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Micardis Plus (Telmisartan and hydrochlorothiazide)

Micardis Plus is a combination of telmisartan (an angiotensin receptor blocker) and hydrochlorothiazide (a thiazide diuretic).

It is used to treat patients with hypertension.

Micardis plus dose in Adults

Micardis plus dose in the treatment of Hypertension:

Replacement therapy:
- Combination product can be substituted for individual titrated agents.
Treatment initiation with Micardis Plus when monotherapy fails:
- Patients currently on telmisartan monotherapy:
  - The initial dose in patients with on telmisartan 80 mg with uncontrolled BP.
    - Telmisartan 80 mg/hydrochlorothiazide 12.5 mg once daily given
    - manufacturer labeling suggests that dose may be titrated up to telmisartan 160 mg/hydrochlorothiazide 25 mg once daily if blood pressure continues uncontrolled after 2 to 4 weeks of therapy.
- Patients currently on hydrochlorothiazide monotherapy:
  - The initial dose in patients on hydrochlorothiazide 25 mg once a day with uncontrolled BP and patients who develop hypokalemia:
    - Telmisartan 80 mg/hydrochlorothiazide 12.5 mg once daily given
    - The manufacturer labeling suggests titrating the dose up to telmisartan 160 mg and hydrochlorothiazide 25 mg once a day if blood pressure remains uncontrolled after 2 to 4 weeks of therapy

Micardis plus dose in Children

Not recommended for use in children

Pregnancy Risk Factor: D

[US Boxed Warning]

Drugs that affect the renin-angiotensin systems (RAAS) can severely harm or kill a developing foetus.
Once pregnancy is confirmed, it should be stopped immediately.

Use of hydrochlorothiazide and telmisartan during lactation:

Breast milk also contains hydrochlorothiazide
It is unknown if telmisartan can be found in breast milk.
The manufacturer does not recommend breastfeeding due to the possibility of adverse reactions in breastfed infants.

Telmisartan and hydrochlorothiazide dose in kidney disease:

CrCl >30 mL/minute:
- No dosage adjustment required.
CrCl ≤30 mL/minute:
- Not advised.

Micardis plus dose in liver disease:

Mild to a moderate hepatic impairment or biliary obstructive disorders:
- Telmisartan 40 mg/hydrochlorothiazide 12.5 mg once daily given
Severe hepatic impairment:
- Not advised.

Side Effects of Micardis Plus (Telmisartan and hydrochlorothiazide) Include:

Central Nervous System:
- Dizziness
- Fatigue
Dermatologic:
- Erythema
Gastrointestinal:
- Diarrhea
- Nausea
- Abdominal Pain
- Dyspepsia
- Vomiting
Neuromuscular & Skeletal:
- Back Pain
Renal:
- Increased Blood Urea Nitrogen
- Increased Serum Creatinine
Respiratory:
- Upper Respiratory Tract Infection
- Sinusitis
- Flu-Like Symptoms
- Bronchitis
- Pharyngitis

Contraindication to Micardis plus (Telmisartan and hydrochlorothiazide) Include:

In individuals with diabetes mellitus, hypersensitivity to telmisartan, hydrochlorothiazide, or any component of the formulation used in conjunction with the direct renin inhibitor aliskiren.
There is only weak evidence that angiotensin II receptor blockers and diuretics related to thiazides can cause allergic reactions.
In individuals with moderate-to-severe renal impairment (GFR 60 mL/minute/1.73 m2), aliskiren should be used concurrently.
anuria.
pregnancy
Breastfeeding
fructose intolerance
galactose intolerance (eg, galactosemia, Lapp Lactase deficiency, glucose-galactose malabsorption).

