#21

@adssx How long were you taking telmi before you noticed the ‘anti-apathy’ effect?

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#22

After a few days I think.

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#23

If i take the whole 80mg in the morning i becomes sluggish and Yawn ( low blood pressure signal i guess ) but if i split it morning and night with 12h interval I’m cool , i also take nebivolol in the morning with it

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#24

I’d be very interested in any additional reports of this effect. How much did your blood pressure change?

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#25

Part of that risk preference would be going too low at night.

I think there are studies that say blood pressure meds are better taken at night. For a lot of people they experience a solid dip in pressure at night, especially if they are taking other agents like melatonin which could possibly affect blood pressure as well (I think melatonin is modulatory though, not sure).

I’m taking 80 and gets reads around 110/65 in the day and am concerned about too low at night. I’m guessing its solidly lower at night when im taking the telmisartan

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#26

But if as adssx says telmisartan has a halflife of 24 hours, so it can be taken all at once, then does it matter quite as much when you take it? Isn’t the danger of going too low at night there almost any time you take it, since at most if you took it right after waking up, you’d still have only 16 hours until you are asleep (assuming you sleep 8 hours)… isn’t 16 hours cutting it a bit close for a drug that has a half life of 24 hours?

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#27

yes, the risk of going too low at night is there no matter when you take it. Although more is in the blood at night if you take it then, so that also has to be taken into consideration

Not sure that’s the point to my post though.

#28

In a small RCT of candesartan in people with Parkinson’s they noticed no improvements except a statistically significant decrease in apathy.

And then some association studies show that ARBs in general might have anti anxiety effects.

And there are many association studies showing that telmisartan specifically has a risk of Alzheimer’s and Parkinson’s divided by 2 vs other anti hypertensives. But nothing for depression or apathy.

I think that’s all we have.

In my case the effect was seen (but quite subtle) as soon as I used telmisartan 20 mg, even though it barely lowered my BP. It became more obvious with 40 mg (that lower by BP by about 10 mmHg?). Amlodipine lowered my BP further but I didn’t notice any improvement in mood with it.

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#29

I checked the literature a bit more: there are many Chinese, Indian, Taiwanese, and South Korean papers showing anti-depressant effects on rodents (FWIW…). There’s this paper about ACEIs and ARBs in general: The renin–angiotensin system: a possible new target for depression 2017, but they don’t specifically highlight telmisartan. And here’s the PD trial I mentioned above: A randomized clinical trial of candesartan for cognitive impairment in Parkinson’s disease 2023

So N = 1 (actually N = 3, as other people reported a similar effect here) and very weak evidence. I would NOT recommend to anyone to take telmisartan just for depression. It’s just a potential welcome side effect on top of the other benefits of telmisartan (and BP lowering in general) for those with elevated blood pressure.

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#30

Good find @adssx! (Here are the required extra characters.)

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#31

How do you dose your rapamycin? What Else is on your essential list?

#32

Started 40mg Telmisartan two weeks ago.
136/87 average before Telmi
131/84 average after Telmi

Current BMI is healthy, 14.8% body fat, good biomarkers across the board. BP has history of hypertension likely from being overweight and some degree of blaming white coat syndrome on high readings at doctors appointments.

At what point do you think I should consider switching to 80mg?

Here’s what Claude.ai suggested:
The time it takes for Telmisartan to have its full effect on blood pressure can vary, but here are some general guidelines:

  1. Initial effects: Some patients may start to see a reduction in blood pressure within a few days of starting treatment.

  2. Full effect: The full blood pressure-lowering effect of Telmisartan is usually achieved within 4-8 weeks of starting treatment at a given dose.

  3. Steady-state: Telmisartan reaches steady-state concentrations in the body after about 5-7 days of daily dosing.

Regarding adjusting the dose from 40mg to 80mg:

A cardiologist might consider increasing the dose to 80mg daily if:

  1. The patient’s blood pressure is not adequately controlled on 40mg after 4-8 weeks of treatment.

  2. The patient is tolerating the 40mg dose well without significant side effects.

  3. Other factors such as lifestyle modifications and adherence to other medications have been addressed.

  4. The patient has a particularly high cardiovascular risk or severe hypertension that requires more aggressive treatment.

Does that sound appropriate @adssx ?

