Hydrochlorothiazide and telmisartan

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Telmisartan is an angiotensin II receptor antagonist. Telmisartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

Hydrochlorothiazide and telmisartan is a combination medicine is used to treat high blood pressure (hypertension). Lowering blood pressure may lower your risk of a stroke or heart attack.

Hydrochlorothiazide and telmisartan may also be used for purposes not listed in this medication guide.

You should not use this medicine if you are allergic to hydrochlorothiazide or telmisartan, if you are unable to urinate.

If you have diabetes, do not use hydrochlorothiazide and telmisartan together with any medication that contains aliskiren (such as Tekturna or Tekamlo).

You may also need to avoid taking hydrochlorothiazide and telmisartan with aliskiren if you have kidney disease.

To make sure hydrochlorothiazide and telmisartan is safe for you, tell your doctor if you have ever had:

• kidney disease;

• liver disease;

• congestive heart failure;

• glaucoma;

• low or high levels of magnesium or potassium in your blood;

• asthma or allergies;

• gout;

• lupus;

• diabetes; or

• an allergy to penicillin or sulfa drugs.

Do not use if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away. Hydrochlorothiazide and telmisartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester.

Hydrochlorothiazide can pass into breast milk and may cause side effects in the nursing baby. You should not breast-feed while using this medicine.

Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take this medicine with or without food.

Your blood pressure will need to be checked often.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medication, which can lead to severely low blood pressure or a serious electrolyte imbalance.

If you need surgery or medical tests, tell the surgeon ahead of time that you are using hydrochlorothiazide and telmisartan.

It may take up to 4 weeks for this medication to control your blood pressure. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Store at room temperature away from moisture and heat. Keep each tablet in its blister pack until you are ready to take it. Gently push the tablet through the foil to remove it.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include fast or slow heart rate, feeling light-headed, or fainting.

Tell your doctor about all your current medicines and any you start or stop using, especially:

• any other heart or blood pressure medications;

• digoxin;

• lithium;

• a diuretic or "water pill";

• insulin or oral diabetes medicine;

• opioid (narcotic) pain medicine;

• a sleeping pill;

• steroid medicine (ACTH);

• a barbiturate such as butabarbital, phenobarbital, or secobarbital; or

• NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

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

Applies to hydrochlorothiazide / telmisartan: oral tablet

Along with its needed effects, hydrochlorothiazide / telmisartan may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking hydrochlorothiazide / telmisartan:

• Bladder pain
• bloody or cloudy urine
• blurred vision
• confusion
• convulsions
• decreased urine
• difficult, burning, or painful urination
• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position
• dry mouth
• fainting
• fast, pounding, or irregular heartbeat or pulse
• frequent urge to urinate
• increased thirst
• irregular heartbeat
• loss of appetite
• lower back or side pain
• muscle pain or cramps
• nausea or vomiting
• numbness or tingling in the hands, feet, or lips
• shortness of breath
• sudden sweating
• unusual tiredness or weakness

• Chills
• cold sweats

• Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Some side effects of hydrochlorothiazide / telmisartan may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• Body aches or pain
• cough
• difficulty breathing
• dizziness
• ear congestion
• fever
• headache
• loss of voice
• runny or stuffy nose
• sneezing
• sore throat

• Abdominal or stomach pain
• acid or sour stomach
• back pain
• belching
• cough producing mucus
• diarrhea
• heartburn
• hoarseness
• indigestion
• joint pain
• loss of appetite
• muscle aches and pains
• pain or tenderness around the eyes and cheekbones
• rash
• shivering
• sweating
• tender, swollen glands in the neck
• tightness in the chest
• trouble sleeping
• trouble swallowing
• voice changes

US BOXED WARNING:
-FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin angiotensin system (RAS) can cause injury and death to the developing fetus.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.