Warnings and precautions

Angioedema
- Some angiotensin II receptor inhibitors can cause the rare adverse effect of angioedema (ARBs). Anytime during therapy, but especially after the first dose, it can happen.
- Airway integrity could be compromised if the neck and head are involved. Abdominal pain may indicate intestinal involvement.
- Patients who have idiopathic angioedema, hereditary angioedema, or angioedema that was previously associated with ACE inhibitor therapy are at increased risk.
- Patients with larynx, tongue, or glottis edema may need to be monitored frequently and for a prolonged period of time.
- Patients who have had previous airway surgery may be at greater risk for obstruction.
- If angioedema develops, stop taking the medication immediately.
- It is crucial to be aggressive in early management.
- Intramuscular (IM) administration of epinephrine is necessary.
- Patients who have angioedema caused by ARBs should not be given.
Electrolyte disturbances:
- When angiotensin II receptor antagonists are taken, hyperkalemia may happen.
- Diabetes mellitus, renal disease, and the concurrent use of potassium-sparing diuretics and potassium supplements are risk factors.
- These agents should be used with caution and potassium should be monitored closely.
- Hypokalemia, hypochloremic acidosis, hypomagnesemia and hyponatremia could be caused by Thiazide diuretics.
Gout:
- Hydrochlorothiazide is used to precipitate gout in patients who have a history of gout or are suffering from chronic renal failure.
- Doses of 25 mg and more may increase the risk.
Hypersensitivity reactions
- Hydrochlorothiazide may cause hypersensitivity reactions.
- Patients with a history bronchial or allergy disorder are at greater risk.
Hypotension
- Patients who have been treated with high-dose diuretics or salt-depleted might experience symptoms of hypotension.
- Correct volume depletion before administration.
- It is not contraindicated to use transient hypotension.
Ocular effects
- Acute transient myopia or acute angle-closure vision may be caused by hydrochlorothiazide. This usually occurs within hours to days of its initiation.
- Patients suffering from severe visual impairment or ocular pain should stop taking any medication immediately.
- If intraocular pressure is not controlled, additional treatments may be required.
- Penicillin and sulfonamide allergy patients are at high risk.
Photosensitivity
- Hydrochlorothiazide can cause it.
Renal function deterioration:
- In patients with limited renal flow, it may cause a decline in renal function and/or an increase in serum creatinine (eg, kidney artery stenosis or heart failure).
- Patients with oliguria, severe renal failure, and progressive azotemia may have glomerular filtration rates (GFR) that are dependent on angiotensin II-induced efferent arterial vasoconstriction.
- Small increases in serum creatinine may happen after starting.
- Patients with significant and progressive deterioration of renal function should be considered for discontinuation.
Allergy to sulfonamide ("sulfa")
- FDA-approved product labeling contains a wide contraindication for patients who have had an allergic reaction to sulfonamides in the past.
- This includes many medications that contain a sulfonamide chemical family.
- There is cross-reactivity among members of a specific class (eg, two antibiotics sulfonamides).
- Crossreactivity issues have previously been brought up for all substances of the sulfonamide structural class (SO NH).
- Nonantibiotic sulfonamides are unlikely to cause cross-reactions caused by antibody production (anaphylaxis).
- Less research has been done on type IV T-cell-mediated reactions like maculopapular eruption.
- Some clinicians opt to avoid these classes in cases of severe reactions (Stevens Johnson syndrome/TEN).
Aortic/mitral stenosis:
- When treating patients who have severe mitral or aortic stenosis, use telmisartan with caution.
Bariatric surgery
- Diuretics should not be taken for the first 24 hours following bariatric surgery.
- Dehydration or electrolyte problems could happen.
- Once oral fluid intake goals have been met, diuretics can be restarted if necessary
Diabetes:
- Patients with diabetes mellitus or prediabetes should be cautious when using hydrochlorothiazide
- You may notice a shift in glucose control
Hepatic impairment
- Patients who have hepatic impairment or biliary blockage diseases should exercise caution.
- Avoid electrolyte imbalances and acid/base imbalances in severe or progressive hepatic diseases to avoid hepatic complications.
Hypercalcemia:
- Patients with hypercalcemia should avoid Thiazide diuretics as they can reduce renal calcium excretion.
Hypercholesterolemia:
- Patients with high or moderate cholesterol levels should be cautious.
- The increased levels of cholesterol and triglyceride are linked to Thiazide Diuretics.
Parathyroid disease
- Calcium excretion is also reduced by Thiazide diuretics
- Long-term use has been associated with pathologic changes in parathyroid glands, including hypophosphatemia and hypercalcemia.
- Should be stopped before testing for parathyroid function.
Renal artery stenosis
- In individuals with unstented unilateral or bilateral renal artery stenosis, use telmisartan with caution.
- Due to the increased risk of renal impairment, this should not be done in cases of bilateral unstented renal artery stenosis.
Renal impairment
- Patients with mild or severe kidney damage must to exercise caution.
- It is not advised to use in cases of severe renal impairment.
Systemic lupus erythematosus (SLE):
- SLE activation or exacerbation can also be caused by hydrochlorothiazide.

