Twynsta 80mg + 10mg #28

Twynsta user manual

You can buy Twynsta tablets on this page

Composition

The amount of active ingredient in one tablet of the drug:
    Twynsta 5 + 80 contains 5 mg of amlodipine and 80 mg of telmisartan;
    Twynsta 10 + 80 - 10 mg of amlodipine and 80 mg of telmisartan;
    Twynsta 5 + 40 - 5 mg of amlodipine and 40 mg of telmisartan.
Auxiliary ingredients: sodium hydroxide, Povidone K25, sorbitol, meglumine, magnesium stearate, MCC, pregelatinized starch, corn starch, anhydrous colloidal silica, dyes (black iron oxide, yellow iron oxide, brilliant blue, aluminum lake).

Form of issue

Produced in the form of oval, convex on both sides of the tablets. Each tablet has two layers: white and blue. On one of the sides is a symbol of the company.
In the blister is 7 tablets, in cardboard packs put 2 or 4 blisters.

pharmachologic effect

Refers to angiotensin II antagonists. It is used to treat essential hypertension.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

The effect of the drug on the body is due to a combination of the action of telmisartan and amlodipine.

Pharmacodynamics of Telmisartan

Telmisartan refers to specific ARA II, has an affinity for the first subtype of receptors that are sensitive to angiotensin II. The mechanism of action is the displacement of angiotensin from the receptor. Telmisartan does not bind to any other receptors.
Has the property to reduce the concentration of aldosterone. Does not inhibit the action of renin in the blood, does not inhibit ACE, and has no effect on ion channels. Telmisartan reduces systolic and diastolic blood pressure, but should not affect the heart rate.
In most cases, a dose of 80 mg is sufficient to completely block the hypertensive effect of angiotensin II. The beginning of the drug - 3 hours after the first reception, but the pronounced effect is usually noticeable after 1-2 months of regular intake of tablets.
There was no withdrawal syndrome. After cessation of treatment, the pressure returned to the initial level gradually.

Pharmacodynamics of amlodipine

Amlodipine is a dihydropyridine derivative. Its action is based on the inhibition of transmembrane intake of calcium ions into the cardiac and smooth muscle cells of the vessels. It has a relaxing effect on these cells, which reduces peripheral vascular resistance and blood pressure.
With healthy kidneys causes an increase in blood flow in them, reduces the resistance of the kidney vessels, but does not cause filtration and proteinuria. Does not affect the metabolic processes and does not cause changes in lipid concentrations in the blood.

Pharmacokinetics

Pharmacokinetics of Telmisartan

Quickly absorbed in the gastrointestinal tract, but with simultaneous intake with fatty foods, the absorption rate may decrease slightly. Bioavailability is 50%. After 3 hours in plasma there is the right concentration. It binds well to plasma proteins (by 99.5%).
The elimination half-life is approximately 24 hours. At reception once a day the minimum concentration of a preparation in a blood will be not below 25% from the maximum.
Metabolism occurs in the liver. There is a conjugation with glucuronic acid. The metabolites formed have no activity. There is no data on the accumulation of telmisartan. It is excreted mainly by the intestines, slightly by the kidneys in the form of metabolites.

Pharmacokinetics of amlodipine

The maximum concentration in the blood is achieved in 6-12 hours, regardless of food intake. Bioavailability is high (64-90%). Approximately 97.5% of amlodipine binds to plasma proteins.
Metabolism mostly (90%) occurs in the liver. Inactive metabolites are formed. It is excreted mainly by the kidneys, both in unchanged and in the form of metabolites.

Indications for use

Used in the treatment of essential hypertension as an adjunctive therapy in patients in whom only amlodipine alone does not produce the desired effect.

