Uses of Twynsta 80/5

Hypertension is increasingly common, and the current treatment trend is to combine multiple drugs for optimal blood pressure control. A product to treat high blood pressure can be mentioned is Twynsta 80/5 combination of Telmisartan and Amlodipine. So what are the uses of Twynsta 80/5?

Twynsta 80/5 by Boehringer Ingelheim pharma GmbH Co. KG is a combination of active ingredients Telmisartan 80mg and Amlodipine 5mg. Therefore, the drug is indicated mainly in the treatment of essential hypertension. In addition, this product is also available in another strength, Twynsta 40/5, with Telmisartan 40mg and Amlodipine 5mg.

The active ingredient Telmisartan in Twynsta 80/5 belongs to the AT1 receptor blocker group of Angiotensin II. This active substance has a very high affinity for the AT1 receptor, thereby antagonizing the binding site of angiotensin II and consequent abrogation of the effects of angiotensin II. In addition, it should be noted that telmisartan does not have an agonist effect at the AT1 receptor, rather it is selective and has a long-lasting effect at this site. Telmisartan has no affinity for the AT2 or other Angiotensin II receptors. The biggest difference of Telmisartan compared to ACE inhibitors is that it does not cause bradykinin degradation, so there is less adverse effect of dry cough.
In humans, a single dose of telmisartan 80 mg can inhibit nearly all the potential for angiotensin II-induced hypertension, while the antihypertensive effect can be maintained for 24 to 48 hours. Optimal blood pressure readings are usually achieved after about 4 weeks of telmisartan and can remain stable throughout treatment. With regard to its ability to lower blood pressure, telmisartan was able to reduce both systolic and diastolic blood pressure without affecting pulse rate. In case of abrupt discontinuation of telmisartan, blood pressure readings will rise again after a few days instead of the rebound hypertension seen with some other drugs.
Another active ingredient in Twynsta 80/5 is Amlodipine, which belongs to the group of dihydropyridine calcium channel blockers, which blocks the influx of calcium ions into the myocardium and vascular smooth muscle. Amlodipine's main antihypertensive mechanism is direct relaxation of vascular smooth muscle. Regarding the mechanism of action, Amlodipine acts relatively selectively on vascular smooth muscle and weaker on cardiomyocytes. In hypertensive patients with normal renal function, treatment with amlodipine at different doses can reduce renal vascular resistance, increase glomerular filtration rate, and increase renal blood flow without altering renal function. change in glomerular filtration rate or proteinuria.
Product Twynsta 80/5 is a combination of the two active ingredients above, so the antihypertensive effect is relatively good and optimal blood pressure can be achieved after 2 weeks of treatment. Some other advantages of Twynsta 80/5:
Patients who have not controlled their blood pressure with Amlodipine 5mg can increase the level of control with Twynsta 80/5 instead of increasing Amlodipine dose to 10mg, while also reducing it significantly. tell side effects; In patients whose blood pressure is not well controlled with Amlodipine 10 mg and is accompanied by edema, Twynsta 40/5 or 80/5 can have similar control of blood pressure while limiting the side effects of limb edema; The effectiveness of Twynsta 80/5 in controlling blood pressure was comparable regardless of age, sex, and comorbidities (such as diabetes).

3.1. Indications Twynsta 80/5 is indicated for the treatment of the following cases:
Essential hypertension; An alternative to combination therapy with Telmisartan and Amlodipine single active tablets of the same strength; Complementary therapy for individuals who have not achieved optimal blood pressure control with telmisartan or amlodipine monotherapy; Initiate treatment in cases where multiple drugs are required to achieve goal blood pressure control. The choice of starting Twynsta 80/5 in hypertensive patients should be made based on an assessment of the risks, potential benefits, and tolerability. At the same time, doctors need to consider baseline blood pressure, optimal blood pressure as well as the ability to achieve treatment goals before deciding for patients to use Twynsta 80/5.
3.2. Contraindications Contraindicated to use Twynsta 80/5 for the following cases:
Allergy to any ingredient in the drug Twynsta 80/5; Hypersensitivity to active substances of the Dihydropyridine group; 2nd and 3rd trimesters of pregnancy; Women who are breastfeeding; Diseases causing obstruction of the biliary tract; Severe liver dysfunction; Patients with cardiogenic shock; Hereditary intolerance to the excipients of Twynsta 80/5 .

