Telmisartan is a prescription blood pressure drug. It belongs to the angiotensin II receptor blockers (ARBs, the “sartans”), and the FDA first approved it in 1998 as Micardis (Boehringer Ingelheim). It is now widely available as a generic tablet.
US labeling covers two uses: treating high blood pressure, and lowering the risk of heart attack, stroke and cardiovascular death in high-risk adults aged 55 or older who cannot take an ACE inhibitor. Outside those uses, telmisartan draws interest because lab studies found it partly activates PPARγ, a receptor targeted by some diabetes drugs. Human trials show only small metabolic effects, and no trials have tested it in people using anabolic steroids. The label carries a boxed warning for fetal toxicity.
This page summarizes what the FDA label, the large outcome trials and meta-analyses report. It is for education only and is not medical advice.
| Property | Detail |
|---|---|
| Drug class | Angiotensin II type 1 (AT1) receptor blocker (ARB) |
| Brand / approval | Micardis (Boehringer Ingelheim), NDA 020850, approved November 10, 1998; generics available |
| Route | Oral tablet, once daily |
| Strengths | 20 mg, 40 mg, 80 mg |
| Labeled dose | Hypertension: start 40 mg, range 40–80 mg/day. Cardiovascular risk reduction: 80 mg/day |
| Half-life (label) | Terminal elimination half-life ≈24 h |
| Elimination | Over 97% excreted unchanged in feces via bile; not metabolized by cytochrome P450 enzymes |
| Boxed warning | Fetal toxicity: stop as soon as pregnancy is detected |
| US status | Prescription only |
| WADA status | Not named on the 2026 Prohibited List; combinations with hydrochlorothiazide contain a prohibited diuretic |
What it is
Telmisartan is a non-peptide molecule with the formula C₃₃H₃₀N₄O₂ and a molecular weight of 514.6 g/mol (PubChem). It is practically insoluble in water across pH 3–9 (telmisartan label). The FDA approved Boehringer Ingelheim’s Micardis under NDA 020850 on November 10, 1998 (Drugs@FDA).
Main mechanism: blocking angiotensin II
Angiotensin II is the main blood-pressure-raising hormone of the renin-angiotensin system. It narrows blood vessels, triggers release of aldosterone (a hormone that makes the kidneys hold on to salt and water) and increases sodium reabsorption. Telmisartan blocks angiotensin II from binding the AT1 receptor. Per the label:
- It binds AT1 with more than 3,000-fold greater affinity than the AT2 receptor.
- In healthy volunteers, 80 mg blocked about 90% of the blood pressure response to infused angiotensin II at peak levels, and about 40% was still blocked 24 hours later.
- Unlike ACE inhibitors, it does not block the breakdown of bradykinin. The label notes that the clinical relevance of this difference is not known; in ONTARGET, cough was less common on telmisartan than on an ACE inhibitor (see below).
Secondary property: partial PPARγ activation
Telmisartan differs from other ARBs in one lab finding. PPARγ (peroxisome proliferator-activated receptor gamma) is a nuclear receptor that controls genes for fat and sugar metabolism; diabetes drugs such as pioglitazone are full activators of it.
- In cell assays, telmisartan acted as a partial PPARγ agonist. In rats on a high-fat, high-carbohydrate diet, it lowered glucose, insulin and triglycerides. Other marketed ARBs did not activate PPARγ at their usual plasma concentrations (Benson et al., Hypertension 2004).
- A second cell-culture study found that telmisartan and irbesartan (10 µmol/L) raised PPARγ activity 2.6-fold and 3.4-fold, compared with 5.2-fold for pioglitazone. The effect persisted in cells without AT1 receptors, so it is separate from blood pressure blockade (Schupp et al., Circulation 2004).
These are animal and cell findings. Whether they translate into clinically meaningful effects in people is addressed in the research section below.
