diuretics.
The risk of hypokalemia is higher in patients with cirrhosis of the liver, in patients with significant diuresis, in patients in whom oral electrolyte intake does not meet their needs, and in patients receiving therapy with corticosteroids or ACTH.
Hyperkalemia. Through antagonism of angiotensin II receptors (AT 1) associated with telmisartan, a component of Telpres Plus, hyperkalemia can occur. Clinically significant hyperkalemia due to the drug Telpres Plus has not been documented. Risk factors for hyperkalemia include renal failure and / or heart failure and diabetes mellitus. Potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes should be prescribed with caution along with the telmisartan / hydrochlorothiazide combination.
Hypercalcemia. Thiazides can reduce the excretion of calcium in the urine and cause a periodic and slight increase in the level of calcium in the blood serum in the absence of calcium metabolism. Significant hypercalcemia can be a sign of latent hyperparathyroidism. You should stop taking thiazides before analyzing the function of the parathyroid glands.
Hypomagnesemia. Thiazides cause an increase in magnesium excretion in the urine, which can lead to hypomagnesemia.
Ethnic differences. Like all other angiotensin II receptor antagonists, telmisartan is clearly less effective in lowering blood pressure in patients of the Negroid race than in other races. Perhaps this is due to the large spread of conditions with a reduced level of renin in patients of the Negroid race suffering from arterial hypertension.
Other states. As with the use of any other antihypertensive drugs, an excessive reduction in blood pressure in patients with ischemic cardiopathy or ischemic cardiovascular disease can lead to myocardial infarction or stroke.
Common disorders. Hypersensitivity reactions to hydrochlorothiazide are more likely in patients with a history of allergies or bronchial asthma.
It is known that the use of thiazide diuretics, including hydrochlorothiazide, can lead to an exacerbation of systemic lupus erythematosus.
When using thiazide diuretics, cases of photosensitivity reactions were observed. If photosensitization occurs during treatment, it is recommended to stop using Telpres Plus. If it is considered necessary to re-use diuretics, it is recommended to protect exposed areas of the body from exposure to the sun or artificial ultraviolet radiation.
Acute myopia and secondary glaucoma. Drugs containing sulfanilamide or its derivatives can cause idiosyncrasy, which leads to transient myopia and acute angle-closure glaucoma. Hydrochlorothiazide is a derivative of sulfonamides, but so far only individual cases of acute angle-closure glaucoma have been reported with the use of hydrochlorothiazide. The symptoms of this disease include acute visual acuity or eye pain. As a rule, these symptoms develop within a few hours or several weeks after the start of therapy with this drug. Leaving acute angle-closure glaucoma without treatment can lead to irreversible loss of vision in the patient. When such a symptom is detected, first of all, therapy with this drug should be discontinued as soon as possible. If after that the intraocular pressure remains uncontrolled, the feasibility of medical or surgical treatment can be considered. Risk factors for developing acute angle-closure glaucoma may include a history of allergy to sulfanilamide or penicillin.
The drug may affect the results of laboratory tests:
Telpres Plus can reduce the level of protein-bound iodine in the blood plasma
treatment should be discontinued before conducting a laboratory examination to assess the function of the parathyroid glands
the drug is able to increase the concentration of free bilirubin in the serum.

Overdose

Information on overdose of telmisartan in humans is limited. The level of withdrawal of hydrochlorothiazide by hemodialysis has not been established.

Symptoms

With an overdose of Telmisartan, the most pronounced manifestations were arterial hypotension and tachycardia also reported bradycardia, dizziness, vomiting, increased serum creatinine levels and acute renal failure. A decrease in the concentration of electrolytes (hypokalemia, hypochloremia) and hypovolemia due to excessive diuresis are associated with overdosing of hydrochlorothiazide.
The most common symptoms of an overdose are nausea and drowsiness. Hypokalemia can lead to muscle spasm and / or exacerbation of cardiac arrhythmias with simultaneous use of glycosides of the digitalis group or certain antiarrhythmic drugs.

