6 Telmisartan (Micardis) Interactions and How to Manage Them

Telmisartan (Micardis) is an oral medication that’s used to treat high blood pressure. It belongs to a class of medications called angiotensin II receptor blockers (ARBs). Telmisartan works on a system in your body that regulates blood pressure as well as fluid and electrolyte balance. Other medication classes also work on this system. But what happens if you take medications from those classes together?

These combinations and others can result in drug interactions with telmisartan. Many interactions are managed upfront by your healthcare team. But it’s a good idea to be aware of other potential interactions, especially if you take over-the-counter (OTC) products. Below, we cover six telmisartan interactions you should know about.

1. ACE inhibitors like lisinopril

Like ARBs, angiotensin-converting enzyme (ACE) inhibitors are common blood pressure medications. Examples include lisinopril (Zestril), enalapril (Vasotec), and benazepril (Lotensin). ACE inhibitors work on the same system in the body as ARBs to manage blood pressure.

But it’s recommended to avoid taking ARBs, such as telmisartan, with ACE inhibitors. Since they work in a similar way, there aren’t any extra health benefits expected from taking both types of medication. What's more, this combination also raises your risk of side effects, such as low blood pressure, kidney problems, and high potassium.

You’ll typically be prescribed either an ACE inhibitor or an ARB to avoid this interaction.

2. Medications that increase potassium

Several types of medications can increase potassium levels in the body. Telmisartan, along with other ARBs, is one example. Combining telmisartan with other medications that raise potassium can increase the risk of hyperkalemia (high potassium levels). Having kidney problems or heart failure can increase this risk even more.

Disclosure

Telmisartan

Avg retail price

$122.36(Save 85.91%)

GoodRx discount

$17.24

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

Medications that can increase potassium levels include:

• ACE inhibitors

• Mineralocorticoid receptor antagonists, such as spironolactone (Aldactone), eplerenone (Inspra), and finerenone (Kerendia)

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)

• Digoxin (Lanoxin)

• Aliskiren (Tekturna)

• Potassium supplements

You may not realize your potassium levels are higher than normal. Because of this, your potassium levels will typically be checked periodically while you’re taking telmisartan. If needed, your regimen may be adjusted. But if your levels are very high, you may need further treatment.

In severe cases, hyperkalemia can result in dangerous abnormal heart rhythms. Call 911 or have someone take you to the nearest ER if you develop symptoms such as a fast or irregular heartbeat, muscle weakness, or chest pain.

3. Digoxin

Digoxin is a medication that treats heart failure and abnormal heart rhythms. It can interact with telmisartan a few different ways. As mentioned above, both medications can increase potassium levels. But telmisartan can also raise digoxin levels, increasing the risk of digoxin toxicity.

It’s OK to take the medications together if your prescriber recommends it. But they may want to check your digoxin levels more often to make sure they’re in a safe and effective range. This includes when you start or stop telmisartan and after dosage changes.

If your digoxin levels are too high, you may have symptoms such as nausea, vomiting, and diarrhea. Vision changes, such as yellow or green-tinted vision, are also possible. Tell your medical care team right away if these symptoms develop.

4. Lithium

Lithium (Lithobid) is used to treat mental health conditions such as bipolar disorder. When it’s taken with telmisartan, lithium levels in your body can go up. This can increase the risk of side effects and lithium toxicity. Other ARBs and ACE inhibitors can also have this effect on lithium.

Mild symptoms of lithium toxicity can include nausea and vomiting, diarrhea, and fatigue. More serious symptoms can include confusion, a fast heartbeat, and worsening shakiness (tremor). Tell your healthcare team right away if you notice new or worsening symptoms. But seek emergency medical care if any symptoms are severe.

Your lithium levels will typically be monitored during treatment to keep them in a safe and effective range. If needed, your lithium dosage may be adjusted when starting, adjusting, or stopping telmisartan.

5. NSAIDs like ibuprofen

NSAIDs are a common class of pain and fever relief medications. Examples include ibuprofen and naproxen (Aleve, Naprosyn). NSAIDs can interact with telmisartan a few different ways.

In addition to raising potassium levels, NSAIDs can increase the risk of kidney damage with telmisartan. This interaction is more likely if you’re an older adult, have pre-existing kidney problems, or are taking a diuretic (water pill). What’s more, NSAIDs may also make telmisartan less effective at managing your blood pressure.

Be sure to check with your healthcare team before taking NSAIDs with telmisartan. This is especially important for OTC NSAIDs, since they don’t require a prescription. Your care team may not be aware if you start taking an OTC NSAID on your own.

Your care team may say that taking an NSAID every now and then is OK. But if you’re taking an NSAID regularly for chronic pain, they may want to monitor your kidneys more closely. Or they may recommend a different pain medication that’s safer for your kidneys.

6. Aliskiren

Aliskiren is a blood pressure medication that can interact with telmisartan. This is because it works on the same system as ARBs and ACE inhibitors. And similar to the interaction with ACE inhibitors, there’s a higher risk of side effects without added benefits.

It’s best to avoid taking aliskiren with telmisartan, especially if you have diabetes. If you need more help lowering your blood pressure, your prescriber can suggest safer options that don’t interact the same way.

When should you contact your prescriber about telmisartan interactions?

If you have any questions about telmisartan interactions, it’s a good idea to ask your healthcare team. And be sure to provide your current medication list so potential interactions can be addressed ahead of time.

Your prescriber may periodically check your blood work during follow-up appointments. This will help them catch potential issues that may result from an interaction, such as high potassium levels and kidney damage. If needed, they may adjust your medication regimen.

But if you develop new or worsening side effects before your next appointment, don’t wait to tell them. And if any symptoms feel severe or life-threatening, you should go to the nearest ER.

Why trust our experts?

Written by:

Austin Ulrich, PharmD, BCACP

​​Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. Ulrich’s experience includes direct patient care in hospital and community pharmacies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Our editorial standards

Meet our experts