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telmisartan / amlodipine

Generic Twynsta
Used for Hypertension
Used for Hypertension

Telmisartan / amlodipine is a combination medication containing an angiotensin II receptor blocker (telmisartan) and a calcium channel blocker (amlodipine). It's used to treat adults with high blood pressure. The typical dosage is to take one tablet by mouth once a day. Common side effects include swelling and dizziness. Although the brand Twynsta has been discontinued, the generic medication is still available.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Daisy Chau, PharmD
Last reviewed on November 21, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesLatest newsReferencesPricesMedicare
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What is Telmisartan / amlodipine?

What is Telmisartan / amlodipine used for?

  • High blood pressure

How Telmisartan / amlodipine works

Telmisartan / amlodipine is a combination of two medications that work together to lower blood pressure.

Are you looking for information on telmisartan (Micardis) alone or amlodipine (Norvasc) alone instead?

Drug Facts

Common BrandsTwynsta (brand no longer available)
Drug ClassARB / CCB
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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$159.60(save 72.36%)
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$44.11
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What are the side effects of Telmisartan / amlodipine?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Swelling (5%)
  • Dizziness (3%)
  • Back pain (2%)

Other Side Effects

  • Low blood pressure
  • Fainting

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Heart problems: cold and clammy skin, sweating, dizziness, tightness and pain in the chest, neck, arms, or back
  • High blood potassium levels: nausea, vomiting, tingling sensation, muscle weakness, fluttering heartbeat
  • Muscle problems: stiffness, tremor, abnormal movement

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Bloating or swelling of the face, arms, hands, lower legs, or feet

body aches or pain

chills

cough

difficulty breathing

ear congestion

fever

headache

loss of voice

nasal congestion

rapid weight gain

runny nose

sneezing

sore throat

tingling of the hands or feet

unusual tiredness or weakness

unusual weight gain or loss

Less common

Bladder pain

bloody or cloudy urine

blurred vision

chest pain

diarrhea

difficult, burning, or painful urination

dizziness

frequent urge to urinate

general feeling of discomfort or illness

joint pain

loss of appetite

lower back or side pain

muscle aches and pains

nausea

nervousness

pounding in the ears

shivering

slow or fast heartbeat

sweating

trouble sleeping

vomiting

Rare

Abdominal or stomach pain

arm, back, or jaw pain

black, tarry stools

bleeding gums

blistering, peeling, or loosening of the skin

blood in the urine or stools

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

chest tightness or heaviness

cold sweats

confusion

constipation

cough or hoarseness

dark urine

difficult or labored breathing

difficulty swallowing

dry mouth

extreme fatigue

fast, irregular, pounding, or racing heartbeat or pulse

feeling of warmth

flushed, dry skin

fruit-like breath odor

hives

increased hunger

increased sweating

increased thirst

increased volume of pale, dilute urine

irregular heartbeat

irritation in the mouth

joint or muscle pain

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

lightheadedness, dizziness, or fainting

loss of consciousness

muscle cramps or stiffness

pale, bluish-colored, or cold hands or feet

pinpoint red spots on the skin

rash

redness and swelling of the gums

redness, soreness, or itching skin

severe or sudden headache

sudden loss of coordination

sudden slurring of speech

swollen glands

tightness in the chest

trembling or shaking of the hands or feet

unexplained weight loss

unusual bleeding or bruising

vomiting of blood

weakness in the arms, hands, legs, or feet

weight gain

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Acid or sour stomach

belching

difficulty with moving

heartburn

indigestion

pain or tenderness around the eyes and cheekbones

sleepiness or unusual drowsiness

Rare

Abnormal dreams

ankle, knee, or great toe joint pain

anxiety

bad, unusual, or unpleasant (after) taste

bleeding after defecation

blistering, crusting, irritation, itching, or reddening of the skin

bloody nose

burning feeling in the chest or stomach

burning, dry, or itching eyes

changes in vision

cold and clammy skin

continuing ringing or buzzing or other unexplained noise in the ears

cough producing mucus

cracked, dry, or scaly skin

decreased sexual performance or desire

depression

dry mouth

earache

excess air or gas in the stomach or intestines

feeling of constant movement of self or surroundings

feeling of warmth

full feeling

hair loss or thinning of the hair

headache, severe and throbbing

hearing loss

hives or welts

hyperventilation

inability to have or keep an erection

increased appetite

irritability

lack of feeling or emotion

lack or loss of strength

loose stools

loss of memory

redness of the skin

redness or swelling in the ear

redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid

restlessness

tenderness in the stomach area

toothache

uncomfortable swelling around the anus

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Telmisartan / amlodipine

thumbs-up

Pros

Contains two first-choice medications for treating high blood pressure

Convenient to take a single pill that's a combination of two medications

Taken once a day by mouth with or without food

Available as a lower-cost generic

thumbs-down

Cons

Can cause swelling in the arms and legs

More difficult to adjust the amount of each individual ingredient in the medication

Can interact with other medications

Not safe in pregnancy or breastfeeding

pharmacist-tips

Pharmacist tips for Telmisartan / amlodipine

pharmacist

  • Take telmisartan / amlodipine with or without food at any time of day. If it hurts your stomach, try taking it with food to help.

