Telmisartan powder down the hatch?

[BigNoOne]

On the other hand, you could cap it for a much more similar release to tabs...

99% of the time raws are way cheaper than even India pharma, but telm is an extremely cheap drug.

Caps don’t do anything to slow absorption of the drug.

Pharmaceutical Telmisartan is not “time released”. The medicine itself has a 800 min half-life.

​

Taking the powder is fine. Just put it into an acceptable air-tight container with a bunch of desiccant packs in it.

Do you need 80 mg to start? Most people start with 40 mg.

 

[BP_6]

Your pharmacy tech is lazy, and dispensing them incorrectly. Next time inquire when calling in refill "I think these are moisture sensitive and supposed to be dispensed in original bottles, will they be?" to gently remind them.

View attachment 302250

pricelist.cosmicpct.com

They have a continuous buy 4 get 1 strip deal going (same as 20% off). You have to specify that in the order. You could ask PCT24 if they'll match.

85¢ per strip of 10. (then -20%).

The first couple bottles I got from the pharmacy were normal prescription bottles. Then they started sending them "only this drug" in the original bottles and now I know why. Looking into it more, it usually is only an issue if you live in a humid environment, but it is better safe than sorry so I make sure to keep them in the bottle now until use.

 

[Ghoul]

Caps don’t do anything to slow absorption of the drug.

Pharmaceutical Telmisartan is not “time released”. The medicine itself has a 800 min half-life.

​

Taking the powder is fine. Just put it into an acceptable air-tight container with a bunch of desiccant packs in it.

Do you need 80 mg to start? Most people start with 40 mg.

Capsules delay absorption of a powder until it's further in the GI tract, in the stomach. rather than absorbing through the mouth and coating the throat and esophagus. Not ideal, but better.

The bioavailability of Telmisartan is specified at 50%. To be FDA approved, a generic couldn't be more than 20% below or 25% above that level. A fucking powder will be near 100%, or twice the dose intended to go systemic, with almost immediate absorption, rather than slowly over hours.

Pharmacokinetics Absorption: Following oral administration, telmisartan is well absorbed, with a mean absolute bioavailability of about 50%. Mean peak concentrations of telmisartan are reached in 0.5-1 hour after dosing.

https://pdf.hres.ca/dpd_pm/00025583.PDF

The tablets are designed to release gradually, with excipients that dissolve at PH 1.5-3.5 in the stomach, then PH 3.5-7 as it travels through the intestine. They don't dump the whole load in one shot in the stomach. They could, but are iintentionally designed not to.

https://www.semanticscholar.org/paper/Commercial-Telmisartan-Tablets-%3A-A-Comparative-with-Patravale/15002fe447ec15ba1ce52530c66fa4c076dad391

Here's a portion of the FDA required dissolution test to ensure it doesn't just release all at once, like a powder:

https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/revisions/telmisartan-tablets.pdf

 

[HUGE McBIGLARGE]

Uh oh. Here’s Ghoul, again, coming out with stuff we never even thought about.

So the conclusion I’m getting so far is:

For drugs that don’t benefit from a prolonged release, slamming some raws is fine.

For drugs that benefit from a delayed release, I should put it in capsules. Which sounds like a pain in the ass. Maybe I’ll just dose it twice at half the mg, 2 hours apart.

 

[Ghoul]

Uh oh. Here’s Ghoul, again, coming out with stuff we never even thought about.

So the conclusion I’m getting so far is:

For drugs that don’t benefit from a prolonged release, slamming some raws is fine.

For drugs that benefit from a delayed release, I should put it in capsules. Which sounds like a pain in the ass. Maybe I’ll just dose it twice at half the mg, 2 hours apart.

Ghoul's rule is just go with India pharma. Cheap as dirt. Cheaper than UGL tabs. Same companies making half the tabs we use in the US...

BTW Huge, what's your BP looking like these days? Lowest hanging fruit when it comes to protecting your health. 90% of the time 1 tab a day can get you to ideal range with no sides.

 

[HUGE McBIGLARGE]

Ghoul's rule is just go with India pharma. Cheap as dirt. Cheaper than UGL tabs. Same companies making half the tabs we use in the US...

I’ve never found any Indian generics that are cheaper than UGL. At least, not any that ship to the UK

BTW Huge, what's your BP looking like these days? Lowest hanging fruit when it comes to protecting your health. 90% of the time 1 tab a day can get you to idea range with no sides.

Thank you for asking

I am on no AHTs (other than 20mg tadalafil daily, if that counts). I test it weekly on an empty stomach after being sat for 10 minutes or longer. Right arm only.

On average I get 130/65. Pulse is 60-70.

Any tips on how to get the systolic down without the diastolic? I’ve cut out all salt. More water. Better sleep. More cardio. It’s helped, but not much.

