Raiyyan Tahsan

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HTN Case No7. Losartan, Olmesartan and Telmisartan.

Losartan, Olmesartan and Telmisartan এর মধ্যে যদি আমরা পার্থক্য খুজতে যাই,

তাহলে জেনে রাখুন,

losartan এর একটা বাড়তি সুবিধা আছে, uric acid কমায়, কারো Gout +HTN থাকলে drug of choice losartan…

Hyperurecemia +HTN =drug of choice হবে losartan,

তবে এইটা BP reduction capacity Olmesartan and Telmisartan থেকে কম,

Olmesartan হচ্ছে সব চেয়ে powerful ARBs

আর Telmisartan এইটার BP reduction capacity প্রায় Olmesartan এর কাছাকাছি , তবে Telmisartan এর দুইটা বাড়তি সুবিধা আছে, এইটা insulin sensitivity বাড়ায়, cholesterol কমায়,

রহিম, newly diagnosed case of HTN,

Secondary cause excluded, serum uric acid raised..

BP: 150/95 mmhg

Write a prescription for him?

Tab- Losartan 25 mg

0+0+1 (4 week পরে f/u)

DM+HTN = Drug of choice Telmisartan

Losartan:-

Tablet 1.Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Indications of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Hypertension: Angilock tablet is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents (eg. thiazide diuretics).

Renal Protection in Type-2 Diabetic Patients with Proteinuria: Angilock tablet is indicated to delay the progression of renal disease in hypertensive type-2 diabetics with proteinuria, defined as urinary albumin to creatinine ratio >300 mg/g.

Pharmacology of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Losartan Potassium is the first non-peptide orally active angiotensin II receptor blocker. It binds to the AT1 receptor found in many tissues (e.g. vascular smooth muscle, adrenal gland, kidneys and the heart) and reduces several important biological actions including vasoconstriction and the release of aldosterone responsible for hypertension.

Dosage & Administration of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

The usual starting and maintenance dose is 50 mg once daily for most patients. If the antihypertensive effect using 50 mg once daily is inadequate, 25 mg twice daily is recommended prior to increasing the dose. For patients with intravascular volume-depletion (e.g., those treated with high-dose diuretics), a starting dose of 25 mg once daily should be considered. Losartan Potassium can be administered once or twice daily. The total daily dose ranges from 25 mg to 100 mg.

Patients upto 75 years: No initial dosage adjustment is necessary for this group of patients.

Patients over 75 years: Presently there is limited clinical experience in this group; a lower starting dose of 25 mg once daily is recommended.

Interaction of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Rifampicin and fluconazole reduce levels of active metabolite of Angilock. Concomitant use of Angilock and hydrochlorothiazide may lead to potentiation of the antihypertensive effects. Concomitant use of potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride), potassium supplements or salt substitutes containing potassium may lead to increases in serum potassium. The antihypertensive effect of losartan may be attenuated by the non-steroidal anti-inflammatory drug indomethacin. The use of ACE-inhibitor, angiotensin receptor antagonist, an anti-inflammatory drug and a thiazide diuretic at the same time increases the risk of renal impairment.

Contraindications of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Losartan Potassium is contraindicated in pregnant women and in patients who are hypersensitive to any component of this product. Losartan Potassium should not be administered with Aliskiren in patients with diabetes.

Side Effects of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

The side effects with the use of Angilock are mild and transient in nature. The most common side effects are dizziness, diarrhea, nasal congestion, cough, upper respiratory infection. Other side effects are fatigue, oedema, abdominal pain, chest pain, nausea, headache & pharyngitis.

Pregnancy & Lactation of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Pregnancy Category D. The risk to the fetus increases if Losartan Potassium is administered during the second or third trimesters of pregnancy. It is not known whether Losartan Potassium is excreted in human milk, as many drugs are excreted in human milk and because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Therapeutic Class of Tablet:-Angilock 100 mg (AS A  Losartan Potassium AS A Angiotensin-ll receptor blocker).

Angiotensin-ll receptor blocke

Olmesartan:-

Tablet 2:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

Indications of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

Olmecar tablet is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents.

