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Is Cresar (telmisartan) superior to Losacar?

Q: Is Cresar (telmisartan) superior to Losacar? My friend, a hypertensive and a patient of tachycardia VCP, is on Amlodac AT twice and Losacar H twice. As he had postural hypotension, the internist advised him to take Cresar H once with Amlodac AT twice. According to him Telma H once is equal to Losacar H twice because of its long life 24 hours control. I am a bit confused about the technical jargon. Can you please guide me. I want to know about Indicontin Continus and Aquazide.

A:Since there is no issue on Amlodac AT (amlodipine 5 mg + atenolol 50 mg) being used by you, I will respond to the rationality or otherwise of replacing Losacar H twice daily with Cresar-H ONCE daily. Losacar-H contains losartan 50 mg and hydrochlorothiazide (diuretic) 12.5 mg. Cresar-H contains telmisartan 40 mg and hydrochlorothiazide (diuretic) 12.5 mg. The usual dose of losartan is 50 mg once daily. It can be increased to 100 mg once daily (or 50 mg twice daily - there is evidence that even though the dose remains the same i. e. 100 mg, the effect of 50 mg twice daily is better than 100 mg once daily) if response is not adequate. The usual dose of telmisartan is 40 mg once daily. It can be increased to 80 mg if response is not adequate. The normal dose of hydrochlorothiazide (diuretic) is 12.5 mg once daily in the morning. It should not be given in the evening to avoid need to go to toilet frequently at night. In any case no purpose is served by increasing the dose to 12.5 mg twice daily (total 25 mg) because the effect in blood pressure patients does not increase with larger dose. In medicine 2+2 do not necessarily make 4. Thus the maximum dose in hypertensive patients should be 12.5 mg. Increasing the dose means not much benefit but more side effects including the risk of developing hyperglycaemia (high blood sugar), glycosuria (sugar in urine), hyperuricaemia (leading to gout) etc. In its clinical effect losartan 50 mg is equal to telmisartan 40 mg. That does not mean that telmisartan is superior to losartan. The amount of medicine differs from one drug to another and has nothing to do with the efficacy or safety. Conclusion: the rational prescription in your case would be Amlodac-AT twice daily + Losacar-H once in the morning + Losacar 50 mg (plain) once at night. There is no clinical logic in shifting you from already tried and tested losartan to telmisartan. An attempt should be made to see if the evening dose of Losacar can be reduced to 25 mg. Aquazide is the brand name of single ingredient hydrochlorothiazide. There is no reason to give you this medicine since it is already there in Losacar-H. Indicontin Continus is the brand name of low-dose, long acting indapamide which has dual action - it reduces blood pressure on its own through a different mechanism and at the same time acts as a diuretic.


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