The last time I was on AHTs (40mg telmisartan, 4mg doxazosin, both pharma) I was at 120/45, pulse 70-80, which seems far too low diastolically.

 

[BigNoOne]

Capsules delay absorption of a powder until it's further in the GI tract, in the stomach. rather than absorbing through the mouth and coating the throat and esophagus. Not ideal, but better.

The bioavailability of Telmisartan is specified at 50%. To be FDA approved, a generic couldn't be more than 20% below or 25% above that level. A fucking powder will be near 100%, or twice the dose intended to go systemic, with almost immediate absorption, rather than slowly over hours.

“Bioavailability of Telmisartan” refers to the drug itself. Regardless of preparation. When you take Telmisartan only 50% of what you take is bioavailable.

Bioavailability is defined as: the proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect.

Making the drug a powder doesn’t increase its bioavailability.

 

[BigNoOne]

Pharmacokinetics Absorption: Following oral administration, telmisartan is well absorbed, with a mean absolute bioavailability of about 50%. Mean peak concentrations of telmisartan are reached in 0.5-1 hour after dosing.

“mean peak concentrations of Telmisartan are reached in 0.5-1 hour after dosing.”

How is that “time-released”?


The document you referenced for one brand of Telisartan does appear to have more optimal release. It compared to some other brands. At least three released in “one load” (abbreviated as GRT, ART, and LUP). These released within 10 mins.

 

[Ghoul]

I’ve never found any Indian generics that are cheaper than UGL. At least, not any that ship to the UK

Thank you for asking

I am on no AHTs (other than 20mg tadalafil daily, if that counts). I test it weekly on an empty stomach after being sat for 10 minutes or longer. Right arm only.

On average I get 130/65. Pulse is 60-70.

Any tips on how to get the systolic down without the diastolic? I’ve cut out all salt. More water. Better sleep. More cardio. It’s helped, but not much.

The last time I was on AHTs (40mg telmisartan, 4mg doxazosin, both pharma) I was at 120/45, pulse 70-80, which seems far too low diastolically.

Forgive me, I always approach the forum from a US centric POV. The cosmic pct guy is a "euro/uk" specialist. He has a location in Turkey, which is supposed to have a good success rate into the EU/UK. You can always email and see what he says.

Yeah 45 is well into hypotension.

For isolated diastolic hypertension, the first line treatments are a CCB or diuretic. I'm assuming you're White, in which case the CCB would be the first thing to try.

Amlodipine is the current "first line of the first line" of isolated systolic treatment.

I've used it for quite a while, in isolation, and later in combination with an ARB, Valsaratan/Telm.

Sides are typical of BP meds, water retention in extremities, slight fatigue. Both typically resolve within a few weeks. You really need 10 days to see what the ultimate impact on your BP will be.

If I were in your position, I'd get my hands on some 5mg tabs, take a half for 10 days. See how BP is doing, and if diastolic isn't creeping below 55, and sides are tolerable if you want to try 5 to reduce systolic further, titrate up and see how it goes over the next two weeks, keeping a close eye on that diastolic.

These are very conservative doses. It's fairly inexpensive. Hopefully it'll get the job done.

If it did, I'd just bring it to my docs attention and say "this worked for me" and get a prescrip. Or use a private telehealth doc, they do have them in the UK, and get a prescription.

 

[BP_6]

I feel HBP is the #1 cause of health issues for many bodybuilders/anabolic users. It really if left unchecked for a long period of time wreaks havoc on the kidneys and heart.

 

[HUGE McBIGLARGE]

Forgive me, I always approach the forum from a US centric POV. The cosmic pct guy is a "euro/uk" specialist. He has a location in Turkey, which is supposed to have a good success rate into the EU/UK. You can always email and see what he says.

Yeah 45 is well into hypotension.

For isolated diastolic hypertension, the first line treatments are a CCB or diuretic. I'm assuming you're White, in which case the CCB would be the first thing to try.

Amlodipine is the current "first line of the first line" of isolated systolic treatment.

I've used it for quite a while, in isolation, and later in combination with an ARB, Valsaratan/Telm.

Sides are typical of BP meds, water retention in extremities, slight fatigue. Both typically resolve within a few weeks. You really need 10 days to see what the ultimate impact on your BP will be.

If I were in your position, I'd get my hands on some 5mg tabs, take a half for 10 days. See how BP is doing, and if diastolic isn't creeping below 55, and sides are tolerable if you want to try 5 to reduce systolic further, titrate up and see how it goes over the next two weeks, keeping a close eye on that diastolic.

These are very conservative doses. It's fairly inexpensive. Hopefully it'll get the job done.

If it did, I'd just bring it to my docs attention and say "this worked for me" and get a prescrip. Or use a private telehealth doc, they do have them in the UK, and get a prescription.

