#181

If you had to take either Telmisartan or Tadalifil, which would be better? I’m afraid that I can’t take them both without killing myself.

#182

I’m interested in neuroprotection and the evidence is strong for telmisartan and weak for tadalafil. So telmisartan. For other endpoints: I don’t know.

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#183

But isn’t this dose dependent? At what dose do you expect to see neuroprotection and in what aspect of neuroprotection? I am preparing to start telmisartan early next year and so have been looking at the literature. Neuroprotection is a very broad term.

#184

By neuroprotection I mean “beneficial for AD, PD, depression and anxiety”. The PD trial is using 40 mg. It seems to be dose–dependent indeed. I’m taking 80 mg.

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#185

What happens if you take both?

#186

I will probably pass out due to low blood pressure based on past experiences.

#187

Could try Telmisartan every other day and Tadalafil on the other alternate days.

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#188

Unfortunately for me, I can’t tolerate telmisartan (gives me serious brain fog even at low doses), but I do great with irbesartan, so that’s the one I take. Good to know that irb is 2nd-best for adiponectin.

#189

What’s your usual blood pressure now and how low does it go when you get symptoms? I’m curious.

#190

When I was taking Telmisartan 40 mg daily, my SBP would vary between 90 and 125. I didn’t measure it when I passed out because I was unconscious at 3 am in the morning, lying on the bathroom floor. I did feel extreme nausea at that time, which is why I was going to the bathroom as I felt like vomiting. In the future, if I feel that way again, I’ll just stay in bed and call for help instead.

#191

I reported this before but am repeating it as an update months later. For me telmisartan 80 mg has been an amazing drug. Setting aside the potential longer term cardiac benefits, it significantly lowered my BP readings from a former daily range from 112/75 to 145/85 to a current typical range of 110/68 to 120/70, with most readings now clustering toward the lower end. I find that telmisartan has other observable effects as well. Reporting purely subjectively, it seems to alter the cause of those daily variations, I have always been somewhat reactive to events for at least the first few seconds until my rational processes take over. That reactivity is no longer a part of my typical reactions but not in the way a tranquilizer might dampen one’s reactions. The effect is much more subtle and “natural” than that. My theory – for which there is some empirical evidence – is that the sartans modulate sympathetic-adreno-medullar axis, the hypothalamic-pituitary-adrenal (HPA) axis, and the immune system. I’ll post more later on this when I have had time to track some issues down.

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#192

Thanks for that report, RobTuck. I’m researching telmisartan as my BP has been climbing the last few years, now getting readings over SBP 120 dr office, at home 115. I’m onlining meds one by one at the moment with copious tests, and have telmisartan scheduled for May 2026 - takes awhile as I’m testing combos too. Hope my BP can hold on not too high until then. I was thinking of starting with a 20mg/day dose and seeing how it goes. Admittedly DeStrider’s passing out experience on 40mg has me somewhat spooked.

I would be interested in any further reports of experiences you may have.

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#193

The literature calls attention to possible dizziness, especially when starting the drug. I started with 40 mg/day and experienced no side effects of any kind. After a few months, I went to 80 mg/day to realize some of the secondary benefits. As far as I can tell, I have never had a side effect of any kind, even a minor one. In the way I described above, I actually feel better for taking telmisartan.

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#194

This is my thinking as to why some of us report subtle positive effects when taking telmisartan.

Basis for speculating positive impact on the sympathetic-adreno-medullar axis is reduced Ang II-mediated sympathetic activation and confirmed reduction in SNS tone.

Basis for speculating positive impact on the hypothalamic-pituitary-adrenal is reduced Ang II-driven CRH-ACTH-Cortisol signaling leading to lowered cortisol levels.

Basis for speculating positive positive immune modulation is inhibition of AT1-mediated inflammatory signaling leading to reduced cytokines and NF-κB signaling.

You can see the synergy here. With reduced CRH-ACTH-Cortisol signaling, for example, there could be a form of learning taking place that would result in increased benefits over time. Of course, the opposite could be true.

2 Likes
#195

Clonidine anyone? Lowers BP, enhances sleep, reduces pain, inhibits anxiety, and manages ADHD. Not without side effects, but what isn’t?

#196

I use Clonidine only in rare extreme situations when BP suddenly skyrockets (usually stress related). It works fast, however if you start taking it it’s not safe to stop abruptly. The smallest dose 0.1 mg is too big for me. I need 0.025 mg to bring my BP down. I also tried Clonidine patch 0.1 mg/week. It works better than a pill for me.

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#197

I can see how a patch would be better. Tapering a tablet down to less than 25 mcg could be tricky.

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#198

I avoid posting direct LLM text. I’m making an exception here both because this is relatively succinct and I’m a little short on time today. My prompt was designed to explore the relationship between supplemental taurine while taking telmisartan.

LLM RESPONSE
The potential interrelationship between supplemental taurine and an ARB such as telmisartan (at a typical clinical dose of 80 mg/day) is intriguing, both from mechanistic and clinical perspectives. While direct research on their combined administration remains limited, we can extrapolate clearly defined theoretical and mechanistic pathways that suggest complementary and possibly synergistic effects, particularly related to cardiovascular health, autonomic balance, metabolic regulation, and anti-inflammatory activity.

I. Mechanistic Foundations for a Synergistic Relationship

A. Modulation of the Renin-Angiotensin System (RAS)

Telmisartan:

  • Blocks Angiotensin II type-1 receptor (AT1), reducing vasoconstriction, aldosterone secretion, and fluid retention, thus lowering blood pressure and cardiovascular strain.