Pharmacokinetics
From the FDA-approved label (telmisartan label):
| Parameter | Value |
|---|---|
| Time to peak level | 0.5–1 h |
| Absolute bioavailability | 42% at 40 mg; 58% at 160 mg (dose-dependent) |
| Dose proportionality | Nonlinear: levels rise more than proportionally from 20 to 160 mg |
| Effect of food | AUC (total exposure) about 6% lower with 40 mg, about 20% lower with 160 mg; may be taken with or without food |
| Terminal half-life | ≈24 h |
| Accumulation with daily dosing | 1.5–2 fold |
| Protein binding | Over 99.5% (albumin and α1-acid glycoprotein) |
| Volume of distribution | ≈500 L |
| Metabolism | Conjugated to an inactive acyl glucuronide; no CYP450 involvement |
| Excretion | Over 97% in feces via bile; under 1% in urine |
Other label points:
- Sex: plasma levels are generally 2–3 times higher in women than in men, without a larger blood pressure drop or more orthostatic hypotension in trials.
- Liver disease: in hepatic impairment, bioavailability approaches 100%. Because the drug is cleared through bile, the label advises starting low and titrating slowly in biliary obstruction or liver insufficiency.
- Kidney disease: no initial dose change is needed. Telmisartan is not removed by hemofiltration and is not dialyzable.
The 24-hour half-life supports once-daily dosing. The label reports a trough-to-peak ratio of 70–100% for blood pressure at 40–80 mg, meaning most of the effect lasts the full day.
Approved medical use
Hypertension
Telmisartan is approved to lower blood pressure, alone or with other antihypertensives. The usual starting dose is 40 mg once daily. Most of the effect appears within 2 weeks and the maximum by about 4 weeks.
In six placebo-controlled trials (1,773 patients with mild to moderate hypertension), the placebo-subtracted reductions were (telmisartan label):
| Daily dose | Systolic / diastolic reduction vs placebo |
|---|---|
| 20 mg | 6–8 / 6 mmHg |
| 40 mg | 9–13 / 6–8 mmHg |
| 80 mg | 12–13 / 7–8 mmHg |
| Up to 160 mg | No further decrease |
Blood pressure returned to baseline over several days to a week after stopping. Response was noticeably smaller in Black patients, a pattern seen with most drugs that act on the renin-angiotensin system.
Combination tablets also exist, including telmisartan with hydrochlorothiazide (Micardis HCT) (DailyMed).
Cardiovascular risk reduction
Some telmisartan labels, including the Mylan generic label cited here, add a second indication: reducing the risk of heart attack, stroke or cardiovascular death in patients aged 55 or older at high cardiovascular risk who cannot take ACE inhibitors. The dose is 80 mg once daily; the label states it is not known whether lower doses work for this purpose. The label also advises considering the ACE inhibitor first. This indication rests on the ONTARGET and TRANSCEND trials described below.
What the research shows
Cardiovascular outcomes: ONTARGET and TRANSCEND
ONTARGET was a double-blind randomized trial in 25,620 patients with vascular disease or high-risk diabetes. It compared ramipril 10 mg (an ACE inhibitor), telmisartan 80 mg, and the two combined, with a median follow-up of 56 months (ONTARGET Investigators, NEJM 2008):
| Outcome | Ramipril (n = 8,576) | Telmisartan (n = 8,542) | Combination (n = 8,502) |
|---|---|---|---|
| Primary composite (CV death, MI, stroke, heart failure hospitalization) | 16.5% | 16.7% (RR 1.01, 95% CI 0.94–1.09) | 16.3% (RR 0.99, 95% CI 0.92–1.07) |
| Cough | 4.2% | 1.1% | — |
| Angioedema | 0.3% | 0.1% | — |
| Hypotensive symptoms | 1.7% | 2.6% | 4.8% |
| Renal dysfunction | 10.2% | — | 13.5% |
Telmisartan was judged equivalent to ramipril, with less cough and angioedema. Combining the two drugs added adverse effects (low blood pressure, fainting, kidney problems) without extra benefit.
TRANSCEND randomized 5,926 patients who could not tolerate ACE inhibitors to telmisartan 80 mg or placebo, with a median follow-up of 56 months (TRANSCEND Investigators, Lancet 2008):
| Outcome | Telmisartan (n = 2,954) | Placebo (n = 2,972) | Hazard ratio (95% CI) |
|---|---|---|---|
| Primary composite (incl. heart failure hospitalization) | 15.7% | 17.0% | 0.92 (0.81–1.05), not significant |
| CV death, MI or stroke | 13.0% | 14.8% | 0.87 (0.76–1.00), p = 0.048 unadjusted; 0.068 adjusted |
| Hospitalization for a cardiovascular reason | 30.3% | 33.0% | RR 0.92 (0.85–0.99) |
Blood pressure ran about 4.0/2.2 mmHg lower on telmisartan. The primary outcome was not significantly reduced; the benefit on the narrower secondary outcome was modest.
