Hypro-Extra
Generic Name
Telmisartan + Hydrochlorothiazide
Manufacturer
Hypothetical Pharma Ltd.
Country
Bangladesh
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Description
Overview of the medicine
Hypro-Extra is a combination medication used to treat high blood pressure (hypertension). It contains Telmisartan, an angiotensin II receptor blocker (ARB), and Hydrochlorothiazide, a thiazide diuretic. This combination helps to lower blood pressure by relaxing blood vessels and increasing the excretion of salt and water.
Uses & Indications
Dosage
Adults
Typically one tablet (Telmisartan 80 mg / Hydrochlorothiazide 12.5 mg) once daily.
Elderly
No dosage adjustment is generally required, but close monitoring is advised.
Renal_impairment
Not recommended for patients with severe renal impairment (creatinine clearance < 30 mL/min). Dosage adjustments may be needed for moderate impairment.
How to Take
Take orally, once daily, with or without food. Swallow the tablet whole with water. It is advisable to take it at the same time each day.
Mechanism of Action
Telmisartan selectively blocks the angiotensin II receptor (AT1 subtype), preventing angiotensin II from binding and causing vasoconstriction and aldosterone release, thus lowering blood pressure. Hydrochlorothiazide inhibits sodium and chloride reabsorption in the distal convoluted tubule of the nephron, leading to increased excretion of sodium, chloride, and water.
Pharmacokinetics
Onset
Blood pressure reduction seen within 3 hours, full effect within 4-8 weeks.
Excretion
Telmisartan is primarily excreted unchanged in feces via biliary excretion. Hydrochlorothiazide is primarily excreted unchanged in urine.
Half life
Telmisartan: ~24 hours; Hydrochlorothiazide: 6-15 hours.
Absorption
Telmisartan is rapidly absorbed, with bioavailability of approximately 42-58%. Hydrochlorothiazide is also well absorbed (60-80%).
Metabolism
Telmisartan is minimally metabolized via glucuronidation. Hydrochlorothiazide is not metabolized.
Side Effects
Contraindications
- Hypersensitivity to Telmisartan, Hydrochlorothiazide, or sulfonamide-derived drugs
- Pregnancy (second and third trimesters)
- Severe hepatic impairment
- Anuria
- Severe renal impairment
- Concomitant use with aliskiren in diabetic patients
Drug Interactions
NSAIDs
Reduced antihypertensive effect and increased risk of renal impairment.
Digoxin
Increased risk of digoxin toxicity due to hypokalemia induced by hydrochlorothiazide.
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
Corticosteroids
Enhanced electrolyte depletion, particularly hypokalemia.
Potassium-sparing diuretics/potassium supplements
Increased risk of hyperkalemia with Telmisartan; increased risk of hypokalemia with Hydrochlorothiazide alone, but combination balances this, still monitor.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include hypotension, dizziness, tachycardia, bradycardia, electrolyte depletion (hypokalemia, hyponatremia), and dehydration. Treatment is symptomatic and supportive. Induce emesis or perform gastric lavage if recent. Administer intravenous fluids and monitor vital signs and electrolytes.
Pregnancy & Lactation
Not recommended during pregnancy, especially in the second and third trimesters, due to fetal toxicity. Discontinue if pregnancy is detected. Not recommended during lactation due to potential for adverse effects on the infant and reduction in milk production.
Side Effects
Contraindications
- Hypersensitivity to Telmisartan, Hydrochlorothiazide, or sulfonamide-derived drugs
- Pregnancy (second and third trimesters)
- Severe hepatic impairment
- Anuria
- Severe renal impairment
- Concomitant use with aliskiren in diabetic patients
Drug Interactions
NSAIDs
Reduced antihypertensive effect and increased risk of renal impairment.
Digoxin
Increased risk of digoxin toxicity due to hypokalemia induced by hydrochlorothiazide.
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
Corticosteroids
Enhanced electrolyte depletion, particularly hypokalemia.
Potassium-sparing diuretics/potassium supplements
Increased risk of hyperkalemia with Telmisartan; increased risk of hypokalemia with Hydrochlorothiazide alone, but combination balances this, still monitor.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include hypotension, dizziness, tachycardia, bradycardia, electrolyte depletion (hypokalemia, hyponatremia), and dehydration. Treatment is symptomatic and supportive. Induce emesis or perform gastric lavage if recent. Administer intravenous fluids and monitor vital signs and electrolytes.
Pregnancy & Lactation
Not recommended during pregnancy, especially in the second and third trimesters, due to fetal toxicity. Discontinue if pregnancy is detected. Not recommended during lactation due to potential for adverse effects on the infant and reduction in milk production.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months
Availability
Pharmacies, hospitals
Approval Status
Approved by regulatory bodies worldwide
Patent Status
Generic available, original patent expired
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of Telmisartan/Hydrochlorothiazide in reducing blood pressure in patients with essential hypertension. Studies typically show superior blood pressure reduction compared to monotherapy.
Lab Monitoring
- Serum electrolytes (potassium, sodium, magnesium, calcium)
- Renal function (creatinine, BUN)
- Liver function tests
- Blood pressure monitoring
Doctor Notes
- Monitor renal function and electrolytes periodically.
- Educate patients on symptoms of hypotension and electrolyte imbalance.
- Consider dose adjustment in elderly or renally impaired patients, though not always required.
- Advise patients about potential photosensitivity due to hydrochlorothiazide.
Patient Guidelines
- Take medicine regularly as prescribed.
- Do not stop taking the medicine without consulting your doctor.
- Avoid sudden changes in posture to prevent dizziness.
- Report any unusual symptoms to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness or fatigue, especially at the start of treatment or after dose changes. Exercise caution when driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Maintain a healthy diet low in sodium.
- Engage in regular physical activity.
- Avoid smoking and limit alcohol intake.
- Monitor your blood pressure at home regularly.
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