Twynsta

Per 40 mg/5 mg tab Telmisartan 40 mg, amlodipine 5 mg. Per 40 mg/10 mg tab Telmisartan 40 mg, amlodipine 10 mg. Per 80 mg/5 mg tab Telmisartan 80 mg, amlodipine 5 mg. Per 80 mg/10 mg tab Telmisartan 80 mg, amlodipine 10 mg

Essential HTN.

Adult Max: 80 mg/10 mg once daily. Replacement therapy 1 tab once daily. Add-on therapy in patient whose BP is inadequately controlled w/ amlodipine or telmisartan alone 40/5 mg once daily. Initial therapy 40/5 mg once daily. Patient requiring larger BP reduction Initially 80/5 mg once daily, may be titrated up to max: 80/10 mg once daily if additional BP lowering is needed after at least 2 wk of therapy. Mild to moderate hepatic impairment Not to exceed telmisartan 40 mg once daily.

May be taken with or without food.

Hypersensitivity to telmisartan, amlodipine & dihydropyridine derivatives. Biliary obstructive disorders, severe hypotension, cardiogenic shock, left ventricle outflow tract obstruction eg, high grade aortic stenosis, haemodynamically unstable heart failure after acute MI. Concomitant use w/ aliskiren in patients w/ DM or renal impairment (GFR <60 mL/min/1.73 m²). Severe hepatic impairment. 2nd & 3rd trimesters of pregnancy. Lactation.

Not recommended in primary aldosteronism & dual blockade of renin-angiotensin-aldosterone system. Bilateral renal artery stenosis or artery stenosis to single functioning kidney; severe CHF or underlying renal disease including renal artery stenosis; aortic or mitral valve stenosis, obstructive hypertrophic cardiomyopathy; unstable angina pectoris, acute MI; hyperkalaemia; intercurrent events; ischaemic cardiopathy or CV disease. Patients w/ severe heart failure (NYHA III & IV); DM & coexistent CAD; biliary obstructive disorders. Black patients (low renin population). Correct vol &/or Na depletion prior to administration. Concomitant use of K supplements, K-containing salt substitutes, K-sparing diuretics, ACE inhibitors, AIIAs, NSAIDs, heparin, immunosuppressives, trimethoprim. May affect ability to drive & use machines. Hepatic impairment. Renal impairment or haemodialysis; recent kidney transplant. Periodic monitoring of K & creatinine serum levels in patients w/ renal impairment. Not to be initiated during pregnancy. Not recommended in childn <18 yr. Not recommended in elderly ≥75 yr. 80 mg/5 mg & 80 mg/10 mg tab: Not recommended in patients w/ hereditary fructose intolerance.

Dizziness; peripheral oedema.

Increased BP-lowering effect w/ other antihypertensive agents. Potentiated hypotensive effects by baclofen, amifostine. Aggravated orthostatic hypotension by alcohol, barbiturates, narcotics or antidepressants. Reduced antihypertensive effect w/ systemic corticosteroids. Telmisartan: Increased hypotensive effect of other antihypertensive agents. Increased median plasma digoxin trough conc. Increased AUC & C_max of ramipril & ramiprilat. Reversible increased in serum lithium conc & toxicity. Reduced antihypertensive effect w/ NSAIDs. Amlodipine: Increased BP-lowering effects w/ grapefruit & grapefruit juice. Increased exposure w/ strong or moderate CYP3A4 inhibitors eg, PIs, azole antifungals, macrolides (eg, erythromycin or clarithromycin), verapamil or diltiazem. Varied plasma conc w/ strong CYP3A4 inducers eg, rifampicin, Hypericum perforatum. Increased tacrolimus blood levels. Increased trough conc of cyclosporine in renal transplant patients. Lethal ventricular fibrillation & CV collapse associated w/ hyperkalemia w/ dantrolene infusion. Increased exposure of simvastatin, mTOR inhibitors.

Angiotensin II Antagonists / Calcium Antagonists

C09DB04 - telmisartan and amlodipine ; Belongs to the class of angiotensin II receptor blockers (ARBs) and calcium channel blockers. Used in the treatment of cardiovascular disease.

B