What are the effects of telmisartan (Angiotensin II Receptor Antagonist) and amlodipine (Calcium Channel Blocker) dosing together?

From the Guidelines

Telmisartan and amlodipine can be safely and effectively dosed together for hypertension management, with a typical starting dose of telmisartan 40-80 mg once daily combined with amlodipine 5-10 mg once daily, as supported by the most recent and highest quality study 1.

Key Considerations

• The combination of telmisartan and amlodipine provides more effective blood pressure control than either medication alone, especially in patients with moderate to severe hypertension or those who haven't responded adequately to monotherapy.
• This combination is particularly beneficial for patients with certain comorbidities like diabetes or kidney disease due to telmisartan's additional protective effects.
• Side effects may include peripheral edema (swelling), dizziness, and headache, though the combination may actually reduce the edema sometimes seen with amlodipine alone.

Mechanism of Action

• Telmisartan blocks angiotensin II receptors to reduce blood vessel constriction.
• Amlodipine blocks calcium channels to relax blood vessels.

Administration and Monitoring

• Patients should take these medications at the same time each day, with or without food.
• Patients should monitor their blood pressure regularly.

Special Considerations

• The use of dual blockade of the renin-angiotensin-aldosterone system, such as combining telmisartan with an ACE inhibitor, is not recommended due to increased risk of adverse events like hyperkalemia or acute kidney injury, as noted in studies like ONTARGET and NEPHRON-D 1.
• Diuretics, calcium channel blockers, and beta-blockers can be used as additional therapy to further lower blood pressure in patients already treated with maximum doses of ACE inhibitors or ARBs, or as alternate therapy in individuals unable to tolerate ACE inhibitors and ARBs 1.

From the FDA Drug Label

Co-administration of telmisartan did not result in a clinically significant interaction with ... amlodipine The FDA drug label does not provide detailed information on the dosing of telmisartan and amlodipine together, but it does indicate that there is no clinically significant interaction between the two drugs 2.

• No dosage adjustment is necessary when co-administering telmisartan and amlodipine.
• The label does not provide specific guidance on the dosing of telmisartan and amlodipine together.

From the Research

Telmisartan and Amlodipine Dosing Together

• The combination of telmisartan and amlodipine has been shown to be effective in reducing blood pressure in patients with hypertension, particularly in those with added-risk factors such as diabetes and metabolic syndrome 3, 4, 5.
• Studies have demonstrated that the combination of telmisartan 40-80 mg and amlodipine 5-10 mg provides consistent reductions in mean systolic and diastolic blood pressure across different sub-populations, including patients with type 2 diabetes, obesity, and metabolic syndrome 3, 5.
• The highest dose combination of telmisartan 80 mg and amlodipine 10 mg has been shown to provide significant reductions in blood pressure, with systolic blood pressure reductions ranging from -19.1 to -34.7 mmHg and diastolic blood pressure reductions ranging from -16.4 to -22.8 mmHg 3.
• The combination of telmisartan and amlodipine has also been shown to be well-tolerated, with a low incidence of peripheral edema compared to amlodipine monotherapy 3.
• A study comparing the efficacy and safety of triple therapy with telmisartan, amlodipine, and rosuvastatin to dual therapy with telmisartan and amlodipine or telmisartan and rosuvastatin found that the triple therapy regimen provided significant reductions in blood pressure and LDL-C, with a favorable safety and tolerability profile 6.

Dosing Regimens

• Telmisartan 40-80 mg and amlodipine 5-10 mg have been used in combination to treat hypertension in various studies 3, 4, 5.
• The highest dose combination of telmisartan 80 mg and amlodipine 10 mg has been shown to be effective in reducing blood pressure in patients with hypertension, particularly in those with added-risk factors 3.
• A fixed-dose combination of telmisartan 80 mg, amlodipine 10 mg, and rosuvastatin 20 mg has been shown to be effective in reducing blood pressure and LDL-C in patients with hypertension and dyslipidemia 6.

Safety and Tolerability

• The combination of telmisartan and amlodipine has been shown to be well-tolerated, with a low incidence of adverse events, including peripheral edema 3, 6.
• A study comparing the safety and tolerability of triple therapy with telmisartan, amlodipine, and rosuvastatin to dual therapy with telmisartan and amlodipine or telmisartan and rosuvastatin found that the triple therapy regimen had a favorable safety and tolerability profile, with no significant differences in adverse events compared to the dual therapy regimens 6.