Key takeaways:
Telmisartan (Micardis) is a medication that treats high blood pressure and lowers the risk of heart-related events. Common telmisartan side effects include dizziness, headache, and diarrhea. In most cases, these side effects are mild and will go away on their own.
Other possible telmisartan side effects include back or muscle pain, upper respiratory infections, and stomach issues. You can typically manage these side effects at home if they occur.
Rare but serious telmisartan side effects include high potassium levels and kidney problems. It can also cause serious birth defects. So you shouldn’t take telmisartan if you’re pregnant or trying to become pregnant.
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Telmisartan (Micardis) is prescribed to treat high blood pressure and lower the risk of heart-related events, such as a heart attack or stroke. It belongs to a group of medications called angiotensin II receptor blockers (ARBs).
In general, ARBs are less likely to cause side effects than other blood pressure medications. But understanding the possible telmisartan side effects can help you recognize them and know when to contact your healthcare team.
Telmisartan side effects at a glance
Below is a list of mild and serious telmisartan side effects reported in clinical studies. Keep in mind that telmisartan may cause other side effects that aren’t listed here. Be sure to contact your prescriber if you’re having concerns about side effects while taking it.
Mild telmisartan side effects include:
Back pain
Upper respiratory infections
Diarrhea
Heartburn
Muscle aches
Leg pain
Urinary tract infection
Pain in your abdomen
Headache
Dizziness
Fatigue
Rare but serious telmisartan side effects include:
Skin ulcers
High potassium levels (hyperkalemia)
Severely low blood pressure
Kidney problems
Angioedema (swelling of the face, neck, and mouth)
Telmisartan also has a boxed warning for the risk of harm to an unborn baby. This is the FDA’s most serious warning for medications. If you’re pregnant or trying to become pregnant while taking telmisartan, let your prescriber know. Other blood pressure medications are safer options during pregnancy.
Let’s take a look at eight telmisartan side effects in more detail.
1. Dizziness
Telmisartan may cause dizziness. Any medication that lowers blood pressure can make you feel dizzy or lightheaded, especially when you first start taking it or after a dose increase. Dizziness usually goes away as your body gets used to telmisartan’s effects.
If you feel dizzy, sit or lie down until the feeling passes to help prevent falls. Be careful when standing up, especially from a lying or sitting position. It’s also a good idea to use caution when driving or performing other activities that require coordination until you know how telmisartan affects you.
If dizziness is severe or doesn’t improve, it could be a sign that your blood pressure is too low (hypotension). This is more likely if you’re taking a diuretic (“water pill”) or another blood pressure medication along with telmisartan. Let your prescriber know if this happens. They may need to lower your dosage or adjust your other medications.
2. Headache
Headaches are another side effect of telmisartan and other ARBs. Like dizziness, it’s usually a temporary side effect that goes away as your body adapts to the medication.
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Most of the time, you can manage headaches at home by staying hydrated or applying a cool compress to your head. If needed, you can also try an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), can interact with telmisartan. So it’s a good idea to get your healthcare team’s OK before taking one.
3. Diarrhea
Diarrhea is another possible telmisartan side effect, but it isn’t common. In clinical trials, 3% of people taking telmisartan reported diarrhea, compared to 2% of people taking a placebo (a pill with no medication in it).
In most cases, diarrhea will go away on its own. In the meantime, you can manage it at home by staying hydrated and eating bland, easy-to-digest foods. If needed, talk to your healthcare team about an OTC treatment option, such as loperamide (Imodium A-D).
In rare cases, ARBs can cause damage to your small intestine (enteropathy). So be sure to let your prescriber know if diarrhea is persistent or severe, especially if you also have unexplained weight loss.They can help determine the cause and how best to proceed.
4. Back or muscle pain
Back and muscle pain were side effects reported in telmisartan clinical studies. But people taking a placebo also reported aches and pains. So it’s not clear whether or not telmisartan was the true cause of these symptoms.
You can help reduce and prevent pain with gentle stretching and regular exercise. Applying a heating pad or ice to the affected area may also help. If the pain worsens or becomes persistent, contact your healthcare team for guidance
5. Upper respiratory infections
It’s not clear why, but taking an ARB such as telmisartan may raise your risk for getting upper respiratory infections (URIs). These may include the common cold.