Treatment

Telmisartan is not removed by hemodialysis. Patients should be closely monitored and receive symptomatic and supportive therapy. Therapy depends on the time elapsed after taking Telpres Plus, and the severity of the symptoms. Recommended interventions include stimulating vomiting and / or gastric lavage. In the treatment of overdose, activated carbon can be used. It is necessary to control the level of electrolytes and serum creatinine. In the event of arterial hypotension, the patient should be placed on his back and provide assistance aimed at quickly replenishing the volume of body fluids and salt.

Adverse reactions

The most commonly reported side effect is dizziness. In rare cases (less than 1 case per 1000 patients), severe angioedema is possible.

Fixed dose combination

The dependence of side effects on doses has not been established, and these effects were not related to gender, age or race.
The side effects reported during all clinical trials and which more often (p ≤ 0.05) occurred when using a combination of Telmisartan with hydrochlorothiazide than when using a placebo, are listed below in accordance with the classes of organ systems. Side effects observed with the use of each component separately, but which did not appear during clinical trials, may appear during treatment with Telpres Plus.
In each group, adverse reactions are presented in descending order of severity.
Infections and invasions: rarely - bronchitis, pharyngitis, sinusitis.
On the part of the immune system: rarely - exacerbation or activation of systemic lupus erythematosus.
On the part of metabolism: rarely - hypokalemia rarely - hyperuricemia, hyponatremia.
On the part of the psyche: infrequently - anxiety; rarely - depression.
On the part of the nervous system: often - dizziness infrequently - fainting, paresthesias; rarely - insomnia, sleep disturbance.
On the part of the organ of vision: rarely - visual impairment, blurred vision.
On the part of the hearing: infrequently - vertigo.
Since the cardiovascular system: infrequently - tachycardia, arrhythmia, arterial hypotension, orthostatic hypotension.
On the part of the respiratory system: infrequently - shortness of breath; rarely, respiratory distress syndrome (including pneumonitis and pulmonary edema).
On the part of the digestive tract: rarely - diarrhea, dry mouth, flatulence rarely - abdominal pain, constipation, dyspepsia, vomiting, gastritis.
On the part of the digestive system: rarely - impaired liver function / liver disease.
From the skin and subcutaneous tissue: rarely - angioedema (also fatal), erythema, pruritus, rash, hyperhidrosis, urticaria.
On the part of the musculoskeletal system: infrequently - back pain, muscle spasms, myalgia rarely - arthralgia, muscle cramps, pain in the legs.
Reproductive System: Infrequently, erectile dysfunction.
General disorders: infrequently - chest pain; rarely flu-like symptoms, pain.
Laboratory indicators: infrequently - an increased level of uric acid is rare - an increase in the level of creatinine, an increased level of blood CK, an increased level of liver enzymes.
Additional information on individual components.
The side effects previously reported in connection with the use of one of the components may occur when using the telmisartan / hydrochlorothiazide combination, even if they were not observed in clinical studies of this combination.
Sepsis. During the PRoFESS study, patients treated with telmisartan had a higher incidence of sepsis than among those who received placebo. This phenomenon can be both random and related to the mechanism, the essence of which is still unknown.

Storage conditions

Store in original packaging at a temperature not higher than 25 ° C. Keep out of the reach of children.
Shelf life 2 years.
Packaging
On 14 tablets in the blister, on 2 or on 7 blisters in a cardboard pack.

Composition

Active ingredients: telmisartan and hydrochlorothiazide;
1 tablet contains telmisartan 40 mg and hydrochlorothiazide 12.5 mg telmisartan 80 mg and hydrochlorothiazide 12.5 mg, telmisartan 80 mg and hydrochlorothiazide 25 mg
Auxiliary substances for dosing 40 mg / 12.5 mg mannitol (E 421), povidone, crospovidone, meglumin, sodium hydroxide, lactose, microcrystalline cellulose, hypromellose, sodium starch (type A), magnesium stearate, ferric oxide yellow (E 172)
Auxiliary substances for dosing 80 mg / 12.5 mg mannitates (E 421), povidone, crospovidone, meglumine, sodium hydro.

Terms of sell

You can buy Telpres Plus without a prescription.