Insulin resistance and metabolic markers
Because of the PPARγ finding, telmisartan has been studied as a “metabolic sartan.” The pooled results show small effects:
| Meta-analysis | Trials (patients) | Main findings |
|---|---|---|
| Telmisartan vs other ARBs in obesity, diabetes or metabolic syndrome (Wang et al., Am J Ther 2018) | 21 RCTs (1,679) | HOMA-IR (an insulin resistance index) −0.23 (95% CI −0.40 to −0.06); fasting glucose and insulin also lower; diastolic BP −1.46 mmHg; systolic BP difference not significant |
| Telmisartan vs control in metabolic syndrome (Takagi et al., J Am Soc Hypertens 2013) | 10 RCTs (546) | Small reductions in fasting glucose, insulin, HbA1c and HOMA index (standardized mean differences −0.22 to −0.51); adiponectin increased |
| Body fat distribution in hypertensive patients with overweight, metabolic syndrome or glucose intolerance (Choi et al., Curr Med Res Opin 2016) | 15 RCTs | Visceral fat area −18.1 cm² (95% CI −27.2 to −9.1); subcutaneous fat unchanged |
| Fatty liver disease (MASLD/NAFLD) (Shojaei et al., Endocrinol Diabetes Metab 2026) | 6 RCTs (258) | Fasting glucose −2.78 mg/dL with high heterogeneity; no significant change in BMI, waist, HOMA-IR, lipids, ALT or AST; GGT rose by 5.4 U/L; no significant histology benefit |
Not every trial is positive. In a 24-week double-blind trial, 95 adults with abdominal obesity took telmisartan (80 mg for 4 weeks, then 160 mg, twice the labeled maximum) or placebo. Telmisartan did not change fat inside muscle, liver fat, body composition, lipids, glucose, insulin sensitivity or adiponectin. Only a measure of insulin-secreting beta-cell function improved (Chetty et al., Blood Press 2014).
The label itself states that in multiple-dose studies in hypertensive patients, telmisartan produced no clinically significant changes in cholesterol, triglycerides, HDL, LDL, glucose or uric acid (telmisartan label). Telmisartan is not approved for diabetes, weight loss or fatty liver disease.
Muscle and endurance
In mice, long-term telmisartan prevented weight gain, increased running endurance and raised the share of slow-twitch muscle fibers. These effects disappeared in mice lacking PPARδ, pointing to a PPARδ/AMPK pathway (Feng et al., J Cell Mol Med 2011). This is animal data only. PPARδ is the same receptor targeted by the research compound Cardarine (GW501516).
The human evidence does not show a performance effect. The TELEX trial randomized 114 patients with peripheral artery disease (narrowed leg arteries) to telmisartan or placebo, with or without supervised exercise, for 6 months. Telmisartan did not improve 6-minute walk distance (adjusted difference −16.8 m, 95% CI −35.9 to 2.2) or any secondary walking outcome (McDermott et al., JAMA 2022). We found no controlled trials of telmisartan on muscle mass, strength or athletic performance in healthy people.
Erectile function and sexual health
Evidence that telmisartan improves sexual function is weak:
- In a prespecified ONTARGET/TRANSCEND substudy of 1,549 patients, erectile dysfunction strongly predicted death and cardiovascular events, but the study drugs (telmisartan, ramipril or both) did not improve or worsen erectile dysfunction (Böhm et al., Circulation 2010).
- A meta-analysis of four randomized trials (2,809 men with hypertension) found improved sexual activity with valsartan, but no significant improvement in erectile function with losartan or telmisartan compared with control or placebo (mean difference 1.36; the confidence interval included no effect) (Ismail et al., Am J Mens Health 2019).
- The label lists impotence among events reported in more than 0.3% of trial patients, with causality undetermined, and erectile dysfunction among postmarketing reports.
For drugs studied specifically for erectile dysfunction, see Cialis (tadalafil).