Contraindications

Do not take Twynsta tablets in these conditions:
    hypersensitivity to one of the active substances or to both, to the auxiliary ingredients, to the dihydidiperidone derivatives;
    second and third trimesters of pregnancy;
    the period of breastfeeding;
    obstructive biliary disorders and severe hepatic insufficiency;
    shock conditions (including cardiogenic shock);
    severe arterial hypotension;
    obstructive changes in the excretory portion of the left ventricle of the heart, for example, severe aortic stenosis;
    hemodynamically unstable heart failure, developed against a background of acute myocardial infarction;
    diabetes;
    severe renal dysfunction.
It is necessary to exercise extreme caution in prescribing the drug to patients with minor violations of the liver function.
Women who breastfeed should stop either lactation or taking the drug.

Side effects

Nearly every tenth patient who takes Twynsta periodically experiences dizziness, or peripheral edema occurs.
Slightly less often (in 1 of 100-1000) there are such side reactions:
    drowsiness, headaches, migraines, sensitivity disorders;
    Vertigo (disorders from the organs of hearing);
    bradycardia or tachycardia;
    hot flashes, a sharp drop in blood pressure;
    cough;
    abdominal pain, nausea, diarrhea;
    itching;
    pain in the joints and muscles, spasms in the muscles of the legs;
    erectile dysfunction;
    asthenia, fatigue, chest pain;
    swelling;
    increase in the level of liver enzymes.
Side effects that occur rarely (not more often than 1 in 1000):
    cystitis;
    Depressive conditions, anxiety, insomnia;
    syncope, peripheral neuropathy, hypoesthesia, dysgeusia, tremor and some other disorders of the nervous system;
    vomiting, gingival hypertrophy, digestive disorders, a feeling of dryness in the mouth;
    eczema, erythema, skin rash;
    pain in the back, limbs (especially the legs);
    nocturia (a condition when nocturnal diuresis exceeds daytime diuresis);
    strong weakness;
    increased levels of uric acid in the blood.
There are also potentially dangerous effects that have not been observed in clinical studies of the Twynsta drug, but are when using its active ingredients.
Side effects due to the action of Telmisartan:
    infections of the upper respiratory tract, rarely - sepsis;
    violations of the blood system in the form of anemia, minor thrombocytopenia or eosinophilia;
    allergic reactions, including anaphylactic;
    hyperkalemia;
    hypoglycemia (in patients with diabetes mellitus);
    visual impairment;
    dyspnea;
    flatulence, heaviness in the stomach;
    violations of hepatic function;
    hyperhidrosis, angioedema (even before death), urticaria, toxic skin rash;
    pain in the tendons;
    impaired renal function, up to acute renal failure;
    symptoms similar to influenza;
    increase in blood levels of creatine and creatine phosphokinase;
    lowering of hemoglobin, leukocytopenia, thrombocytopenia;
    hyperglycemia;
    mood swings, confusion;
    peripheral neuropathy, extrapyramidal syndrome;
    visual impairment;
    noise in ears;
    myocardial infarction, severe heart rhythm disturbances, ventricular tachycardia, atrial fibrillation;
    vasculitis;
    disorders of peristalsis in the intestine, pancreatitis, gastritis;
    hepatitis;
    alopecia, hemorrhagic rash, skin discoloration, angioedema, exfoliative dermatitis, erythema polymorph, Stephen-Johnson syndrome, high photosensitivity;
    disturbances of urination, for example, a sharp increase in their frequency;
    gynecomastia;
    change in body weight.
Additional side effects of amlodipine (are rare):
    flushed face;
    bradycardia, peripheral ischemia, fainting;
    anorexia, swallowing disorders, stool disorders (diarrhea or constipation);
    arthrosis, convulsions;
    sexual dysfunction (observed in both sexes);
    nervousness, strange for a person's dreams, anxiety, depersonalization;
    dyspnea;
    maculopapular rash;
    conjunctivitis, pain in the eye area, diplopia;
    increased sweating;
    very rarely observed perversion of taste, muscle weakness, xerophthalmia.