Telmisartan and hydrochlorothiazide: Drug Interaction

Risk Factor C (Monitor therapy)
Ajmaline	Sulfonamides might make ajmaline more harmful or poisonous. In particular, there may be an elevated risk for cholestasis.
Alcohol (Ethyl)	Increases the effectiveness of thiazide and thiazide-like diuretics in lowering orthostatic blood pressure.
Alfuzosin	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Allopurinol	The possibility of allergic or hypersensitive reactions to allopurinol may be increased by thiazide and thiazide-like diuretics. The serum concentration of Allopurinol may rise in response to thiazides and thiazide-like diuretics. In particular, Thiazide Diuretics may raise Oxypurinol's levels, an active metabolite of Allopurinol.
Aminolevulinic Acid (Topical)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical).
Amphetamines	May lessen the effectiveness of antihypertensive agents.
Angiotensin II	The therapeutic benefit of angiotensin II may be reduced by receptor blockers.
Anticholinergic Agents	May raise the levels of thiazide and thiazide-like diuretics in the blood.
Antidiabetic Agents	The therapeutic value of anti-diabetic agents may be diminished by thiazide and thiazide-like diuretics.
Antidiabetic Agents	The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Barbiturates	Increases the effectiveness of thiazide and thiazide-like diuretics in lowering orthostatic blood pressure.
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Beta2-Agonists	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Brigatinib	May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Calcium Salts	The excretion of calcium salts may be decreased by thiazide and thiazide-like diuretics. Metabolic alkalosis can also be brought on by continued concurrent usage.
CarBAMazepine	Thiazide and Thiazide-Like Diuretics may intensify CarBAMazepine's negative/toxic effects. Particularly, there could be a higher risk of hyponatremia.
Cardiac Glycosides	Cardiac Glycosides' serum levels may rise in response to telmisartan.
Corticosteroids (Orally Inhaled)	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Corticosteroids (Systemic)	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Cyclophosphamide	Thiazide and Thiazide-Like Diuretics may intensify Cyclophosphamide's harmful or hazardous effects. Particularly, granulocytopenia could be worsened.
CycloSPORINE (Systemic)	CycloSPORINE's hyperkalemic impact may be enhanced by angiotensin II receptor blockers (Systemic).
Dapoxetine	Angiotensin II Receptor Blockers' orthostatic hypotensive action might be improved.
Dexketoprofen	Sulfonamides' harmful or poisonous effects could be amplified.
Dexmethylphenidate	May lessen the effectiveness of antihypertensive agents.
Diacerein	Could make diuretics' therapeutic effects stronger. Particularly, there may be a higher chance of hypokalemia or dehydration.
Diazoxide	Thiazide and Thiazide-Like Diuretics may intensify Diazoxide's harmful or toxic effects.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Drospirenone	Drospirenone's hyperkalemic impact may be enhanced by angiotensin II receptor blockers.
DULoxetine	The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.
Eplerenone	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Heparin	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Heparins (Low Molecular Weight)	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Herbs (Hypertensive Properties)	May lessen the effectiveness of antihypertensive agents.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Ipragliflozin	The toxic and harmful effects of thiazide and thiazide-like diuretics may be increased. In particular, there may be an elevated risk for intravascular volume depletion.
Ivabradine	The arrhythmogenic impact of ivabradine may be enhanced by thiazide and thiazide-like diuretics.
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.
Licorice	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Methylphenidate	May lessen the effectiveness of antihypertensive agents.
Molsidomine	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Multivitamins/Fluoride (with ADE)	May intensify the effects of thiazide and thiazide-like diuretics on hypercalcemia.
Multivitamins/Minerals (with ADEK, Folate, Iron)	The effect of multivitamins and minerals on hypercalcemia may be enhanced by thiazide and thiazide-like diuretics (with ADEK, Folate, Iron).
Multivitamins/Minerals (with AE, No Iron)	The serum concentration of multiple vitamins and minerals may rise after taking thiazide and thiazide-like diuretics (with AE, No Iron). Particularly, thiazide diuretics may reduce calcium excretion, and long-term concurrent usage may result in metabolic alkalosis.
Naftopidil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Neuromuscular-Blocking Agents (Nondepolarizing	The neuromuscular-blocking action of neuromuscular-blocking agents may be enhanced by thiazide and thiazide-like diuretics (Nondepolarizing).
Nicergoline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicorandil	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Nonsteroidal Anti-Inflammatory Agents	Nonsteroidal Anti-Inflammatory Agents' nephrotoxic effects may be intensified by thiazide and thiazide-like diuretics. Thiazide and Thiazide-Like Diuretics may have less of a therapeutic impact when used with nonsteroidal anti-inflammatory drugs.
