Telmisartan + Amlodipine

Indications

Telmisartan + Amlodipine is used for: Hypertension

Adult Dose

Oral Hypertension Adult: PO Each tab contains telmisartan (mg)/amlodipine (mg): 40/5, 40/10, 80/5, and 80/10: 1 tab once daily. Dosage is individualised and may be increased after at least 2 wk. Max: Telmisartan 80 mg and amlodipine 10 mg once daily. Mild to moderate: Max: 40 mg of telmisartan component. Severe: Contraindicated.

Child Dose

Renal Dose

Administration

May be taken with or without food.

Contra Indications

Biliary obstructive disorders, cardiogenic shock. Severe hepatic impairment. Pregnancy and lactation. Concomitant use w/ ACE inhibitors or aliskiren-containing products in patients w/ DM or renal impairment (GFR <60 mL/min).

Precautions

Patient w/ Na- or volume-depletion, idiopathic or hereditary angioedema, primary hyperaldosteronism, severe obstructive coronary artery disease, heart failure, recent MI, mitral or aortic stenosis, hypertrophic cardiomyopathy w/ outflow tract obstruction, DM. Patient undergoing surgery or dialysis. Renal (e.g. unilateral/bilateral renal artery stenosis) and mild to moderate hepatic impairment.

Pregnancy-Lactation

Interactions

Increased hypotensive effects w/ other antihypertensive agents and agents w/ BP lowering potential (e.g. baclofen, amifostine). Orthostatic hypotension may be aggravated by barbiturates, narcotics, or TCAs. Reduced therapeutic effect w/ corticosteroids. Telmisartan: Reduced antihypertensive effect and risk of acute renal insufficiency w/ NSAIDs. May cause reversible increase in serum lithium concentration and toxicity. Increased risk of hyperkalaemia w/ K-sparing diuretics, K supplements or K-containing salt substitutes. Amlodipine: Increased exposure CYP3A4 enzyme inhibitors (e.g. protease inhibitors, azole antifungals, erythromycin, diltiazem). Decreased plasma concentration w/ CYP3A4 enzyme inducers (e.g. rifampicin). May increase systemic exposure of ciclosporin or tacrolimus. Potentially Fatal: Dual blockade of the renin-angiotensin-aldosterone system (RAAS) by concomitant use w/ ACE inhibitors (e.g. ramipril) or aliskiren may cause an increased risk of hypotension, hyperkalaemia, and acute renal failure (esp in patients w/ DM or renal impairment).

Adverse Effects

Side effects of Telmisartan + Amlodipine : >10% Peripheral edema (1-11%) 1-10% Dizziness (3%) Orthostatic hypotension (6%) Syncope (2%) Back pain (2%)

Mechanism of Action

Telmisartan, a nonpeptide tetrazole derivative, is an angiotensin II type 1 (AT1) receptor antagonist producing its BP lowering effects by selectively blocking the binding of angiotensin II to angiotensin type 1 (AT1) receptors, thereby reducing angiotensin II-induced vasoconstriction, aldosterone release, and Na reabsorption. Amlodipine, a dihydropyridine Ca channel blocker, reduces peripheral vascular resistance and BP by producing a relaxation of vascular smooth muscle and coronary vasodilation through inhibition of Ca ion transmembrane influx into cardiac and vascular smooth muscles.