Home Drug Guide Amlodipine Besylate and Telmisartan

Drug Guide

Generic Name

Amlodipine Besylate and Telmisartan

Brand Names Twynsta, Telmisartan And Amlodipine

Classification

Therapeutic: Antihypertensive, combination agent

Pharmacological: Calcium channel blocker (Amlodipine), Angiotensin II receptor blocker (Telmisartan)

FDA Approved Indications

  • Hypertension

Mechanism of Action

Amlodipine inhibits calcium ion influx into vascular smooth muscle and cardiac muscle, leading to vasodilation; Telmisartan selectively blocks angiotensin II receptor subtype 1 (AT1), reducing vasoconstriction and aldosterone secretion, thereby lowering blood pressure.

Dosage and Administration

Adult: Typically, 2.5-10 mg once daily, titrated according to response; maximum dose usually 10 mg/day.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Start at lower dose, titrate cautiously due to increased sensitivity and comorbidities.

Renal Impairment: Adjust dose with caution, monitor blood pressure and renal function.

Hepatic Impairment: Use with caution; no specific dose adjustment established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Amlodipine and telmisartan are extensively protein-bound.

Metabolism: Amlodipine undergoes hepatic metabolism (primarily via CYP3A4); telmisartan undergoes minimal hepatic metabolism.

Excretion: Amlodipine excreted via urine and feces; telmisartan is mainly excreted unchanged in feces.

Half Life: Amlodipine approximately 30-50 hours; telmisartan approximately 24 hours.

Contraindications

  • Hypersensitivity to amlodipine or telmisartan.
  • Pregnancy (especially second and third trimesters) due to risk of fetal toxicity.

Precautions

  • Monitor for angioedema, hypotension, and renal function deterioration. Use with caution in patients with hepatic impairment, volume-depleted patients, or those taking other antihypertensives.

Adverse Reactions - Common

  • Swelling (edema) (Common)
  • Dizziness, fatigue (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Angioedema (Rare)
  • Hypotension (Rare)
  • Elevated serum potassium or renal dysfunction (Rare)

Drug-Drug Interactions

  • Other antihypertensives, diuretics, potassium supplements, NSAIDs (may reduce effectiveness of telmisartan).

Drug-Food Interactions

  • Avoid excessive potassium intake.
  • Alcohol can intensify blood pressure lowering effects.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function, serum potassium.

Diagnoses:

  • Ineffective tissue perfusion (renal or cerebral) related to hypotension or vasodilation.
  • Risk for electrolyte imbalance.

Implementation: Administer as prescribed, monitor response, assess for adverse effects.

Evaluation: Aim for controlled blood pressure without adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not discontinue abruptly.
  • Monitor blood pressure regularly.
  • Report signs of swelling, dizziness, or hyperkalemia.

Special Considerations

Black Box Warnings:

  • Pregnancy: risk of fetal injury; discontinue as soon as pregnancy is detected.

Genetic Factors: Genetic variations in CYP3A4 may affect amlodipine metabolism.

Lab Test Interference: None noted.

Overdose Management

Signs/Symptoms: Severe hypotension, tachycardia, bradycardia, dizziness, somnolence.

Treatment: Supportive care, IV fluids, vasopressors as needed, monitor ECG and vital signs.

Storage and Handling

Storage: Store at room temperature, 20-25°C; protect from moisture and light.

Stability: Stable through expiration when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.