Repace-H
Generic Name
Telmisartan 50 mg + Hydrochlorothiazide 12.5 mg Tablet
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| repace h 50 mg tablet | ৳ 8.03 | ৳ 80.30 |
Description
Overview of the medicine
Repace-H 50 mg Tablet is a combination medicine containing Telmisartan (an Angiotensin II Receptor Blocker) and Hydrochlorothiazide (a thiazide diuretic). It is primarily used to treat essential hypertension (high blood pressure) when monotherapy is not sufficient or when combination therapy is deemed appropriate by a physician.
Uses & Indications
Dosage
Adults
The usual recommended dose is one tablet (Telmisartan 50 mg + Hydrochlorothiazide 12.5 mg) once daily. The maximum recommended dose is Telmisartan 80 mg + Hydrochlorothiazide 25 mg once daily.
Elderly
No dose adjustment is generally required for elderly patients.
Renal_impairment
Not recommended for patients with severe renal impairment (creatinine clearance < 30 mL/min). No dose adjustment is usually needed for mild to moderate renal impairment, but regular monitoring is advised.
How to Take
Take orally, once daily, with or without food. Swallow the tablet whole with a glass of water. It is advisable to take it at the same time each day.
Mechanism of Action
Telmisartan selectively blocks the AT1 receptor, preventing angiotensin II from binding and causing vasoconstriction and aldosterone secretion, thus lowering blood pressure. Hydrochlorothiazide inhibits sodium reabsorption in the distal convoluted tubule, increasing the excretion of sodium, chloride, and water, which reduces blood volume and blood pressure.
Pharmacokinetics
Onset
Telmisartan: Antihypertensive effect within 3 hours, maximum effect within 4-8 weeks. Hydrochlorothiazide: Diuresis within 2 hours.
Excretion
Telmisartan: Primarily excreted unchanged in feces (>97%). Hydrochlorothiazide: Primarily excreted unchanged in urine.
Half life
Telmisartan: Approx 24 hours. Hydrochlorothiazide: 5.6-14.8 hours.
Absorption
Telmisartan: Rapidly absorbed, bioavailability is dose-dependent (approx 42% for 40 mg). Food can slightly reduce bioavailability. Hydrochlorothiazide: Rapidly absorbed, absolute bioavailability is 65-75%.
Metabolism
Telmisartan: Primarily metabolized by glucuronidation. Hydrochlorothiazide: Not metabolized.
Side Effects
Contraindications
- Hypersensitivity to Telmisartan, Hydrochlorothiazide, or any sulfonamide-derived drugs.
- Pregnancy (especially second and third trimesters).
- Severe hepatic impairment, cholestasis, biliary obstructive disorders.
- Severe renal impairment (creatinine clearance < 30 mL/min), anuria.
- Hereditary angioedema related to previous ACE inhibitor or ARB therapy.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
Drug Interactions
Digoxin
Increased digoxin levels and toxicity due to hydrochlorothiazide-induced hypokalemia.
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
Corticosteroids, ACTH
Intensified electrolyte depletion (hypokalemia).
Other Antihypertensives
Additive hypotensive effect.
Alcohol, Barbiturates, Narcotics
Orthostatic hypotension may be aggravated.
NSAIDs (e.g., ibuprofen, naproxen)
Reduced antihypertensive effect; increased risk of renal impairment, especially in dehydrated or elderly patients.
Colestyramine and colestipol resins
May impair absorption of hydrochlorothiazide.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, dizziness, tachycardia, bradycardia, electrolyte imbalance (e.g., hypokalemia, hyponatremia), and dehydration. Management is supportive and symptomatic, focusing on restoring fluid and electrolyte balance.
Pregnancy & Lactation
Contraindicated during pregnancy, especially in the second and third trimesters, due to risks of fetal injury and death. It is not recommended during breastfeeding as both components are excreted in milk.
Side Effects
Contraindications
- Hypersensitivity to Telmisartan, Hydrochlorothiazide, or any sulfonamide-derived drugs.
- Pregnancy (especially second and third trimesters).
- Severe hepatic impairment, cholestasis, biliary obstructive disorders.
- Severe renal impairment (creatinine clearance < 30 mL/min), anuria.
- Hereditary angioedema related to previous ACE inhibitor or ARB therapy.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
Drug Interactions
Digoxin
Increased digoxin levels and toxicity due to hydrochlorothiazide-induced hypokalemia.
Lithium
Increased serum lithium concentrations and toxicity. Monitor lithium levels.
Corticosteroids, ACTH
Intensified electrolyte depletion (hypokalemia).
Other Antihypertensives
Additive hypotensive effect.
Alcohol, Barbiturates, Narcotics
Orthostatic hypotension may be aggravated.
NSAIDs (e.g., ibuprofen, naproxen)
Reduced antihypertensive effect; increased risk of renal impairment, especially in dehydrated or elderly patients.
Colestyramine and colestipol resins
May impair absorption of hydrochlorothiazide.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, dizziness, tachycardia, bradycardia, electrolyte imbalance (e.g., hypokalemia, hyponatremia), and dehydration. Management is supportive and symptomatic, focusing on restoring fluid and electrolyte balance.
Pregnancy & Lactation
Contraindicated during pregnancy, especially in the second and third trimesters, due to risks of fetal injury and death. It is not recommended during breastfeeding as both components are excreted in milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 24 to 36 months from the date of manufacture. Refer to the packaging for specific expiry date.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Generic available
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of Telmisartan/Hydrochlorothiazide combination therapy in reducing blood pressure and improving cardiovascular outcomes in patients with essential hypertension.
Lab Monitoring
- Serum electrolytes (especially potassium and sodium) periodically.
- Renal function (serum creatinine, BUN) before and during treatment.
- Liver function tests.
- Blood pressure monitoring regularly.
Doctor Notes
- Emphasize the importance of consistent daily dosing.
- Educate patients on symptoms of hypotension (dizziness, lightheadedness) and electrolyte imbalance (muscle cramps, weakness).
- Monitor renal function and serum electrolytes periodically, especially in patients with pre-existing renal impairment or those on concomitant medications that affect electrolytes.
- Advise patients about the increased risk of non-melanoma skin cancer with long-term HCTZ use and to report any new skin lesions.
Patient Guidelines
- Take Repace-H exactly as prescribed by your doctor.
- Do not stop taking the medicine suddenly without consulting your doctor, even if you feel well.
- Monitor your blood pressure regularly as advised by your healthcare provider.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
- Report any unusual or severe side effects immediately to your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next scheduled dose. In that case, 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
This medicine may cause dizziness, lightheadedness, or fatigue, especially at the start of treatment or when changing doses. Exercise caution when driving or operating machinery until you know how Repace-H affects you.
Lifestyle Advice
- Maintain a healthy lifestyle by adopting a balanced, low-sodium, low-fat diet.
- Engage in regular physical activity as recommended by your doctor.
- Limit alcohol intake and avoid smoking to help manage blood pressure.
- Manage stress effectively through relaxation techniques or hobbies.
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