Pharmacology of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin converting enzyme (ACE, Kininase II). Angiotensin II is the principal pressor agent of the renin-angiotensin system, with effects that include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation and renal reabsorption of sodium. Olmesartan blocks the vasoconstrictor effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT 1 receptor in vascular smooth muscle. An AT 2 receptor is found also in many tissues, but this receptor is not known to be associated with cardiovascular homeostasis. Olmesartan has more than a 12,500-fold greater affinity for the AT 1 receptor than for the AT 2 receptor. Olmesartan medoxomil does not inhibit ACE (kininase II), it does not affect the response to bradykinin. Blockade of the angiotensin II receptor inhibits the negative regulatory feedback of angiotensin II on renin secretion, but the resulting increased plasma renin activity and circulating angiotensin II levels do not overcome the effect of olmesartan on blood pressure.

Dosage & Administration of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

Dosage must be individualized. The usual recommended starting dose of Olmesartan is 20 mg once daily when used as monotherapy in patients who are not volume-contracted. For patients requiring further reduction in blood pressure after 2 weeks of therapy, the dose of Olmesartan may be increased to 40 mg. Doses above 40 mg do not appear to have a greater effect. Twice-daily dosing offers no advantage over the same total dose given once daily.

No initial dosage adjustment is recommended for elderly patients, for patients with moderate to marked renal impairment (creatinine clearance <40 ml/min) or with moderate to marked hepatic dysfunction. For patients with possible depletion of intravascular volume (e.g. patients treated with diuretics, particularly those with impaired renal function), Olmesartan should be initiated under close medical supervision and consideration should be given to use of a lower starting dose. Olmesartan may be administered with or without food.

Paediatric use: Safety and effectiveness in paediatric patients have not been established.

Interaction of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

No significant drug interactions were reported in studies in which Olmecar was co-administered with digoxin or warfarin in healthy volunteers. The bioavailability of olmesartan was not significantly altered by the co-administration of antacids. Olmecar is not metabolized by the cytochrome P450 system and has no effects on P450 enzymes; thus, interactions with drugs that inhibit, induce, or are metabolized by those enzymes are not expected. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) including selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including Olmecar, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving Olmecar and NSAID therapy. The antihypertensive effect of angiotensin II receptor antagonists, including Olmecar may be attenuated by NSAIDs including selective COX-2 inhibitors.

Contraindications of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

Olmesartan is contraindicated in patients who are hypersensitive to any component of this product.

Side Effects of Tablet 4.Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

Olmecar has been evaluated for safety in more than 3825 patients/subjects, including more than 3275 patients treated for hypertension in controlled trials. Treatment with Olmecar was well tolerated, with an incidence of adverse reactions similar to placebo. The overall frequency of adverse reactions was not dose related. Analysis of gender, age and race groups demonstrated no differences between Olmecar and placebo treated patients. The rate of withdrawals due to adverse reactions in all trials of hypertensive patients was 2.4% of patients treated with Olmecar and 2.7% of control patients. In placebo controlled trials, the only adverse reaction that occurred in more than 1% of patients treated with Olmecar and at a higher incidence versus placebo was dizziness (3% vs. 1%)

The following adverse reactions occurred in placebo-controlled clinical trials at an incidence of more than 1% of patients treated with Olmecar, but also occurred at about the same or greater incidence in patients receiving placebo: back pain, bronchitis, creatine phosphokinase increased, diarrhea, headache, hematuria, hyperglycemia, hypertriglyceridemia, influenza-like symptoms, pharyngitis, rhinitis and sinusitis. The incidence of cough was similar in placebo (0.7%) and Olmecar (0.9%) patients.

Pregnancy & Lactation of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

When pregnancy is detected, discontinue this product as soon as possible. When used in pregnancy during the second and third trimesters, drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus. It is not known whether Olmesartan is excreted in human milk, but Olmesartan is secreted at low concentration in the milk of lactating rats. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals treated with Olmecar. In patients whose renal function may depend upon the activity of the renin-angiotensin-aldosterone system (e.g. patients with severe congestive heart failure), treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. Similar results may be anticipated in patients treated with Olmecar.