Relevance to anabolic steroid use
Telmisartan is discussed in performance-enhancement circles mainly as a blood pressure drug. The underlying problem is real: in a cross-sectional study of men doing recreational strength training, 37 current AAS users had a higher 24-hour systolic blood pressure than 30 controls (132 vs 124 mmHg), and systolic hypertension was more frequent (51% vs 17%). Current users also had higher aldosterone and stiffer aortas (Rasmussen et al., J Hypertens 2018).
However, we found no published trials testing telmisartan, or any ARB, in people using anabolic steroids. Claims that it offsets steroid-related cardiovascular, kidney or metabolic harm are not backed by controlled human data. Other blood pressure drugs covered in this library include nebivolol and spironolactone.
Side effects and risks
Boxed warning: fetal toxicity
Drugs that act on the renin-angiotensin system can injure and kill a developing fetus when used in the second and third trimesters. Reported harms include low amniotic fluid, underdeveloped lungs and skull, kidney failure and death. The label says to stop telmisartan as soon as pregnancy is detected and advises against breastfeeding during treatment (telmisartan label).
Common side effects
In placebo-controlled hypertension trials, overall adverse event rates were similar to placebo. Events at least 1% more often than placebo were few:
| Adverse event | Telmisartan (n = 1,455) | Placebo (n = 380) |
|---|---|---|
| Upper respiratory tract infection | 7% | 6% |
| Back pain | 3% | 1% |
| Sinusitis | 3% | 2% |
| Diarrhea | 3% | 2% |
| Pharyngitis | 1% | 0% |
| Stopped due to adverse events | 2.8% | 6.1% |
Cough occurred in 1.6% on both telmisartan and placebo. In TRANSCEND, the only serious events at least 1% more common on telmisartan were intermittent claudication (leg pain on walking; 7% vs 6%) and skin ulcer (3% vs 2%).
Low blood pressure, kidney function and potassium
- Hypotension: more likely in people who are salt- or volume-depleted, such as those on high-dose diuretics. Dehydration from sweating, vomiting or diarrhea can lead to lightheadedness or fainting.
- Kidney function: in people whose kidney function depends on the renin-angiotensin system (severe heart failure, kidney disease, narrowed renal arteries), ARBs have been linked to reduced urine output, rising creatinine and, rarely, acute kidney failure.
- Hyperkalemia (high blood potassium): risk rises with advanced kidney disease, heart failure, and potassium supplements, potassium-sparing diuretics or potassium-containing salt substitutes.
- Angioedema: swelling of the face, lips or throat is rare; postmarketing reports include fatal cases.
- Rhabdomyolysis: rare cases (breakdown of muscle tissue) have been reported with ARBs, including telmisartan.
Interactions
From the label (telmisartan label):
| Drug | Effect |
|---|---|
| ACE inhibitors (e.g. ramipril) | Dual blockade raised kidney dysfunction in ONTARGET with no added benefit; the label advises avoiding the combination. Telmisartan also raised ramipril exposure about 2-fold |
| Aliskiren | Contraindicated in patients with diabetes; avoid if GFR is under 60 mL/min/1.73 m² |
| NSAIDs, including COX-2 inhibitors | Risk of worsening kidney function in older, volume-depleted or kidney-impaired patients; may blunt the blood pressure effect |
| Lithium | Raised lithium levels and toxicity reported; monitor levels |
| Digoxin | Median peak digoxin level up 49% and trough up 20%; monitor levels |
| Drugs metabolized by CYP2C19 | Some inhibition of CYP2C19 in vitro; otherwise no CYP450 interactions expected |
Who should not take it
- People with known hypersensitivity (anaphylaxis or angioedema) to telmisartan.
- People with diabetes taking aliskiren.
- Pregnancy (boxed warning).
Safety and effectiveness in children have not been established.
Legal status and use in sport
In the US, telmisartan is a prescription-only drug (telmisartan label).
Telmisartan and ARBs as a class are not named on the WADA 2026 Prohibited List. Two points matter for tested athletes:
- Hydrochlorothiazide, found in telmisartan combination tablets, is a diuretic and is prohibited at all times under class S5.
- Class S4.4 prohibits PPARδ agonists and AMPK activators. Telmisartan is not named there; the PPARδ link comes only from mouse research.
Key takeaways
- A once-daily blood pressure drug. Telmisartan blocks the angiotensin II type 1 receptor, has a ≈24-hour half-life and lowers blood pressure by about 12–13/7–8 mmHg vs placebo at 80 mg.