Nonsteroidal Anti-Inflammatory Agents	Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be amplified by angiotensin II receptor blockers. In particular, the combination may cause a marked decline in renal function. Angiotensin II Receptor Blockers' therapeutic impact may be lessened by non-steroidal anti-inflammatory drugs. Both glomerular filtration rate and renal function may be considerably reduced by the combination of these two drugs.
Opioid Agonists	Could make diuretics' harmful or toxic effects worse. Opioid antagonists may reduce diuretics' therapeutic benefit.
Oxcarbazepine	Thiazide and Thiazide-Like Diuretics may intensify OXcarbazepine's negative/toxic effects. Particularly, there could be a higher risk of hyponatremia.
Pentoxifylline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Pholcodine	Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Porfimer	The photosensitizing effect of Porfimer may be strengthened by photosensitizing agents.
Potassium Salts	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Potassium-Sparing Diuretics	Potassium-Sparing Diuretics may have a stronger hyperkalemic impact when used with Angiotensin II Receptor Blockers.
Prostacyclin Analogues	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Quinagolide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Ranolazine	Angiotensin II Receptor Blockers' hazardous or harmful effects might be exacerbated.
Reboxetine	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Selective Serotonin Reuptake Inhibitors	The hyponatremic effects of thiazide and thiazide-like diuretics may be enhanced.
Tacrolimus (Systemic)	Tacrolimus's hyperkalemic impact may be enhanced by angiotensin II receptor blockers (Systemic).
Tolvaptan	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Toremifene	Toremifene's hypercalcemic impact may be enhanced by thiazide and thiazide-like diuretics.
Trimethoprim	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Valsartan	HydroCHLOROthiazide may increase Valsartan's ability to lower blood pressure. The serum concentration of HydroCHLOROthiazide may rise in response to Valsartan.
Verteporfin	Verteporfin's photosensitizing effect may be strengthened by photosensitizing agents.
Vitamin D Analogs	The hypercalcemic impact of vitamin D analogues may be enhanced by thiazides and thiazide-like diuretics.
Yohimbine	May lessen the effectiveness of antihypertensive agents.
Risk Factor D (Consider therapy modification)
Aliskiren	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened. The hypotensive effects of angiotensin II receptor blockers may be strengthened by aliskiren. Angiotensin II Receptor Blockers' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels.
Amifostine	Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped.
Angiotensin-Converting Enzyme Inhibitors	Angiotensin II Receptor Blockers may make angiotensin-converting enzyme inhibitors more harmful or toxic. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: According to US labelling, it is not advisable to take telmisartan and ramipril. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When possible, take into account alternatives to the mix.
Bile Acid Sequestrants	The absorption of thiazide and thiazide-like diuretics may be reduced. Also reduced is the diuretic reaction.
Lithium	The excretion of lithium may be reduced by thiazide and thiazide-like diuretics.
Lithium	It's possible that angiotensin II receptor blockers will raise the level of lithium in the blood. Management: After adding an angiotensin II receptor antagonist, it will probably be necessary to lower the dosage of lithium.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished.
Sodium Phosphates	Angiotensin II Receptor Blockers may make sodium phosphates more nephrotoxic. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ARBs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided.
Sodium Phosphates	The nephrotoxic effects of sodium phosphates may be increased by diuretics. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking diuretics or look for an alternative to the oral sodium phosphate bowel preparation in order to prevent this combo. If the combination cannot be avoided, drink well and keep an eye on your kidney and fluid levels.
Topiramate	The hypokalemic impact of topiramate may be enhanced by thiazide and thiazide-like diuretics. The blood concentration of topiramate may rise in response to thiazide and thiazide-like diuretics. Management: When starting or increasing the dosage of a thiazide diuretic, keep an eye out for elevated topiramate levels and any negative effects (such as hypokalemia). Serum potassium levels should be closely watched when receiving concurrent treatment. There may be a need to lower topiramate dosage.
Risk Factor X (Avoid combination)
Aminolevulinic Acid (Systemic)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic).
Bromperidol	The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.
Dofetilide	The QTc-prolonging action of dofetilide may be strengthened by hydrochlorothiazide. The serum levels of Dofetilide may rise in response to HydroCHLOROthiazide.
Levosulpiride	Thiazide and Thiazide-Like Diuretics may intensify Levosulpiride's negative/toxic effects.
Mecamylamine	Sulfonamides may intensify Mecamylamine's harmful or hazardous effects.
Promazine	Promazine's ability to prolong QTc may be enhanced by thiazide and thiazide-like diuretics.
Ramipril	Telmisartan may intensify Ramipril's harmful or hazardous effects. Ramipril's serum levels may be raised by telmisartan. Ramiprilat, the active metabolite, may also have higher concentrations.

