Heart Problems
Patients with heart problems such as weak heart muscles (ischemic cardiopathy) or blood vessel-related heart disease are at an increased risk while using Hydrochlorothiazide+Telmisartan. These patients may experience an excessive decrease in blood pressure, which may lead to heart attack and
stroke. Precaution should be taken in patients with obstruction in the blood flow of the heart (aortic and mitral valve
stenosis) and thickening of the heart muscles (Hypertrophic
cardiomyopathy).
Abnormality in the Functioning of the Kidney
Patients with an abnormality in the functioning of the kidney or with narrowing of kidney arteries (renal artery
stenosis) are at increased risk when using Hydrochlorothiazide+Telmisartan. Use of Hydrochlorothiazide+Telmisartan may cause reduced urination or blood pressure, kidney failure, high levels of nitrogen-containing compounds (azotemia),
creatinine, blood urea nitrogen, and other fatal conditions. Precaution should be taken in patients with severe kidney disease while using thiazides. Hydrochlorothiazide+Telmisartan should not be used in patients with the severe abnormality in the function of the kidney. Also, monitoring of the creatinine,
potassium, or uric acid levels should be considered in these patients.
Dual Blockade of the Renin-Angiotensin-Aldosterone System
Patients using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, ramipril or aliskiren are at an increased risk while using Hydrochlorothiazide+Telmisartan. Such patients are at an increased risk of low blood pressure, low
potassium level, and decreased functioning of the kidney. Using telmisartan with ramipril may increase the exposure of ramipril. Avoid the combined use of angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, ramipril or aliskiren. If necessary the combination therapy should be used under medical supervision. Also, monitoring of the functioning of the kidney, and electrolytes should be considered.
Increased Production of Aldosterone
These patients do not respond to blood pressure lowering drugs. Hydrochlorothiazide+Telmisartan should not be used in patients with increased production of aldosterone (primary
hyperaldosteronism).
Increased Level of Calcium
Thiazides may cause increased levels of
calcium by decreasing the urinary excretion. Increased levels of calcium may be due to increased production of parathyroid
hormone (
hyperparathyroidism). Thiazides should be stopped before performing a parathyroid function test.
Electrolyte Imbalance
Patients receiving
diuretic therapy are at an increased risk. Hydrochlorothiazide may cause decrease in
potassium,
sodium and chloride levels (hypochloremic
alkalosis ). Symptoms of electrolyte imbalance may include lack of energy, thirst, dryness of mouth, and restlessness, etc. Periodic examination of the electrolytes should be performed. Electrolyte determination by urine and blood test should be performed when the patient receives fluids parentally or on the occurrence of excessive vomiting.
Decreased Levels of Potassium
Patients with liver cell damage (
cirrhosis of the liver), diuresis, taking corticosteroids/adrenocorticotrophic
hormone, using Hydrochlorothiazide+Telmisartan for long-term or receiving inadequate electrolytes are at increased risk. These patients may experience thiazide-induced low level of
potassium which may cause abnormal heart rate and increased response of the heart to the harmful effect of the digitalis.
Increased Levels of Potassium
Patients with kidney failure, heart failure, high blood sugar levels, or taking Hydrochlorothiazide+Telmisartan are at increased risk. Telmisartan may oppose
diuretics induced low levels of
potassium, which may lead to increased levels of potassium in the blood. Precaution should be taken in patients using Hydrochlorothiazide+Telmisartan with potassium-sparing diuretics, potassium-containing
salt substitutes or potassium supplements.
Decreased Levels of Sodium and Chloride
Patients taking Hydrochlorothiazide+Telmisartan are at increased risk. Hydrochlorothiazide may increase the level of bicarbonate (metabolic
alkalosis) and decrease the level of chloride in the blood. Patients suffering from fluid build up in the body may experience low levels of
sodium in the body. Chloride replacement therapy should be considered in patients suffering from metabolic alkalosis. Water restriction, replacement therapy or
salt intake should be considered according to the patient's condition.
Decreased Levels of Magnesium
Patients taking Hydrochlorothiazide+Telmisartan are at increased risk. Thiazides may increase the urinary elimination of magnesium, which may result in decreased levels of magnesium in the body.
Increased Mortality in Infants
A fetus is at increased risk when pregnant women use this medicine. The use of Hydrochlorothiazide+Telmisartan during the second and third trimesters of
pregnancy may lead to fetal and neonatal injury, including reduced functioning of the kidney, low blood pressure, deficiency of amniotic fluid, abnormalities of the skull and lung, insufficiency to produce urine, kidney failure, increased levels of
potassium and other fatal conditions. Management of high blood pressure is essential during pregnancy to improve the outcomes for the fetus and mother. Discontinue the use of Hydrochlorothiazide+Telmisartan immediately after diagnosis of pregnancy.
Volume or Sodium Depleted Patients
Sodium or volume-depleted patients taking Hydrochlorothiazide+Telmisartan are at increased risk. Symptomatic low blood pressure may occur in these patients due to dietary or
salt restriction, and
diarrhea. The condition of the patients should be corrected before taking Hydrochlorothiazide+Telmisartan. Close supervision along with precaution should be recommended when starting Hydrochlorothiazide+Telmisartan therapy. On the occurrence of the low blood pressure, the patient should be placed in the supine position or infusion of normal saline in the veins should be given to the patients. In case of the temporary decrease in blood pressure, discontinuation of Hydrochlorothiazide+Telmisartan should be considered. Precaution should be taken in such patients.
Abnormality in the Functioning of the Liver
Patients with an abnormality in the functioning of the liver or in the bile flow (
cholestasis), patients with blockage of the bile ducts (biliary obstructive disorders) or with severe liver failure are at increased risk when using Hydrochlorothiazide+Telmisartan. These patients may experience decreased elimination of telmisartan. Also, hydrochlorothiazide may cause a disturbance in the electrolyte or fluid
balance in these patients, which may lead to liver
coma. Precaution should be taken in patients with an abnormality in the functioning of the liver and using thiazides
diuretics. Also, Hydrochlorothiazide+Telmisartan should not be given to patients with cholestasis, biliary obstructive disorders, or severe liver failure.
Allergic Reaction
Patients with a history of difficulty in breathing or
allergy, and taking Hydrochlorothiazide+Telmisartan are at increased risk. Such patients may see an increased risk of development of symptoms such as purple or red-colored spots on the skin, increased sensitivity to sunlight,
hives, swelling of the lower layer of the skin, respiratory distress including inflammation of the lung tissue (
pneumonitis) and build up of excess fluid in the lungs and life-threatening allergic reactions (anaphylactic reactions). If this happens, stop taking Hydrochlorothiazide+Telmisartan and contact your doctor as soon as possible.
Eye Problems
Patients taking Hydrochlorothiazide+Telmisartan are at increased risk of developing eye problems. Hydrochlorothiazide may cause a rare and unpredictable reaction, which may result in poor distance vision (
myopia) and optic nerve damage (angle-closure
glaucoma). Symptoms such as decreased vision clarity or
pain in eyes may occur within a few hours or weeks after starting the therapy. History of penicillin or sulphonamide
allergy is the risk factor for developing optic nerve damage (angle-closure glaucoma). Use of hydrochlorothiazide should be stopped as early as possible. Surgical or medical treatment should be considered when the intraocular pressure remains uncontrolled.
