Amlodipine and Telmisartan

Amlodipine and Telmisartan Brand Name– Twynsta

What is Amlodipine and Telmisartan

Amlodipine and telmisartan (Twynsta) is a combination product for treating hypertension.

Amlodipine is a calcium-channel blocker. It is a potent vasodilator and has the longest half-life of the calcium-channel blocker group, thus allowing for once-daily dosing.

Telmisartan is a specific angiotensin II antagonist that selectively and competitively blocks the AT-1 receptor, which mediates the vasopressor and aldosterone effects of angiotensin II.

Because telmisartan does not inhibit angiotensin converting enzyme (ACE), it does not result in bradykinin accumulation, which is theorized to cause the cough and angioedema associated with ACE inhibitors.

However, angioedema has been rarely associated with angiotensin II antagonists.

Because AT-1 receptors are nearly saturated at the starting dose for most angiotensin II antagonists, the antihypertensive dose-response curve of these drugs are nonlinear, with proportionally small decreases in blood pressure attained with increased dosage.

Amlodipine and telmisartan was approved by the FDA in October 2009.

Indications

  • hypertension

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. angina
  4. angioedema
  5. azotemia
  6. back pain
  7. cholestasis
  8. cough
  9. dizziness
  10. edema
  11. elevated hepatic enzymes
  12. flushing
  13. gynecomastia
  14. headache
  15. hepatitis
  16. hyperkalemia
  17. hypotension
  18. impotence (erectile dysfunction)
  19. jaundice
  20. leukopenia
  21. oliguria
  22. orthostatic hypotension
  23. palpitations
  24. pancreatitis
  25. peripheral edema
  26. renal failure (unspecified)
  27. rhabdomyolysis
  28. syncope
  29. teratogenesis
  30. thrombocytopenia

Monitoring Parameters

  • blood pressure
  • heart rate
  • LFTs
  • serum creatinine/BUN
  • serum potassium

Contraindications

  • ACE-inhibitor induced angioedema
  • acute myocardial infarction
  • angina
  • angioedema
  • aortic stenosis
  • Black patients
  • bradycardia
  • breast-feeding
  • cardiogenic shock
  • coronary artery disease
  • dihydropyridine hypersensitivity
  • geriatric
  • heart failure
  • hepatic disease
  • hyperkalemia
  • hypotension
  • hypovolemia
  • pregnancy
  • renal artery stenosis
  • renal impairment
  • surgery
  • ventricular dysfunction

Interactions

  • Acarbose
  • Acebutolol
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Alemtuzumab
  • Alfentanil
  • Aliskiren
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Alogliptin; Metformin
  • Alpha-glucosidase Inhibitors
  • Alprostadil
  • Amifostine
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Aminolevulinic Acid
  • Amiodarone
  • Amlodipine; Celecoxib
  • Amobarbital
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
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  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
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  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
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  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
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  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
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  • Haloperidol
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  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Ibuprofen
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  • Ibuprofen; Pseudoephedrine
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