- Proven outcome data. In ONTARGET (25,620 patients), it matched ramipril for preventing cardiovascular events with less cough and angioedema; combining the two caused more harm without more benefit.
- Metabolic effects are small. Lab studies show partial PPARγ activation, but human meta-analyses find only modest changes in insulin resistance and visceral fat, and some trials found none.
- No evidence for performance or sexual benefit. Endurance gains were seen in mice only; a human walking trial was negative, and trials did not show improved erectile function.
- Untested in steroid users. AAS use is linked to higher blood pressure, but no trials have tested telmisartan in this group.
- Key risks. Fetal toxicity (boxed warning), low blood pressure, high potassium and kidney problems, especially with ACE inhibitors, aliskiren or NSAIDs.
Sources
- Mylan Pharmaceuticals. Telmisartan tablets prescribing information (revised March 2023). DailyMed.
- US Food and Drug Administration. Drugs@FDA: Micardis (telmisartan), NDA 020850, approval history. FDA.
- Boehringer Ingelheim. Micardis HCT (telmisartan and hydrochlorothiazide) tablets prescribing information. DailyMed.
- National Center for Biotechnology Information. PubChem Compound Summary for CID 65999, Telmisartan. PubChem.
- ONTARGET Investigators, Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547–1559. PubMed.
- TRANSCEND Investigators, Yusuf S, Teo K, Anderson C, et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet. 2008;372(9644):1174–1183. PubMed.
- Benson SC, Pershadsingh HA, Ho CI, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARgamma-modulating activity. Hypertension. 2004;43(5):993–1002. PubMed.
- Schupp M, Janke J, Clasen R, et al. Angiotensin type 1 receptor blockers induce peroxisome proliferator-activated receptor-gamma activity. Circulation. 2004;109(17):2054–2057. PubMed.
- Wang Y, Qiao S, Han DW, et al. Telmisartan improves insulin resistance: a meta-analysis. Am J Ther. 2018;25(6):e642–e651. PubMed.
- Takagi H, Niwa M, Mizuno Y, et al. Telmisartan as a metabolic sartan: the first meta-analysis of randomized controlled trials in metabolic syndrome. J Am Soc Hypertens. 2013;7(3):229–235. PubMed.
- Choi GJ, Kim HM, Kang H, Kim J. Effects of telmisartan on fat distribution: a meta-analysis of randomized controlled trials. Curr Med Res Opin. 2016;32(7):1303–1309. PubMed.
- Shojaei S, Shekouh D, Mousavi A, et al. Efficacy of telmisartan in MASLD/NAFLD: a systematic review and meta-analysis of randomized controlled trials. Endocrinol Diabetes Metab. 2026;9(5):e70319. PubMed.
- Chetty VT, Damjanovic S, Gerstein H, et al. Metabolic effects of telmisartan in subjects with abdominal obesity: a prospective randomized controlled trial. Blood Press. 2014;23(1):54–60. PubMed.
- Feng X, Luo Z, Ma L, et al. Angiotensin II receptor blocker telmisartan enhances running endurance of skeletal muscle through activation of the PPAR-δ/AMPK pathway. J Cell Mol Med. 2011;15(7):1572–1581. PubMed.
- McDermott MM, Bazzano L, Peterson CA, et al. Effect of telmisartan on walking performance in patients with lower extremity peripheral artery disease: the TELEX randomized clinical trial. JAMA. 2022;328(13):1315–1325. PubMed.
- Böhm M, Baumhäkel M, Teo K, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation. 2010;121(12):1439–1446. PubMed.
- Ismail SB, Noor NM, Hussain NHN, et al. Angiotensin receptor blockers for erectile dysfunction in hypertensive men: a brief meta-analysis of randomized control trials. Am J Mens Health. 2019;13(6):1557988319892735. PubMed.
- Rasmussen JJ, Schou M, Madsen PL, et al. Increased blood pressure and aortic stiffness among abusers of anabolic androgenic steroids: potential effect of suppressed natriuretic peptides in plasma? J Hypertens. 2018;36(2):277–285. PubMed.
- World Anti-Doping Agency. The 2026 Prohibited List (in effect January 1, 2026). WADA 2026 Prohibited List.