A fixed-dose combination (FDC) of an Angiotensin II Receptor Blocker (ARB) and an Angiotensin-Converting Enzyme (ACE) inhibitor. This dual renin-angiotensin-aldosterone system (RAAS) blockade provides synergistic antihypertensive and cardioprotective effects, offering superior blood pressure control and potential organ protection compared to monotherapy, particularly in high-risk hypertensive patients with diabetes or chronic kidney disease.
Adult: One tablet (Telmisartan 40mg + Ramipril 5mg) once daily. Initiation with this FDC is not recommended. Therapy should be initiated after individual titration of each component. Dose may be increased to Telmisartan 80mg + Ramipril 10mg (as separate tablets or higher strength FDC if available) if needed and tolerated.
Note: Can be taken with or without food, but consistency is advised. Preferably taken at the same time each day, often in the morning to control daytime BP. If taken once daily and BP is not controlled over 24 hours, consider evening dosing or divided doses (as separate components). Ensure adequate hydration. Do not crush or chew.
Provides dual blockade of the Renin-Angiotensin-Aldosterone System (RAAS). Ramipril inhibits the Angiotensin Converting Enzyme (ACE), reducing the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II and decreasing the breakdown of bradykinin (a vasodilator). Telmisartan selectively and competitively blocks the binding of Angiotensin II to the AT1 receptor subtype, which mediates vasoconstriction, aldosterone secretion, and sympathetic activation. This dual action results in more complete RAAS suppression, leading to vasodilation, reduced aldosterone secretion (decreasing sodium/water retention), and decreased cardiac afterload and preload.
Pregnancy: CONTRANDICATED in second and third trimesters (Pregnancy Category D). Can cause fetal injury and death, including oligohydramnios, fetal hypocalvaria, renal failure, and limb contractures. Discontinue as soon as pregnancy is detected.
Driving: Caution advised, especially during initiation and dose adjustment, due to potential dizziness, lightheadedness, or fatigue.
| Diuretics (especially Potassium-Sparing: Spironolactone, Amiloride) | Profound first-dose hypotension; Severe hyperkalemia | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduced antihypertensive effect; Risk of acute renal failure; Increased hyperkalemia | Major |
| Lithium | Increased serum lithium levels and toxicity | Major |
| Aliskiren | Increased risk of hyperkalemia, hypotension, and renal impairment (contraindicated in diabetes/CKD) | Major |
| Potassium Supplements/Salt Substitutes | Increased risk of hyperkalemia | Major |
| Other Antihypertensives (Beta-blockers, CCBs) | Additive hypotensive effect | Moderate |
| Antidiabetics (Insulin, Sulfonylureas) | Enhanced hypoglycemic effect | Moderate |
| Gold Injections (Sodium aurothiomalate) | Increased risk of nitritoid reactions (flushing, hypotension) with Ramipril | Moderate |
Same composition (Telmisartan (40mg) + Ramipril (5mg)), different brands: