A fixed-dose combination (FDC) of an angiotensin II receptor blocker (ARB) and a cardioselective beta-1 adrenergic blocker. Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II, while Metoprolol Succinate reduces heart rate, cardiac output, and renin release. This combination provides synergistic blood pressure control and is particularly effective in hypertensive patients with high sympathetic drive, tachycardia, or coexisting conditions like stable coronary artery disease.
Adult: One tablet (Telmisartan 40mg + Metoprolol Succinate 25mg) once daily, preferably in the morning. Dose may be titrated upwards after 2-4 weeks to a maximum of Telmisartan 80mg + Metoprolol Succinate 50mg or 100mg per day, based on response and tolerability.
Note: Swallow the tablet whole with a glass of water, with or without food. Do not crush, chew, or split the tablet as it contains an extended-release formulation of Metoprolol. Take at the same time each day. If a dose is missed, take it as soon as remembered unless it is close to the next dose. Do not double the dose.
The combination exerts a dual mechanism for blood pressure reduction. Telmisartan selectively and competitively antagonizes the binding of angiotensin II to the AT1 receptor in vascular smooth muscle and adrenal glands, blocking vasoconstriction and aldosterone release. Metoprolol Succinate competitively blocks beta-1 adrenergic receptors in the heart, reducing heart rate, myocardial contractility, and renin secretion from the kidneys. The net effect is a reduction in peripheral vascular resistance and cardiac output.
Pregnancy: CONTRANDICATED in second and third trimesters (Pregnancy Category D). Drug exposure during these trimesters can cause injury and death to the developing fetus (oligohydramnios, renal failure, skull hypoplasia, contractures). Discontinue as soon as pregnancy is detected. First trimester use should be avoided unless absolutely necessary.
Driving: May cause dizziness, fatigue, or visual disturbances, especially during initiation or dose escalation. Patients should not drive or operate machinery until their individual response is known.
| Other Antihypertensives (Diuretics, CCBs, ACEIs) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Digoxin | Metoprolol may increase digoxin concentration; risk of bradycardia. | Moderate |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect of Telmisartan; risk of renal impairment. | Moderate |
| Lithium | Telmisartan may increase lithium levels and toxicity risk. | Major |
| Potassium-sparing diuretics (Spironolactone) / Potassium supplements | Increased risk of hyperkalemia with Telmisartan. | Major |
| Clonidine | Risk of rebound hypertension if clonidine is withdrawn while on beta-blocker. | Major |
| Verapamil, Diltiazem | Additive negative chronotropic and inotropic effects; risk of severe bradycardia, AV block. | Major |
| Insulin, Sulfonylureas | Metoprolol may mask hypoglycemic symptoms (tachycardia) and potentiate hypoglycemia. | Moderate |
| CYP2D6 Inhibitors (Fluoxetine, Paroxetine, Quinidine) | Increase Metoprolol plasma levels, increasing risk of bradycardia. | Moderate |
| Beta-2 Agonists (Salbutamol) | Antagonistic effect; may reduce bronchodilator efficacy. | Moderate |
Same composition (Telmisartan (40mg) + Metoprolol Succinate (25mg)), different brands: