• Dosage of Chlorthalidone (Misart C) in details
• Chlorthalidone (Misart C) interactions
• Dosage of Telmisartan (Misart C) in details
• Telmisartan (Misart C) interactions
• Misart C reviews

Consists of Chlorthalidone, Telmisartan

Dosage of Chlorthalidone (Misart C) in details

Chlorthalidone (Misart C) Dosage

Applies to the following strength(s): 50 mg; 25 mg; 100 mg; 15 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

• Edema
• Hypertension

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Edema

Initial dose: 50-100 mg orally once a day.

Maintenance dose: 25-100 mg once a day or

50-200 mg every other day.

Usual Adult Dose for Hypertension

Initial dose: 25 mg orally once a day (15 mg for Thalitone).

Maintenance dose: 25-100 mg once a day (15-50 mg for Thalitone).

Renal Dose Adjustments

Chlorthalidone (Misart C) is not expected to be filtered into the renal tubule (its site of action) when the glomerular filtration rate is less than 10 mL/min.

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage adjustments are recommended to be made no more frequently than weekly. Patients with liver disease or renal dysfunction should have dosage adjustments made cautiously.

Precautions

Chlorthalidone (Misart C) is contraindicated in patients with anuria.

Chlorthalidone (Misart C) therapy should be used with caution in severe renal disease. In patients with renal disease, Chlorthalidone (Misart C) or related drugs may precipitate azotemia. Cumulative effects may develop in patients with impaired renal function. If progressive renal impairment becomes evident, as indicated by a rising nonprotein nitrogen or blood urea nitrogen, a careful reappraisal of the treatment is necessary with consideration given to withholding or discontinuing diuretic therapy.

Chlorthalidone (Misart C) therapy should be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma.

Sensitivity reactions may be observed in patients with a history of allergy or bronchial asthma.

The possibility of exacerbation or activation of systemic lupus erythematosus has been observed with thiazide diuretics, which are structurally related to Chlorthalidone (Misart C). However, systemic lupus erythematosus has not been observed following Chlorthalidone (Misart C) administration.

Hypokalemia may develop with Chlorthalidone (Misart C) as with any other diuretic, especially with brisk diuresis when severe cirrhosis is present. Interference with adequate oral electrolyte intake will also contribute to hypokalemia.

Any chloride deficit is generally mild and usually does not require specific therapy except under extraordinary circumstances (as in liver disease or renal disease). Dilutional hyponatremia may be observed in edematous patients in hot weather, appropriate therapy is water restriction, rather than administration of salt except in rare instances when the hyponatremia is life threatening. In actual salt depletion, appropriate replacement is the treatment of choice.

Hyperuricemia may occur or frank gout may be precipitated in certain patients receiving Chlorthalidone (Misart C) therapy. Thiazide-like diuretics have been shown to increase the urinary excretion of magnesium, which may result in hypomagnesemia.

The antihypertensive effects Chlorthalidone (Misart C) may be enhanced in the post-sympathectomy patient.

Calcium excretion is decreased by thiazide-like agents. Pathological changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported in few patients on thiazide therapy. The common complications of hyperparathyroidism such as renal lithiasis, bone resorption and peptic ulceration have not been observed.

Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be conducted at appropriate intervals.

Electrolyte abnormalities (i.e., hypokalemia, hyponatremia) and glucose intolerance may occur during Chlorthalidone (Misart C) therapy.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

The maximum daily dose for hypertension is 100 mg (50 mg for Thalitone).

The maximum daily dose for edema is 200 mg (120 mg for Thalitone).

Periodic monitoring of electrolytes is recommended, particularly in elderly patients and in patients receiving a high dose.

More about Chlorthalidone (Misart C)

• Side Effects
• During Pregnancy or Breastfeeding
• Dosage Information
• Drug Images
• Drug Interactions
• Support Group
• Pricing & Coupons
• En Espanol
• 6 Reviews - Add your own review/rating

Consumer resources

• Chlorthalidone (Misart C)
• Chlorthalidone (Misart C) (Advanced Reading)

• Other brands: Thalitone

Professional resources

• Chlorthalidone (Misart C) (AHFS Monograph)
• More (2) »

Related treatment guides

• Edema
• High Blood Pressure

What other drugs will affect Chlorthalidone (Misart C)?

Before using Chlorthalidone (Misart C), tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by Chlorthalidone (Misart C).

• lithium;

• digoxin (Lanoxin);

• steroids (prednisone and others);

• other blood pressure medications; or

• insulin or diabetes medicine taken by mouth.

This list is not complete and there may be other drugs that can interact with Chlorthalidone (Misart C). Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Chlorthalidone (Misart C) interactions

Allopurinol

Concurrent use may increase incidence of hypersensitivity reactions to allopurinol.

Amphotericin B, corticosteroids

May intensify potassium depletion.

Anticholinergics

May increase Chlorthalidone (Misart C) absorption.

Anticoagulants

May diminish anticoagulant effects.

Bile acid sequestrants

May reduce Chlorthalidone (Misart C) absorption. Give Chlorthalidone (Misart C) at least 2 h before bile acid sequestrant.