Thanks for the reply. You’ve cared more about my blood pressure than the doctors ever have lol

What would you say is the lower limit for diastolic? I’ve read CCBs have a neutral or slightly negative effect on erectile function, whereas alpha blockers have improved my erections a lot. So I’d rather take alpha blockers first until I get near a lower diastolic limit, then take CCBs to make up the difference.

 

[deadbeef]

Your pharmacy tech is lazy, and dispensing them incorrectly. Next time inquire when calling in refill "I think these are moisture sensitive and supposed to be dispensed in original bottles, will they be?" to gently remind them.

Not according to them:

The manufacturer labeling reads "moisture sensitive tablets - do not remove from bottle until immediately before administration." This can be either the original manufacturer bottle or a prescription vial. We utilize amber prescription vials that meet the USP "light and tight" requirements in which the vials are airtight, moisture resistant, and odor proof. Therefore, these tablets are protected inside the vial from external moisture and the medication was dispensed correctly.

For your convenience we have included a link to the prescription vials we utilize in the pharmacy: 16 Dram Reversible Cap Vials Amber (240 units/box)

And since they certainly understand their jobs better than you or me, I tend to believe them.

 

[Ghoul]

Not according to them:



And since they certainly understand their jobs better than you or me, I tend to believe them.

Your naïveté and faith in a low level pharmacy employee having your best interests at heart is endearing. Be sure to advise the FDA, the manufacturer, and my pharmacist they're all wrong, so Micardis can be removed from the short list of "special handling" drugs. Imagine all the wasted effort over the years:

https://www.goodrx.com/drugs/medication-basics/dispense-in-original-container

 

[deadbeef]

You have the worst case of Dunning Kruger I've ever seen.

 

[Ghoul]

You have the worst case of Dunning Kruger I've ever seen.

Still believe your pharmacy, or prefer to keep deflecting from the fact I did your homework for you?

 

[deadbeef]

Still believe your pharmacy, or prefer to keep deflecting from the fact I did your homework for you?

Over a Dunning Kruger dude who posted a bunch of screenshots from goodrx? That's a resounding yes!

 

[Tbaz192]

well I’m definitely not 100% believing the pharmacy employees unless it’s the pharmacist and he specifically shows me proof.

Most pharmacy techs absolutely hate their jobs and life. Every time I go in, they’re so dry and rude. So I highly doubt they’d give a flying fuck about you or health.
and typically when they ask if you have any questions.
If you say yes. They grab the pharmacist. Because they don’t know & simply reading the papers on the medication isn’t enough.

 

[deadbeef]

well I’m definitely not 100% believing the pharmacy employees unless it’s the pharmacist and he specifically shows me proof.

Most pharmacy techs absolutely hate their jobs and life. Every time I go in, they’re so dry and rude. So I highly doubt they’d give a flying fuck about you or health.
and typically when they ask if you have any questions.
If you say yes. They grab the pharmacist. Because they don’t know & simply reading the papers on the medication isn’t enough.

You only think it's a tech because Ghoulber assumed it was, when it fact that's the pharmacist's reply.

 

[Ghoul]

Everyone ready for the North American Pharmacist Licensure Examination question of the week?

BU is a 68 year old female who asks to speak to the pharmacist at the community pharmacy. She is considering using a pillbox planner in order to help increase adherence with her medications. Upon questioning and according to the pharmacy records, she takes the following medications: telmisartan 80mg daily, atorvastatin 80mg daily, prasugrel 10mg daily, amlodipine 10mg daily, dabigatran 150mg BID, and allopurinol 300mg daily.

Which of the following medications may be safely placed from the original packaging in her pill planner?

A. Prasugrel

B. Dabigatran

C. Telmisartan

D. Allopurinol







Answer with rationale:

The correct answer is D, allopurinol. The vast majority of medications may be taken from the original "stock" container and placed in an amber prescription vial for dispensing to the patient. However certain medications must be maintained in their original packaging due to light, temperature, moisture, or humidity concerns. The classic example of this is nitroglycerin sublingual tablets. Failure to meet these requirements may affect the integrity of the medication leading to decreased effectiveness. The medications in answers A, B, and C should be retained in their original bottle (often with desiccant) or their foil packaging in order to preserve their integrity and ultimately effectiveness.

Pharmacists (and Ghoul) are often the only healthcare providers keenly aware of these requirements and should communicate these to patients upon dispensing as part of routine patient counseling. Otherwise a potential loss of potency could occur, especially in longer duration pill planners which may be as much as a month at a time.

NAPLEX Question of the Week: Proper Storage

This week's question gets at an important part of pharmacy practice that ensures patient's receive the intended therapeutic effect from their medication.

www.accessmedicinenetwork.com

 

[deadbeef]

Blah blah blah

The definition describes you so perfectly:

The Dunning–Kruger effect is a cognitive bias in which people with limited competence in a particular domain overestimate their abilities.