Amlodipine + Telmisartan

Amlodipine + Telmisartan is a antihypertensive combination (calcium channel blocker + arb) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• High blood pressure (hypertension) — when blood pressure is not adequately controlled by amlodipine or telmisartan alone
• Replacement therapy — patients already stable on the two medicines taken separately, to reduce pill burden
• Hypertension with high cardiovascular risk — where both vessel relaxation and organ protection are desired

Your doctor will choose the strength of Amlodipine + Telmisartan based on your current blood pressure, previous medicines and kidney function, and may adjust it at follow-up visits.

• Take it once daily, at about the same time every day, with or without food.
• Swallow whole with water; do not split unless your doctor advises.
• If you miss a dose, take it as soon as you remember unless the next dose is near — never take a double dose.

This is a long-term medicine. Never stop Amlodipine + Telmisartan on your own, even when readings look perfect — the readings are good because the medicine is working every day.

Most people tolerate the combination well. Possible side effects include:

• Swelling of the ankles or feet (from the amlodipine part, though less than amlodipine alone)
• Dizziness or light-headedness, especially on standing quickly
• Headache, flushing or warmth in the face
• Tiredness, palpitations
• High blood potassium, changes in kidney tests (telmisartan part)
• Rare but serious: fainting from very low pressure, or swelling of the face, lips, tongue or throat (angioedema) — seek emergency care immediately

• Check your blood pressure regularly and attend all follow-up visits.
• Your doctor may order periodic blood tests for kidney function and potassium.
• Rise slowly from sitting or lying; avoid driving until you know how the medicine affects you.
• Tell your doctor if you have liver disease, kidney disease, bile duct problems, severe heart valve narrowing (aortic stenosis) or heart failure.
• Vomiting, diarrhoea or dehydration can drop pressure too far — drink fluids and contact your doctor if you feel faint.
• Avoid potassium supplements or potassium-based salt substitutes unless approved.
• Mild ankle swelling can occur; raise your legs and inform your doctor if it bothers you — do not stop the tablet yourself.

• NSAID painkillers (ibuprofen, diclofenac, naproxen): reduce the blood-pressure effect and can strain the kidneys
• Potassium supplements and potassium-sparing diuretics (spironolactone): risk of high potassium with the telmisartan part
• ACE inhibitors (ramipril) or aliskiren: generally avoided together with an ARB
• Lithium: levels can rise to toxic range
• Strong CYP3A4 inhibitors (clarithromycin, ketoconazole) or inducers (rifampicin): can raise or lower the amlodipine part
• Simvastatin: amlodipine raises its level — doses are capped
• Other blood pressure medicines: additive pressure-lowering effect

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to amlodipine, telmisartan, other dihydropyridines or ARBs
• Pregnancy — especially the second and third trimesters (telmisartan part)
• Severe liver disease or bile duct obstruction
• Severe low blood pressure, shock, or severe aortic stenosis
• Use with aliskiren in patients with diabetes or significant kidney disease

Pregnancy: This combination is contraindicated in pregnancy because of the telmisartan component. ARBs can cause serious kidney damage, low amniotic fluid and even death of the unborn baby, particularly in the second and third trimesters. If you become pregnant or plan to conceive, tell your doctor immediately so you can be switched to a pregnancy-safe blood pressure medicine.

Lactation: Not recommended while breastfeeding, as data for telmisartan are lacking and amlodipine passes into milk in small amounts. Your doctor can prescribe a better-studied alternative for nursing mothers.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Keep the tablets in the original blister pack until use, and keep out of the reach of children. Do not use after the expiry date.