    • Take telmisartan / amlodipine exactly as prescribed. Don't change your dose or suddenly stop taking the medication without talking to your provider first. Doing so can cause your blood pressure to rise quickly.

      • To help see how well telmisartan / amlodipine is working for you, Check your blood pressure regularly at home. Record your readings and bring your log to your medical appointments. Based on your results, your provider might recommend any dose changes if needed.

        • If you accidentally forget to take telmisartan / amlodipine, take it as soon as you remember. But if the time you typically take your medication next is soon, then skip the missed dose. Never take two doses at the same time to make up any missed doses.

          • You might feel dizzy when you first start taking telmisartan / amlodipine and when your dose is raised. It should lessen over time as you continue taking the medication and as your body gets used to your new blood pressure.

            • Stand up slowly or hold onto something when moving from sitting or lying down to prevent a sudden drop in blood pressure. If you feel dizzy or lightheaded while taking telmisartan / amlodipine, contact your provider, as your dose might need adjusting.

              • Swelling in your feet, ankles, legs, or hands can happen when taking telmisartan / amlodipine. Talk with your provider if you notice swelling. They might recommend tips to ease the swelling, such as sitting or lying down with your legs raised or wearing compression socks.

                • Try to limit foods high in potassium and potassium-containing salt substitutes. Eating them with telmisartan / amlodipine might raise your potassium levels too much, which can lead to nausea, vomiting, or muscle weakness.

                  faqs

                  Frequently asked questions about Telmisartan / amlodipine

                  Can you take amlodipine and telmisartan together?
                  Yes, it's safe to take amlodipine and telmisartan together because they work differently from each other to lower blood pressure. Also, both medications are first-choice treatment options for high blood pressure. Depending on how high your blood pressure is and your risk for other problems caused by high blood pressure (e.g., heart attack or stroke), your provider might recommend that you take a combination blood pressure medication like telmisartan / amlodipine.
                  Is telmisartan / amlodipine a blood thinner?
                  No, telmisartan / amlodipine isn't a blood thinner and doesn't raise your risk for bleeding. It's a combination medication that works to lower your blood pressure by relaxing your blood vessels.
                  What is the best time to take telmisartan / amlodipine?
                  In general, it's not completely clear when the best time of day to take blood pressure medications like telmisartan / amlodipine is. While studies are mixed, the most important thing is to take telmisartan / amlodipine consistently at the same time every day so it can work as best as possible.
                  Can telmisartan / amlodipine be cut in half?
                  The manufacturer of telmisartan / amlodipine doesn't specify if the tablets can be cut in half or not. The tablets aren't made with a special coating around them, which means it might be safe to cut them. But, the tablets also aren't scored (an indented line in the middle of the tablet), so cutting them in half might be difficult. If you're having trouble swallowing the tablets, talk to your provider
                  How long does it take for telmisartan / amlodipine to start working?
                  It typically takes about 2 weeks for telmisartan / amlodipine to lower your blood pressure. If needed, your provider can raise your dose as long as you're not having side effects from the medication. Keep in mind that it can take some time before you reach a dose that controls your blood pressure. So make sure to be patient, continue taking telmisartan / amlodipine, and follow up with your provider regularly.
                  Is there a generic for telmisartan / amlodipine?
                  Yes, telmisartan / amlodipine is only available as a lower-cost generic. The brand, Twynsta, was discontinued by the manufacturer and is no longer available.
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                  What are the risks and warnings for Telmisartan / amlodipine?