Monitor:

Blood pressure
serum electrolytes
BUN
creatinine

How to administer Micardis Plus ( Telmisartan and hydrochlorothiazide)?

Administer orally without regard to meals.

Mechanism of action of Telmisartan and hydrochlorothiazide:

Telmisartan:

An angiotensin receptor antagonist is telmisartan.
Vasoconstriction is the effect of angiotensin II.
Angiotensin II is able to cause vasoconstriction and can stimulate the release aldosterone.
This causes hypertension.
The AT1 angiotensin II receptor binds telmisartan.
This binding prevents angiotensin I from attaching to the receptor, blocking both the effects of angiotensin 2 on vasoconstriction and the release of aldosterone.

Hydrochlorothiazide:

The drug hydrochlorothiazide prevents the distal tubules from reabsorbing sodium.
As a result, there is an increase in the excretion of hydrogen ions, sodium, water, and potassium.

See individual agents (Telmisartan & Hydrochlorothiazide)

International Brands of Telmisartan and hydrochlorothiazide:

Actelsar
Actelsar HCT
Actelstar HCT
Agimstan-H
Cardiz-CO
Cilzec Plus
Hangitor Plus
Kinzalcomb
Mibetel HCT
Mibetel Plus
Micardis HCT
Micardis Plus
Micombi
Mikardisplus
Mitosan Plus
Pritorplus
PritorPlus
Telcardis Plus
Telisid-H
Telma 80H
Telma H
Telma Plus
Telmican Plus
Telmione Plus
Telmisartan Plus HCT EG
Telmito Plus
Telmitrend Plus
Telstan-H
Tolucombi

Telmisartan and hydrochlorothiazide Brands in Pakistan:

Telmisartan [Tabs 4 Mg]
Telsitan-H	Macter International (Pvt) Ltd.

Telmisartan [Tabs 40 Mg]
Co Telmas	Global Pharmaceuticals
Co Telsan	Hilton Pharma (Pvt) Limited
Co-Ezitab	Werrick Pharmaceuticals
Co-Tasmi	Getz Pharma Pakistan (Pvt) Ltd.
Co-Telisartan	Schazoo Zaka
Cresar H	Tabros Pharma
De-Nile Plus	Pharma Health Pakistan (Pvt) Ltd
Gelfer	Genix Pharma (Pvt) Ltd
Mecardis-H	Maple Pharmaceuticals (Pvt) Ltd
Misar-H	Highnoon Laboratories Ltd.
Misartan -H	Indus Pharma (Pvt) Ltd.
Normisar	Nabiqasim Industries (Pvt) Ltd.
Normisar Plus	Nabiqasim Industries (Pvt) Ltd.
Telmis-H	Genix Pharma (Pvt) Ltd
Telsarta-D	Pharmevo (Pvt) Ltd.

Telmisartan [Tabs 80 Mg]
Co Telmas	Global Pharmaceuticals
Co Telsan	Hilton Pharma (Pvt) Limited
Co-Ezitab	Werrick Pharmaceuticals
Co-Tasmi	Getz Pharma Pakistan (Pvt) Ltd.
Cresar H	Tabros Pharma
Mecardis-H Forte	Maple Pharmaceuticals (Pvt) Ltd
Misar-H	Highnoon Laboratories Ltd.
Telsarta-D	Pharmevo (Pvt) Ltd.