Aliskiren
Contraindicated
Textbook
Increased risk of hypotension, hyperkalemia, and renal impairment.
Avoid concomitant use.
Source: G&G 14e · p603
Drug reference
Telmisartan + Chlorthalidone
Antihypertensive fixed-dose combination (ARB + thiazide-like diuretic) · Antihypertensive
Also known as Telmikind-CH, Tazloc-CT, Telsartan-CH, Arbitel-CH, Telma-CH, Cortel-LN
START
Telmisartan 40 mg / chlorthalidone 12.5 mg PO once daily
TYPICAL MAX
Telmisartan 80 mg / chlorthalidone 25 mg once daily
STOP IF
Pregnancy, severe electrolyte disturbance, or AKI
WATCH
K, Na, creatinine/eGFR, urate, BP at baseline and after changes
CDSCO approvedSchedule HATC C09DA07
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption
- PEAK
- 2h · combined peak
- t½
- 1.7d · chlorthalidone t½
- DURATION
- 1d · once-daily
EXCRETION
Telmisartan biliary; chlorthalidone renal
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated.
FDA category + note
Top interactionssee all 12 →
- AliskirenContraindicatedTextbookG&G 14e · p603
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- Aliskiren In DiabetesContraindicatedDatabaseKimi deep-research + Cla
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
Mechanism
Telmisartan blocks angiotensin II type-1 (AT1) receptors, reducing vasoconstriction and aldosterone; chlorthalidone inhibits Na/Cl reabsorption in the distal tubule, producing mild diuresis — complementary BP lowering with synergistic efficacy.
Indications
Hypertension when telmisartan + chlorthalidone components are appropriate
Dosing
- Adult
- Telmisartan 40 mg/chlorthalidone 12.5 mg PO once daily; titrate to telmisartan 80 mg/chlorthalidone 12.5 or 25 mg once daily.
- Pediatric
- Not established for combination.
- Renal adjustment
- Reduced efficacy of thiazide at CrCl <30; use loop diuretic in advanced CKD.
- Hepatic adjustment
- Severe hepatic impairment: avoid (telmisartan).
- Geriatric
- Start low; volume/electrolyte monitoring.
- Max dose
- Telmisartan 80 mg + chlorthalidone 25 mg once daily
Pharmacokinetics
Onset
BP effect within hours; full effect 2–4 weeks
Peak effect
Telmisartan Tmax 0.5–1 h; chlorthalidone ~2 h
Duration
~24 h (once-daily)
Half-life
Telmisartan ~24 h; chlorthalidone ~40–60 h
Bioavailability
Telmisartan ~50%; chlorthalidone ~64%
Protein binding
Telmisartan >99%; chlorthalidone ~75%
Metabolism
Telmisartan hepatic glucuronidation; chlorthalidone minimal
Excretion
Telmisartan biliary/faecal; chlorthalidone renal
Contraindications
- Pregnancy (RAAS-blocker fetotoxicity)
- Bilateral renal artery stenosis
- Anuria
- Concomitant aliskiren in diabetes
- Sulfonamide hypersensitivity (thiazide)
- Severe hepatic impairment
Side effects
Common
DizzinessHyperuricaemiaHypokalaemiaHyperglycaemiaHeadacheFatigue
Serious
- Hyperkalaemia (with K-sparing/RAAS combination) or hypokalaemia (thiazide)
- Acute kidney injury (volume depletion)
- Severe electrolyte/acid-base disturbance
- Angioedema (rare with ARB)
Pregnancy & lactation
Pregnancy
Contraindicated.
Lactation
Avoid; thiazide may reduce milk supply.
Drug interactions
Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Aliskiren In Diabetes
Contraindicated
Database
Dual RAAS blockade
Avoid combination
Source: Kimi deep-research + Cla
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Benazepril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Captopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalapril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Fosinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Lisinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Moexipril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
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