                  Telmisartan / amlodipine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Harm to unborn baby

                  Telmisartan / amlodipine shouldn't be taken during pregnancy because it can cause severe, and sometimes life-threatening harm, to unborn babies. Tell your provider before starting treatment if you're pregnant or thinking of becoming pregnant. They'll discuss with you about safer options to lower your blood pressure. If you find out that you're pregnant while taking telmisartan / amlodipine, stop the medication and let your provider know right away.

                  risk-warning

                  Low blood pressure

                  • Risk factors: Not enough fluid in your body | Having diarrhea or vomiting for a long time | Low salt levels in your body | Taking high doses of diuretic medications | History of narrow heart valves (aortic stenosis)

                    Telmisartan / amlodipine can cause your blood pressure to drop too much, which can make you feel dizzy, tired, or lightheaded. This side effect is more common when you first start telmisartan / amlodipine or when the dose is raised. Make sure to stay well hydrated to avoid having blood pressure that's too low. If your blood pressure drops too much and you feel dizzy, sit down slowly while holding onto something and let your provider know. If you fall and hit your head, get medical help right away.

                    risk-warning

                    High potassium levels

                    • Risk factors: Taking other medications that can raise potassium levels | Heart failure | Kidney problems

                      Telmisartan / amlodipine can cause high potassium levels in the blood, even in people with healthy kidneys. Your risk is higher if you take other medications that can raise potassium, such as spironolactone (Aldactone). While taking telmisartan / amlodipine, your provider will order blood tests to check your potassium on a regular basis. If you experience signs of high potassium levels, such as nausea, muscle weakness, or irregular heartbeat, tell your healthcare provider right away. If left untreated, high potassium levels can be dangerous.

                      risk-warning

                      Risk of heart attack or chest pain

                      • Risk factors: Severe coronary artery disease

                        It's possible for some people to experience worsening chest pain or develop a heart attack while taking telmisartan / amlodipine. The risk is higher when you first start this medication or when your dose is raised. Your risk is also higher if you have severe coronary artery disease (CAD). Get medical help right away if you experience chest pain, pressure in the chest, heartburn, dizziness, or trouble breathing.

                        risk-warning

                        Possible kidney damage in certain people

                        • Risk factors: Heart failure | Certain kidney problems | Taking other medications that can cause kidney damage

                          Sometimes, telmisartan / amlodipine can affect your kidneys and cause them to not work as well. The risk is higher for people who have certain types of kidney problems, such as renal artery stenosis or severe heart failure. Your provider might order lab tests every so often to make sure your kidneys are healthy and working properly. If you develop kidney problems, or if your kidney problems worsen while taking telmisartan / amlodipine, your provider might recommend that you stop taking this medication. Let your provider know if you're urinating less often than usual, as this could be a sign that your kidneys aren't working as well.

                          dosage

                          Telmisartan / amlodipine dosage forms

                          The average cost for 30 tablets of 40mg/5mg of Telmisartan / amlodipine is $44.12 with a free GoodRx coupon. This is 72.36% off the average retail price of $159.60.
                          tablet
                          Tablet
                          DosageQuantityPrice as low asPrice per unit
                          40mg/5mg30 tablets$44.12$1.47
                          80mg/5mg30 tablets$44.32$1.48
                          40mg/10mg30 tablets$44.11$1.47
                          80mg/10mg90 tablets$123.85$1.38

                          Typical dosing for Telmisartan / amlodipine

                          The typical starting dose is either 40 mg / 5 mg (telmisartan / amlodipine) or 80 mg / 5mg (telmisartan / amlodipine) by mouth once daily.

                          The maximum dose is 80 mg / 10 mg (telmisartan / amlodipine) once daily.

                          interactions

                          Interactions between Telmisartan / amlodipine and other drugs

                          Telmisartan / amlodipine may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Telmisartan / amlodipine. Please note that only the generic name of each medication is listed below.

                          Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                          Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                          Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                          Telmisartan / amlodipine (generic)
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                          contraindications-icon

                          Telmisartan / amlodipine contraindications

                          Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Telmisartan / amlodipine will not be safe for you to take.
                          alternatives

                          What are alternatives to Telmisartan / amlodipine?

                          There are a number of medications that your doctor can prescribe in place of Telmisartan / amlodipine. Compare a few possible alternatives below.
                          Telmisartan / amlodipine
                          Used for:

                          • High blood pressure

                          $44.11 Lowest GoodRx priceView Prices
                          Lotrel (amlodipine / benazepril)
                          Used for:

                          • High blood pressure

                          $8.70 Lowest GoodRx priceView Prices
                          Exforge (amlodipine / valsartan)
                          Used for:
                          $24.90 Lowest GoodRx priceView Prices

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                          References

                          Best studies we found

                          Department of Health and Human Services. (2023). Determination that CATAPRES (clonidine hydrochloride) tablets, 0.1 milligrams; 0.2 milligrams; and 0.3 milligrams, and other drug products were not withdrawn from sale for reasons of safety or effectiveness.

                          Lupin Pharmaceuticals, Inc. (2023). Telmisartan and amlodipine- telmisartan and amlodipine tablet [package insert]. DailyMed.

                          National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Renal artery stenosis.

                          View All References (2)

                          Unger, T., et al. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension.

                          You and Your Hormones. (2019). Angiotensin.

                          GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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