Overdose Effects of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

There is no experience of overdose with Olmecar. The most likely effects of Olmecar overdosage are hypotension and tachycardia; bradycardia could be encountered if parasympathetic (vagal) stimulation occurred. If intake is recent, gastric lavage or induction of emesis may be considered. Clinically significant hypotension due to an overdose of Olmecar requires the active support of the cardiovascular system, including close monitoring of heart and lung function, the elevation of the extremities, and attention to circulating fluid volume and urine output.

Therapeutic Class of Tablet:-Olmecar 40mg (AS A Olmesartan Medoxomil Angiotensin-ll receptor blocker).

 

Angiotensin-ll receptor blocker

Telmisartan:-

Tablet 3: Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

0+0+1 (continue) F/U 4 weeks later.

Indications of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

Telmicard is indicated in-

Hypertension: Treatment of essential hypertension in adults.
Cardiovascular prevention: Reduction of cardiovascular morbidity in adults with:

  • Atherothrombotic cardiovascular disease (history of coronary heart disease, stroke, or peripheral arterial disease) or
  • Type 2 diabetes mellitus with documented target organ damage.

Pharmacology of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

Telmisartan is a non-peptide angiotensin-ll receptor antagonist. Angiotensin-ll is formed from angiotensin-l in a reaction catalyzed by angiotensin converting enzyme. Angiotensin-ll is the principal agent of the renin-angiotensin system, with effects that include vasoconstriction, stimulation of synthesis and release of aldosterone, cardiac stimulation, and renal reabsorption of sodium. Telmisartan blocks the vasoconstrictor and aldosterone secreting effects of angiotensin-ll by selectively blocking the binding of angiotensin-ll to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. Its action is therefore independent of the pathways for angiotensin-ll synthesis. Telmisartan has much greater affinity (>3,000 fold) for the AT1 receptor than for the AT2 receptor. Because Telmisartan does not inhibit ACE (kininase-ll), it does not affect the response to bradykinin. Telmisartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation.

Dosage & Administration of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

Dosage must be individualized. The usual starting dose of Telmisartan tablets is 40 mg once a day. Blood pressure response is dose-related over the range of 20 to 80 mg. Most of the antihypertensive effect is apparent within 2 weeks and maximal reduction is generally attained after 4 weeks. When additional blood pressure reduction beyond that achieved with 80 mg Telmisartan is required, may switch to the combination. No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis. Patients on dialysis may develop orthostatic hypotension; their blood pressure should be closely monitored. Telmisartan tablets may be administered with other antihypertensive agents. Telmisartan tablets may be administered with or without food. Initial therapy with Telmisartan is not recommended in patients ≥75 years old or with hepatic impairment.

Pediatric use: The safety and effectiveness of Telmisartan in pediatric patients have not been established.

Geriatric use: No overall differences in effectiveness and safety were observed in these patients compared to younger patients.

Hepatic impairment: Monitor carefully and up titrate slowly in patients with biliary obstructive disorders or hepatic insufficiency.

Interaction of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

  • NSAIDS: Increased risk of renal impairment and loss of antihypertensive effect.
  • Co-administration with aliskiren with Telmicard: in patients with diabetes should be avoided.

Contraindications of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

Known hypersensitivity to this product or any of its components.

Side Effects of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

In hypertensive patients: The most common side effects of Telmicard tablets include sinus pain and congestion (sinusitis), back pain, diarrhea etc.

For patients of cardiovascular risk reduction: The most common side effects of Telmicard tablets in CV risk reduction include intermittent claudication and skin ulcer.

Pregnancy & Lactation of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

Pregnancy Category C (first trimester) and D (second and third trimester). Because of the potential for adverse effects on the nursing infant, decide whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings

  • Avoid fetal or neonatal exposure.
  • Hypotension.
  • Monitor carefully in patients with impaired hepatic or renal function.
  • Avoid concomitant use of an ACE inhibitor and angiotensin receptor blocker.

Overdose Effects of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

The most likely manifestation of overdosage with Telmicard tablets would be hypotension, dizziness and tachycardia; bradycardia, increase in serum creatinine and acute renal failure could occur from parasympathetic (vagal) stimulation.

Therapeutic Class of Tablet : -Telmicard 40 mg (As A Telmisartan As A Angiotensin-ll receptor blocker).

Angiotensin-ll receptor blocker

Raiyyan Tahsan Date:-27-01-2025 Monday Time:-6-18-55 Pm

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