ARB Plus Special Precautions

Hepatic Impairment: Telmisartan and Hydrochlorothiazide should not be given to patients with cholestasis, biliary obstructive disorders or severe hepatic insufficiency since telmisartan is mostly eliminated with the bile. These patients can be expected to have reduced hepatic clearance for telmisartan.
Renovascular hypertension: There is an increased risk of sever hypotension and renal insufficiency when patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney are treated with medicinal products that affect the renin-angiotensin-aldosterone system.
The use of telmisartan in combination with aliskiren is contraindicated in patients with diabetes mellitus or renal impairment (GFR<60ml/min/1.73m²).
Metabolic and endocrine effects: Thiazide therapy may impair glucose tolerance whereas hypoglycaemic may occur in diabetic patients under insulin or antidiabetic therapy and telmisartan treatment.
Therefore, in these patients, blood glucose monitoring should be considered; a dose adjustment of insulin or antidiabetics may be required, when indicated. Latent diabetes mellitus may become manifest during thiazide therapy.