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Some patients due RAAS suppression, particularly when using a combination of means acting on the system, kidney function is impaired (including acute renal failure). Therefore, therapy, followed by a similar dual blockade of the RAAS, should be carried out strictly individually and with careful monitoring of renal function (including periodic monitoring of the concentration of potassium and creatinine in serum).
In cases of association of vascular tone and renal function predominantly on the activity of the RAAS (eg, patients chronic heart failure, or kidney disease, including those with renal artery stenosis or stenosis of the artery to a solitary kidney), the appointment of drugs that affect this system may be accompanied by the development of acute hypotension, hyperasotemia, oliguria, and, in rare cases, acute renal failure.
Based on the experience of other means affecting the RAAS, with a joint appointment of the drug Mikardis ® and potassium-sparing diuretics, potassium-supplements, potassium-containing food-grade salt and other means to increase the blood concentration of potassium (eg heparin) should be monitored, this figure patients.
in an alternative preparation Mikardis ® may be used in combination with a thiazide diuretic, such as hydrochlorothiazide, which additionally have a hypotensive effect (., a drug MikardisPlyus ® 40 mg / mg, 80 mg /) mg).
in patients with severe hypertension telmisartan dose of 160 mg / day in combination with hydrochlorothiazide -25 mg was well tolerated and effective. Mikardis ® is less effective in blacks patients.