Taurine:

  • Acts as a mild natural inhibitor of Angiotensin Converting Enzyme (ACE), decreasing Ang II formation modestly.
  • Reduces plasma aldosterone levels, complementing ARB-mediated aldosterone reduction.

Potential Synergy:

  • Taurine may slightly enhance the RAS-modulating effects of telmisartan, creating more comprehensive suppression of Ang II signaling and aldosterone-mediated sodium retention.

B. Sympathetic-Adreno-Medullary (SAM) Axis Modulation

Telmisartan:

  • Reduces sympathetic nervous system (SNS) activity indirectly via AT1 receptor blockade, leading to reduced norepinephrine release and improved autonomic balance.

Taurine:

  • Demonstrated sympatholytic effects, reducing sympathetic tone, stabilizing heart rate variability (HRV), and improving baroreceptor sensitivity.
  • Acts centrally and peripherally to attenuate sympathetic overactivity, reducing norepinephrine release.

Potential Synergy:

  • Concurrent supplementation of taurine and telmisartan could yield additive or synergistic reductions in sympathetic overactivity, resulting in improved autonomic regulation and potentially beneficial effects on cardiovascular risk.

C. Hypothalamic-Pituitary-Adrenal (HPA) Axis Regulation

Telmisartan:

  • Mitigates HPA-axis hyperactivation via decreased Ang II-mediated stimulation of CRH-ACTH-cortisol axis.
  • Reduces stress-related cortisol spikes and maladaptive neuroendocrine responses.

Taurine:

  • Exhibits mild anxiolytic and stress-modulating properties, including suppression of stress-induced cortisol elevation, possibly mediated through GABAergic or NMDA receptor modulation.

Potential Synergy:

  • Taurine could enhance the HPA-axis-modulating effects of telmisartan, further buffering the neuroendocrine response to stress and improving psychological and physiological resilience.

D. Immune and Anti-inflammatory Modulation

Telmisartan:

  • Potently reduces inflammation via blockade of AT1-mediated NF-κB signaling, cytokine production (IL-6, TNF-α), and improvement in endothelial function.
  • PPARγ partial agonism uniquely enhances telmisartan’s anti-inflammatory and metabolic regulatory capacity.

Taurine:

  • Known anti-inflammatory agent, reducing NF-κB signaling, oxidative stress, cytokine production (IL-6, TNF-α), and macrophage activation.
  • Supports endothelial function, reduces arterial stiffness, and mitigates inflammation-driven cardiovascular damage.

Potential Synergy:

  • Combining taurine with telmisartan might result in enhanced anti-inflammatory effects, a broader reduction in inflammatory cytokines, and improved endothelial function and cardiovascular protection.

E. Metabolic Regulation and Cardiovascular Health

Telmisartan:

  • Dual-activity via AT1 blockade and PPARγ partial agonism improves insulin sensitivity, lipid profiles, adipokine secretion, and glucose metabolism.

Taurine:

  • Enhances insulin sensitivity, reduces insulin resistance, positively influences lipid profiles (lowers triglycerides, LDL-C modestly), and improves mitochondrial function and energy metabolism.

Potential Synergy:

  • The metabolic-improving actions of telmisartan and taurine appear complementary, possibly leading to more significant improvements in metabolic syndrome components, insulin resistance, and lipid disorders when combined.

II. Clinical Implications and Potential Benefits:

Given the theoretical mechanistic compatibility, a patient concurrently receiving telmisartan (80 mg/day) and supplemental taurine might experience the following benefits:

  • Improved Blood Pressure Control:
    Additive antihypertensive effects through combined RAS inhibition and enhanced sympatholysis.
  • Enhanced Cardiovascular Protection:
    Synergistic anti-inflammatory and endothelial-protective effects, possibly translating to a reduced risk of atherosclerosis progression and ASCVD events.
  • Superior Metabolic Outcomes:
    Improved insulin sensitivity, glucose tolerance, and lipid profiles due to complementary metabolic regulatory actions.
  • Reduced Stress and Improved Autonomic Function:
    Enhanced modulation of the SAM and HPA axes, potentially improving heart rate variability, psychological stress resistance, and general well-being.

III. Speculative and Cautionary Considerations

  • Hypotension Risk:
    Though beneficial synergism is likely, one could theoretically observe exaggerated reductions in blood pressure or orthostatic hypotension in susceptible individuals. Clinically, this appears modest, but warrants attention.
  • Electrolyte Balance:
    Combined reduction of aldosterone secretion might modestly increase potassium retention. Clinical surveillance of serum potassium would be prudent.
  • Dose Optimization:
    Taurine doses commonly employed in human studies range from 1–3 grams/day, a safe range. No documented negative interaction is known at these levels, and risks appear minimal. However, explicit pharmacokinetic interaction studies remain sparse.

IV. Research Evidence Gap and Recommendation for Further Study:

Direct clinical trials specifically assessing combined administration of telmisartan (or other sartans) with supplemental taurine remain rare. Nevertheless, the strong theoretical and mechanistic compatibility provides sufficient rationale for clinical inquiry:

  • Prospective trials should be undertaken to investigate the specific additive or synergistic interactions between taurine and telmisartan, with endpoints including blood pressure, inflammation, insulin sensitivity, HRV, and endothelial function.
  • Assessment of optimal dosing strategies and long-term safety profiles should be pursued.