Calcium salts

Hypercalcemia may develop.

Diazoxide

May cause hyperglycemia.

Digitalis glycosides

Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.

Lithium

May decrease renal excretion of lithium.

Loop diuretics

Synergistic effects may result in profound diuresis and serious electrolyte abnormalities.

Methenamines, NSAIDs

May decrease effectiveness of Chlorthalidone (Misart C).

Sulfonylureas, insulin

May decrease hypoglycemic effect of sulfonylureas.

Laboratory Test Interactions

Increased serum bilirubin levels. Serum magnesium levels in uremic patients may be increased.

Dosage of Telmisartan (Misart C) in details

Telmisartan (Misart C) Dosage

Generic name: TELMISARTAN 20mg

Dosage form: tablet

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

2.1  Hypertension

Dosage must be individualized. The usual starting dose of Telmisartan (Misart C) 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 (Misart C) is required, a diuretic may be added.

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 (Misart C) tablets may be administered with other antihypertensive agents.

Telmisartan (Misart C) tablets may be administered with or without food.

2.2  Cardiovascular Risk Reduction

The recommended dose of Telmisartan (Misart C) tablets is 80 mg once a day and can be administered with or without food. It is not known whether doses lower than 80 mg of telmisartan are effective in reducing the risk of cardiovascular morbidity and mortality.

When initiating Telmisartan (Misart C) therapy for cardiovascular risk reduction, monitoring of blood pressure is recommended, and if appropriate, adjustment of medications that lower blood pressure may be necessary.

More about Telmisartan (Misart C) (telmisartan)

• Side Effects
• During Pregnancy or Breastfeeding
• Dosage Information
• Drug Images
• Drug Interactions
• Support Group
• Pricing & Coupons
• En Espanol
• 25 Reviews - Add your own review/rating
• Generic Availability

Consumer resources

• Telmisartan (Misart C)
• Telmisartan (Misart C) (Advanced Reading)

Professional resources

• Telmisartan (Misart C) (AHFS Monograph)
• Telmisartan (Misart C) (FDA)

Other formulations

• Telmisartan (Misart C) HCT

Related treatment guides

• Cardiovascular Risk Reduction
• High Blood Pressure
• Prevention of Cardiovascular Disease

What other drugs will affect Telmisartan (Misart C)?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with telmisartan, especially:

• digoxin;

• lithium;

• a diuretic or "water pill";

• NSAIDs (non-steroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, or meloxicam, and others; or

• ramipril or other blood pressure medicines.

This list is not complete. Other drugs may interact with telmisartan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Telmisartan (Misart C) interactions

Aliskiren: Do not co-administer aliskiren with Telmisartan (Misart C) in patients with diabetes. Avoid use of aliskiren with Telmisartan (Misart C) in patients with renal impairment (GFR < 60 mL/min).

Digoxin: When Telmisartan (Misart C) was co-administered with digoxin, median increases in digoxin peak plasma concentration (49%) and in trough concentration (20%) were observed. Therefore, monitor digoxin levels when initiating, adjusting, and discontinuing telmisartan for the purpose of keeping the digoxin level within the therapeutic range.

Lithium: Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists including Telmisartan (Misart C). Therefore, monitor serum lithium levels during concomitant use.

Non-Steroidal Anti-Inflammatory Agents 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 telmisartan, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving telmisartan and NSAID therapy.

The antihypertensive effect of angiotensin II receptor antagonists, including telmisartan may be attenuated by NSAIDs including selective COX-2 inhibitors.

Ramipril and Ramiprilat: Co-administration of telmisartan 80 mg once daily and ramipril 10 mg once daily to healthy subjects increases steady-state Cmax and AUC of ramipril 2.3-and 2.1-fold, respectively, and Cmax and AUC of ramiprilat 2.4-and 1.5-fold, respectively. In contrast, Cmax and AUC of telmisartan decrease by 31% and 16%, respectively. When co-administering telmisartan and ramipril, the response may be greater because of the possibly additive pharmacodynamic effects of the combined drugs, and also because of the increased exposure to ramipril and ramiprilat in the presence of telmisartan. Concomitant use of Telmisartan (Misart C) and ramipril is not recommended.

Other Drugs: Co-administration of telmisartan did not result in a clinically significant interaction with acetaminophen, amlodipine, glyburide, simvastatin, hydrochlorothiazide, warfarin, or ibuprofen. Telmisartan is not metabolized by the cytochrome P450 system and had no effects in vitro on cytochrome P450 enzymes, except for some inhibition of CYP2C19. Telmisartan is not expected to interact with drugs that inhibit cytochrome P450 enzymes; it is also not expected to interact with drugs metabolized by cytochrome P450 enzymes, except for possible inhibition of the metabolism of drugs metabolized by CYP2C19.

References

1. DailyMed. "AMLODIPINE BESYLATE; TELMISARTAN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. DailyMed. "ATENOLOL; CHLORTHALIDONE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
3. FDA/SPL Indexing Data. "U5SYW473RQ: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology