Meta Information
ID:telmisartan
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan can cause significant injury or death to a developing fetus, particularly when taken during the second and third trimesters.
Actionable advice:
This should not be taken during pregnancy and should be stopped immediately if pregnancy occurs; it is important to consult a doctor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Drugs that act directly on the renin-angiotensin system can cause injury
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/class/ace-inhibitors
Target name:
ACE Inhibitors
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining telmisartan with an ACE inhibitor (e.g., lisinopril, ramipril) constitutes dual RAAS blockade, which significantly increases the risk of hyperkalemia (high potassium), hypotension (low blood pressure), and acute kidney injury without providing additional benefit.
Actionable advice:
Telmisartan should not be used in combination with any ACE inhibitor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Avoid concomitant use of an ACE inhibitor and angiotensin receptor
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/intervention/aliskiren
Target name:
Aliskiren
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The combination of telmisartan and aliskiren (a direct renin inhibitor) is contraindicated, especially in patients with diabetes or renal impairment, due to a high risk of severe adverse events including kidney failure, hyperkalemia, and hypotension.
Actionable advice:
Telmisartan and aliskiren should not be taken together, especially in diabetes or kidney disease.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Avoid concomitant use of an ACE inhibitor and angiotensin receptor
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/class/potassium-sparing-diuretics
Target name:
Potassium-Sparing Diuretics
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan decreases aldosterone, reducing potassium excretion. Co-administration with potassium-sparing diuretics (e.g., spironolactone, eplerenone, amiloride) can lead to dangerously high potassium levels (hyperkalemia), which can cause cardiac arrhythmias.
Actionable advice:
This combination should be avoided unless under strict medical supervision with frequent potassium monitoring.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes or other drugs that increase potassium levels
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/intervention/potassium
Target name:
Potassium Supplements
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking potassium supplements while on telmisartan can easily lead to hyperkalemia (high potassium levels) because the drug already reduces your body's ability to excrete potassium.
Actionable advice:
Potassium supplements should not be taken unless specifically prescribed and monitored by a doctor.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
potassium supplements, potassium-sparing diuretics, potassium-containing salt substitutes or other drugs that increase potassium levels
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/biomarker/serum-potassium
Target name:
Serum Potassium Levels
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Because telmisartan can increase potassium levels, regular monitoring is essential to prevent hyperkalemia, a condition that can affect heart rhythm.
Actionable advice:
Serum potassium levels should be checked periodically as recommended by a healthcare provider.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Consider periodic determinations of serum electrolytes to detect possible electrolyte imbalances
Label source:
FDA label: Telmisartan (Micardis)
Action type:
monitor
Target id:
/biomarker/egfr
Target name:
Kidney Function (eGFR, Creatinine)
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan can affect renal blood flow and function, particularly at the start of therapy or in susceptible individuals. Monitoring is crucial to ensure renal safety.
Actionable advice:
Kidney function (creatinine and eGFR) should be checked before starting and periodically during treatment.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Monitor carefully in patients with impaired hepatic
Label source:
FDA label: Telmisartan (Micardis)
Action type:
monitor
Target id:
/intervention/lithium
Target name:
Lithium (Medication)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan can decrease the kidneys' ability to clear lithium from the body, leading to elevated lithium levels and a high risk of toxicity.
Actionable advice:
This combination should be avoided. If unavoidable, serum lithium levels must be monitored very closely.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists including MICARDIS
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
NSAIDs (e.g., ibuprofen, naproxen) can reduce the blood pressure-lowering effect of telmisartan and, especially in dehydrated or elderly individuals, increase the risk of acute kidney damage.
Actionable advice:
Long-term use of NSAIDs is best avoided. For occasional use, staying well-hydrated is a good idea, and it is worth monitoring blood pressure.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
NSAIDS: Increased risk of renal impairment and loss of anti- hypertensive effect
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/class/antihypertensives
Target name:
Other Antihypertensive Medications
Severity:
moderate
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Using telmisartan with other blood pressure-lowering drugs has an additive effect, which can increase the risk of hypotension (dizziness, fainting). This is often a therapeutic goal but requires careful monitoring.
Actionable advice:
Blood pressure should be monitored regularly, especially when starting or adjusting the dose of another antihypertensive.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
MICARDIS tablets may be administered with other antihypertensive agents
Label source:
FDA label: Telmisartan (Micardis)
Action type:
monitor
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Patients with pre-existing kidney disease are at higher risk for further decline in renal function, hypotension, and hyperkalemia when taking telmisartan.
Actionable advice:
This is best used with caution under medical supervision; dose adjustments and frequent monitoring of kidney function and potassium are necessary.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
Monitor carefully in patients with impaired hepatic
Label source:
FDA label: Telmisartan (Micardis)
Action type:
adjust_with_prescriber
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan is cleared from the body primarily via the liver and bile. Impaired liver function can significantly increase drug levels, raising the risk of side effects.
Actionable advice:
This is best used with caution at a lower dose in mild-to-moderate liver impairment, and is best avoided in severe cases.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
As the majority of telmisartan is eliminated by biliary excretion, patients with biliary obstructive disorders or hepatic insufficiency can be expected to have reduced clearance
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/condition/dehydration
Target name:
Dehydration or Volume Depletion
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
In a dehydrated state (e.g., from diuretics, diarrhea, or vomiting), starting telmisartan can cause a sharp drop in blood pressure and increase the risk of kidney dysfunction.
Actionable advice:
It is a good idea to be adequately hydrated before starting telmisartan, and any volume depletion is best corrected.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur
Label source:
FDA label: Telmisartan (Micardis)
Action type:
informational_none
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if telmisartan passes into human breast milk, but due to the potential for serious harm to the nursing infant, it is generally not recommended.
Actionable advice:
It is important to talk to a doctor about the risks and benefits, as an alternative medication may be preferred while breastfeeding.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
It is not known whether telmisartan is excreted in human milk, but telmisartan was shown to be present in the milk of lactating rats
Label source:
FDA label: Telmisartan (Micardis)
Action type:
informational_none
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan can slightly increase the concentration of digoxin in the blood, which may enhance its effects and potential for toxicity.
Actionable advice:
If taking both medications, your doctor may need to monitor your digoxin levels, especially when starting or stopping telmisartan.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
median increases in digoxin peak plasma concentration (49%) and in trough concentration (20%) were observed
Label source:
FDA label: Telmisartan (Micardis)
Action type:
monitor
Target id:
/dietary/potassium-salt-substitutes
Target name:
Potassium-Containing Salt Substitutes
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Salt substitutes often contain potassium chloride instead of sodium chloride. Using these products while taking telmisartan can significantly increase potassium intake and risk of hyperkalemia.
Actionable advice:
Salt substitutes that contain potassium should not be used.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
potassium-containing salt substitutes or other drugs that increase potassium levels
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/dietary/potassium-rich-foods
Target name:
High-Potassium Foods
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
While normal dietary intake is generally safe, excessive consumption of foods very high in potassium (e.g., potatoes, spinach, avocados, bananas) can contribute to elevated potassium levels.
Actionable advice:
A normal, balanced diet is generally best maintained, and excessive amounts of high-potassium foods are best avoided.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
potassium-containing salt substitutes or other drugs that increase potassium levels
Label source:
FDA label: Telmisartan (Micardis)
Action type:
avoid
Target id:
/class/ampk-activators
Target name:
AMPK Activators (e.g., Metformin, Berberine)
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Telmisartan acts as a partial PPAR-gamma agonist, which can improve insulin sensitivity. This action may complement the metabolic benefits of AMPK activators, potentially enhancing metabolic health.
Actionable advice:
This combination may offer synergistic metabolic benefits, but monitor blood glucose and blood pressure for additive effects.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
FDA label: Telmisartan (Micardis)
Action type:
monitor
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
informational
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The absorption and effectiveness of telmisartan are not significantly affected by food, which provides flexibility in administration.
Actionable advice:
Telmisartan is generally best taken at the same time each day, either with or without food, to maintain consistent levels.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Exact phrase from label:
May be administered with or without food
Label source:
FDA label: Telmisartan (Micardis)
Action type:
informational_none
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
null
Description:
Some evidence suggests that bedtime dosing of antihypertensives may improve control of nighttime blood pressure and potentially reduce cardiovascular risk, though this is not definitive for all individuals.
Actionable advice:
Consider taking your daily dose about an hour before bedtime, but confirm this timing strategy with your doctor.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
FDA label: Telmisartan (Micardis)
Action type:
separate