Common URI symptoms include a sore throat, stuffy nose, and cough. Getting plenty of rest and fluids can help you feel better. OTC medications can also help ease your symptoms. Just be sure to steer clear of ingredients that can raise your blood pressure. Ask your pharmacist for guidance if needed.
6. Heartburn and nausea
Heartburn and nausea are possible telmisartan side effects. Some people also report abdominal pain, but it isn’t common.
You can take telmisartan with or without food. But if it upsets your stomach, taking it with food may help. An OTC heartburn medication may also provide some relief, if needed. But if stomach-related symptoms feel severe or don’t improve, talk to your prescriber. They can help identify what’s causing them and the best course of action.
7. High potassium levels
Like all ARBs, telmisartan can increase your potassium levels. In some cases, potassium levels may go too high (hyperkalemia). The risk for this is greater if you take other medications that can raise potassium levels or if you’re living with kidney problems.
High potassium doesn’t always cause symptoms. But your prescriber will likely check your levels regularly while you’re taking telmisartan to keep an eye out for this side effect. Be sure to keep up with your regular checkups as recommended by your healthcare team. If you develop chest pain, weakness, or an irregular heartbeat while taking telmisartan, seek emergency care right away.
8. Kidney problems
In most cases, telmisartan has a positive effect on your kidneys. ARBs are even considered a safe treatment option if you’re living with chronic kidney disease (CKD). But in rare cases, telmisartan may cause sudden (acute) kidney problems. The risk of acute kidney problems is higher if you take NSAIDs with telmisartan or if you have existing kidney problems.
Your healthcare team will likely keep an eye on your kidney function while you're taking telmisartan. If you notice swelling in your feet or ankles, you’re peeing less often than usual, or you stop peeing altogether, let your prescriber know right away. These are signs that your kidneys aren’t working as well as they should.
Does telmisartan cause a cough like ACE inhibitors do?
No. Cough isn’t a common side effect of ARBs. This side effect is more common with angiotensin converting enzyme (ACE) inhibitors, a different type of blood pressure medication. In fact, if you develop a cough while taking an ACE inhibitor, it’s likely your prescriber will switch you to telmisartan or another ARB instead.
Does telmisartan cause hair loss?
Hair loss isn’t a reported side effect of telmisartan or other ARBs. But it can be a side effect of beta blockers, a different type of blood pressure medication. If you notice hair loss or thinning while taking telmisartan, talk to your prescriber. They can help determine what might be causing it and recommend treatment options.
Will telmisartan make you pee more?
No. Telmisartan shouldn’t make you pee more on its own. But you may pee more often if you’re taking a diuretic, such as hydrochlorothiazide. So if you’re taking Micardis HCT, a combination pill that contains telmisartan and hydrochlorothiazide, you may pee more often than usual.
The bottom line
Telmisartan (Micardis) is a prescription medication that treats high blood pressure and lowers the risk of serious heart-related events. It’s generally safe to take, and side effects are mild in most cases.
Dizziness, headache, and diarrhea are telmisartan side effects that typically appear when you start taking it and go away on their own over time. Other possible side effects include back or muscle pain, upper respiratory infections, and upset stomach. In most cases you can manage these side effects on your own at home.
Rare but serious telmisartan side effects include high potassium levels and kidney problems. In most cases your healthcare team will keep an eye out for these issues while you’re taking telmisartan. If you’re pregnant or planning to become pregnant, telmisartan is not recommended. Talk to your prescriber about a safer blood pressure medication during pregnancy.
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References
A-S Medication Solutions. (2024). Telmisartan- telmisartan tablet [package insert].
Abraham, H. M. A., et al. (2016). The comparative efficacy and safety of the angiotensin receptor blockers in the management of hypertension and other cardiovascular diseases. Drug Safety.
Schiepatti, A., et al. (2024). Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers. Alimentary Pharmacology and Therapeutics.
Tomson, C. R. V., et al. (2021). Management of blood pressure in patients with chronic kidney disease not receiving dialysis: Synopsis of the 2021 KDIGO clinical practice guideline. Annals of Internal Medicine.
