Telmisartan
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Telmisartan: From Hypertension and Stroke Prevention to Prinzmetal Angina
One-Sentence Summary
Telmisartan is an oral angiotensin receptor blocker, originally used for hypertension and for conditions related to stroke and cerebral infarction. The TxGNN model predicts it may be effective for Prinzmetal angina, but no clinical trials and no publications were found for this specific prediction, so it rests on the model score alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Hypertension; stroke and cerebral infarction (including susceptibility to ischemic stroke) |
| Predicted New Indication | Prinzmetal angina |
| TxGNN Prediction Score | 99.98% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 20 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data are not available in the data compiled for this report. Telmisartan belongs to the angiotensin receptor blocker class. Its efficacy in hypertension and stroke-related conditions is established, and mechanistically it may be applicable to Prinzmetal angina.
Prinzmetal (vasospastic) angina is caused by episodic spasm of the coronary arteries. The plausible links are blockade of the renin-angiotensin system, vasodilation, and the partial PPAR-gamma-mediated effects on the vascular lining described for telmisartan. These links are theoretical. No trials or publications were found to show that they translate into benefit in this condition.
The very high score (99.98%) shows the model finds the drug closely connected to this disease in its knowledge graph. It is not evidence of clinical efficacy.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available.
Singapore Market Information
All 20 registrations are valid single-ingredient oral tablets (40 mg or 80 mg). Approved indication text was not available for these licences. The five below are examples:
| Authorization Number | Product Name | Dosage Form | Manufacturer |
|---|---|---|---|
| SIN15447P | JUBITEL 40 Tablet 40 mg | Tablet | Jubilant Generics Limited |
| SIN16850P | CORXEVA Tablet 40 mg | Tablet | Laboratorios Liconsa S.A. |
| SIN16587P | TELFOCUS 80 Tablets 80 mg | Tablet | Aurobindo Pharma Limited - Unit VII |
| SIN16640P | TELCORD 40 Tablet 40 mg | Tablet | Intas Pharmaceuticals Limited |
| SIN14807P | ACTELSAR Tablet 40 mg | Tablet | Actavis Ltd. |
Safety Considerations
- Contraindication-related conditions (from the knowledge graph, not label text):
- Liver and biliary: liver failure, liver disease, hepatic coma and encephalopathy, cholestasis (including benign recurrent and familial intrahepatic forms), gallbladder disease, pancreatitis, neonatal jaundice.
- Kidney and urinary: kidney disease, anuria, renal artery obstruction, pyoureter, nephrocalcinosis.
- Metabolic and electrolyte: diabetes mellitus, diabetic ketoacidosis, potassium deficiency, hypercalcemia, hyperparathyroidism and osteitis fibrosa, phosphorus metabolism disease, hyperuricemia, gout.
- Other: hypotensive disorder, systemic lupus erythematosus (including paediatric).
- Drug Interactions (100 interactions recorded; the 20 reviewed include):
- Major: potassium citrate and potassium bicarbonate (risk of raised blood potassium).
- Moderate: corticosteroids (hydrocortisone, dexamethasone, betamethasone, budesonide, triamcinolone), acetylsalicylic acid, SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin), insulin and exenatide, morphine, bupropion, dronabinol, and several bowel-preparation products.
Package insert warnings and contraindications were not available. Please refer to the package insert for the authoritative safety information.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction for Prinzmetal angina is supported only by the model score (L5), with no trials or publications. The mechanistic argument is plausible but untested.
To proceed, the following is needed:
- A systematic literature search specifically for telmisartan or ARBs in vasospastic angina, plus clinical trial registry checks
- Mechanism of action data and package insert warnings and contraindications
- A review of the comparison with standard vasospastic angina therapy (e.g., calcium channel blockers) and of safety in patients with low blood pressure, kidney disease or electrolyte disturbances
Note on other predictions: Among the other predicted indications for telmisartan, intracerebral hemorrhage has the strongest support. It rests on a completed Phase 3 trial (TRIDENT, NCT02699645, n=1671) of a triple low-dose antihypertensive pill that includes telmisartan. It is rated L1 with a "Proceed with Guardrails" recommendation. The benefit cannot be attributed to telmisartan alone, and the trial results should be verified. This indication may merit its own evaluation.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.