#33

Telmi is not a particularly strong agent, especially the closer you get to normotensive. I’m in a similar situation with my BP numbers, and waiting for telmi - I intend to go on it sometime in November. I’m a little surprised though at the tiny lowering you’re getting from 40mg, it’s the kind of numbers I’d expect from 20mg. The conventional wisdom is that you don’t get as much proportionally from 40 to 80, but given how little you got from 40 maybe you’ll get more, some people have different responses. You may be better off combining several lower dose agents, adding a CCB and/or diuretic. But adssx is the guy for telmi, so I’d defer to him. Out of curiosity, do you have a PCP supervising your BP, or are you flying under your own power on this?

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#34

I’m not a doctor so I don’t want to give medical advice :slight_smile:

Here’s what the literature on telmisartan and amlodipine says:

Single-Pill Telmisartan and Amlodipine 2012
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FDA:

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So you got -5/-3 after two weeks compared to -7/-5 in the first graph and -12/-7 in the FDA file. They say that the majority of the effect is attained after 2 weeks but you might still get a few more mmHg after another two weeks and I’ll assume you’ll be around -7/-5 as in the first chart. Assuming that this chart is correct then 80 mg will give you -11/-7 mmHg and adding amlodipine 5 mg would bump that. So it’s up to you and your doctor to decide which BP target you want to reach and if you think the current one is not low enough whether you want to try telmisartan 80 mg first or adding amlodipine first. The American and European guidelines suggest ARB/ACEI (e.g., telmisartan) + DHP CCB (e.g., amlodipine) + thiazide/thiazide-like (e.g., indapamide SR) and to introduce from the beginning two agents (for instance ARB + CCB or ACEI + thiazide) at low-dose to combine their effect rather than one agent at high dose.

I’m not sure this is true. This is an Indian paper but I remember that other papers I read in the past concluded the same thing: Efficacy and Tolerability of Olmesartan, Telmisartan, and Losartan in Patients of Stage I Hypertension: A Randomized, Open-label Study. 2017

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The most efficacious drug in reducing BP is Olmesartan whereas telmisartan and losartan show equal efficacy. Telmisartan shows the most favorable effects on FBG and lipid profile.

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#35

Flying solo, but discussions with PCP. They suggest that because sometimes my BP reaches health levels (110-120 / 70-79) after cardio exercise, that it is transient high BP. Perhaps stress or inadequate sleep or other issues maintain high BP.

But those post-workout healthy BP hours are too few / rare over this past 15 years. If I maintain average over 130 / 85, then it sounds like my PCP would be on board for 40mg Telmisartan to start then wait and see about 80mg.

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#36

That chart is super helpful, I agree I’ll wait another 1-2 weeks and if consistent with the study you referenced then I’d bump to 80mg.

Thoughtful and helpful reference to the Guidelines. As I’m already on the path of Telmi solo I’ll hold out on adding Amlodipine but re-evaluate after 30 days of 80mg.

Thanks again for your insights. I’ll probably be back for more soon.

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#37

Here I thought I was the only one.

I’ve taken 40mg/12.5mg of Telmisartan/HCTZ for the better part of a year now.

I have noticed a significant improvement of my mood, so much so that I was able to pair back my use of as-needed alprazolam to once a month or during crazy flights. when I take the dose, I experience brief euphoria fifteen to twenty minutes (I usually meditate now during this period) then a general ease to my day.

My partner says he can notice a difference in the way I carry my body, less stiff and organic in the last year. I swing my arms more and I’m more animated in my movements.

I take my dose in the morning, otherwise I’m urinating all night.

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#38

I had this at times! Damned I’m not crazy :rofl:

I should maybe take it in the morning then :thinking:

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#39

Guys, is it possible that your mood elevation with telmisartan is mediated by lithium? If you take lithium, telmisartan turbocharges it. But my thought is rather something else: we all take in lithium through food/diet. Is it possible that somehow telmi spares and amplifies lithium or at least somehow affects the same pathway seeing as the interaction of those two is so strong - and that’s how you get mood elevation on telmi. Conversely, drugs like empa get rid of lithium and are associated with more depression/suicide.

Here:

https://www.drugs.com/drug-interactions/lithium-with-telmisartan-1477-0-2152-0.html#:~:text=Interactions%20between%20your%20drugs&text=Telmisartan%20may%20significantly%20increase%20the,threatening%20and%20may%20require%20hospitalization.

[Edit]: Which makes me wonder if you take telmi with empa, if telmi might not take the edge off of the depression aspect of SGLT2i. This is assuming the mood thing in both cases is mediated through lithium levels sparing/elimination. Also we dont know if these work along different pathways, so there may or may not be that particular interaction between telmi and empa.

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#40

I take both lithium and telmisarten.
IMO: Telesmarten is not a mood elevator.

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