Twynsta, instructions for use (Method and dosage)

Instructions for use Twynsta provides for one tablet a day, regardless of food intake. The maximum dose is 80 mg / 10 mg. The tablet is washed down with a small amount of liquid.
It is advisable not to combine the medicine with grapefruit or its juice, since this combination leads to an increase in the bioavailability of the drug, which can cause too much antihypertensive effect.

Overdose

Symptoms of overdose:
    a sharp drop in blood pressure;
    expansion of peripheral vessels, which can cause systemic hypotension and result in death;
    tachycardia, but there were reports of bradycardia;
    dizziness;
    increased serum creatinine levels;
    acute renal failure.
Treatment of an overdose of Twynsta consists of symptomatic and maintenance therapy:
    stimulation of vomiting;
    gastric lavage;
    activated carbon reception;
    control over the levels of electrolytes in plasma;
    when the pressure decreases, it is necessary to put a person and raise his legs so that they are above the level of the whole body;
    introduction of water-salt solutions;
    if necessary, intravenously inject calcium gluconate.
Hemodialysis is ineffective in the treatment of Twynsta overdose.

Interaction

For this period of time, there has been almost no research on the interaction of Twynsta's tablets with other drugs.
Assumed interactions:
    with hypotensive drugs - it is possible to enhance the effect;
    with medicines that can reduce blood pressure - possibly enhancing the effect;
    with corticosteroids (with systemic application) - there may be a decrease in effectiveness.
Studies on the interactions of each of the active substances of the drug were separately carried out.
Combinations with telmisartan:
    can not be combined with ramipril;
    simultaneous administration with an ACE inhibitor, Aliskeron, a direct inhibitor of renin, NSAIDs is dangerous for the development of acute renal failure;
    when combined with lithium preparations, it is necessary to monitor blood levels (lithium content);
    combination with non-steroidal anti-inflammatory drugs can cause a decrease in the effectiveness of telmisartan;
    possibly an excessive increase in Digoxin concentration in the blood with simultaneous reception with telmisartan.
Combinations with amlodipine:
    with inhibitors of the isoenzyme CYP3A4 (diltiazem, ketoconazole, ritonavir, itraconazole), it is possible to inhibit the metabolism of amlodipine, which will cause its concentration and effect to increase;
    inducers of the isoenzyme CYP3A4 (mainly anticonvulsants) reduce concentration and effectiveness;
    with Simvastatin increased exposure Simvastatin.

Terms of sale

To buy Twynsta online the prescription is not required.

Storage conditions

At temperatures up to 25 ° C, in a dark, dry place, in the original packaging.
Shelf life - 3 years.

special instructions

Special instructions, which are important to remember when treating Twynsta:
    extreme caution and constant medical control are necessary in appointing patients with minor violations of liver function, stenosis of the renal artery, stenosis of the mitral or mitral valve, hypertrophic obstructive cardiomyopathy, heart failure;
    the drug will not be effective in people with primary aldosteronism;
    there is no data on the safety of treatment of patients with unstable angina or acute myocardial infarction, heart failure, patients after kidney transplantation;
    if the patient has a reduced BCC or is diagnosed with hyponatremia, the drug should not be prescribed until the test results are corrected;
    if at least once there was hyperkalemia, it is necessary to regularly check the level of potassium in the blood;
    it is impossible to combine medicine with grapefruit;
    due to the fact that dizziness refers to common side effects, it is undesirable during the treatment period to drive vehicles or work with dangerous mechanisms.

Children

There is no data on the safety of drug treatment for people under 18 years of age.

With alcohol

The combination may provoke or exacerbate manifestations of such a side effect as orthostatic hypotension.

In pregnancy and lactation

There have been no clinical studies on the influence of Twins on the bearing of pregnancy and the state of the fetus.
There is also no data on the safety of the use of the medication during breastfeeding, but it is suggested that Twynsta, in breast milk, may cause a sharp drop in blood pressure in the baby. Therefore, taking the drug during these periods of life is strictly prohibited.

Twynsta Reviews

Reviews of doctors and patients about the pill show that they are effective in fighting hypertension, but side effects are manifested often.