Product Twynsta 80/5 used orally, once a day, before or after meals and can be combined with other antihypertensive drugs.
Dosage of Twynsta 80/5 in adults:
Alternative to combination therapy of Telmisartan and Amlodipine single active ingredient: Take 1 tablet of Twynsta 80/5, 1 time a day; Patients who are using Amlodipine 10mg/day who have undesirable effects (such as edema) or have not had optimal blood pressure control can switch to taking 1 Twynsta 40/5 tablet, once/day. Although the dose of Amlodipine was reduced, it did not reduce the effectiveness of blood pressure control; Initiation in patients with difficult to control blood pressure with 1 drug: The starting dose is 1 Twynsta 40/5 tablet, once a day. In cases requiring stronger lowering of blood pressure, 1 tablet of Twynsta 80/5 can be used, once a day. Dosage of Twynsta 80/5 in some special subjects:
Patients with renal failure: No dose adjustment of Twynsta 80/5, including patients on hemodialysis; Patients with hepatic impairment: Telmisartan should be used with caution in patients with mild to moderate hepatic impairment, the dose should not exceed 40 mg/time/day; Elderly: No dose adjustment is required; Children, adolescents: Twynsta 80/5 is not recommended for people under 18 years of age.

Cystitis ; Psychiatric disorders such as anxiety, depression, insomnia; Fainting, drowsiness, dizziness, headache or migraine; Peripheral neuropathy, paresthesia, decreased touch, dysgeusia; Trembling; slow heart rate or palpitations ; low blood pressure, orthostatic hypotension or flushing; Digestive disorders such as abdominal pain, diarrhea, vomiting, indigestion; Enlarged gums, dry mouth; Joint pain, leg cramps, muscle pain; Nocturia; Erectile dysfunction ; Increased liver enzymes or blood uric acid; Peripheral edema: This is a common side effect of Amlodipine, but the incidence is lower with Telmisartan and Amlodipine than with Amlodipine monotherapy.

The active substance Telmisartan is eliminated primarily via the bile, so clearance may be impaired if biliary tract obstruction or hepatic failure occurs. In addition, the half-life of Amlodipine is often prolonged in patients with impaired liver function. Therefore, Twynsta 80/5 should be used with caution in patients with hepatobiliary problems; Be careful with the risk of severe hypotension and renal failure in patients with bilateral or unilateral renal artery stenosis in case of only 1 kidney; Periodic testing of potassium and creatinine in the blood during the use of Twynsta 80/5 in people with renal failure; Twynsta 80/5 may cause symptomatic hypotension, especially in patients with hypovolemia or hyponatremia; Telmisartan is not recommended for confirmed cases of primary hyperaldosteronism due to unresponsiveness to antihypertensive agents through inhibition of the renin-angiotensin system; Treatment with drugs that affect the RAA system may cause hyperkalemia, especially when accompanied by renal or cardiac failure. Concomitant use of potassium-sparing diuretics, potassium-containing supplements or substitutes in combination with Twynsta 80/5 may increase serum potassium; Twynsta 80/5 ingredients contain sorbitol, therefore suitable for people with fructose intolerance; Antihypertensive drugs that reduce blood pressure excessively against the background of ischemic heart disease may increase the risk of myocardial infarction or stroke.

7.1. A general interaction of note The antihypertensive effect is increased when Twynsta 80/5 is co-administered with other antihypertensive agents; Some drugs increase the antihypertensive effect of all antihypertensive agents, including Twynsta 80/5, such as Baclofen or Amifostine; Orthostatic hypotension can be severe in patients who use alcohol, barbiturates, narcotics, or antidepressants; Systemic corticosteroids may reduce the antihypertensive effect of Twynsta 80/5. 7.2. Drug interactions of active ingredients Telmisartan Combining telmisartan and digoxin may increase the median trough plasma concentration of digoxin by 20%, so it is necessary to monitor blood digoxin levels closely; Combining Telmisartan with NSAIDs increases the risk of acute renal failure when the patient is dehydrated, so if the combination is necessary, it is necessary to ensure adequate rehydration and monitor renal function; The inhibition of vasodilator prostaglandins by NSAIDs may reduce the antihypertensive effect of telmisartan when co-administered. 7.3. Drug Interactions of Amlodipine Do not use Twynsta 80/5 with grapefruit or grapefruit juice due to increased bioavailability and excessive hypotension; Studies in elderly patients have shown that Diltiazem inhibits the metabolism of Amlodipine, possibly via the CYP3A4 system. Therefore, stronger CYP3A4 inhibitors may result in a greater increase in amlodipine plasma concentrations than with Diltiazem; CYP3A4 inducers (such as Carbamazepine, Phenobarbital, Phenytoin, Rifampicin...) may decrease Amlodipine blood levels; The combination of Amlodipine and Simvastatin 80mg resulted in a 77% increase in Simvastatin exposure compared with Simvastatin monotherapy, therefore limiting the dose of Simvastatin to 20mg/day in combination with Amlodipine; Amlodipine increases the systemic absorption of immunosuppressive agents (eg, Cyclosporin, Tacrolimus).