A fixed-dose triple combination antihypertensive therapy containing an angiotensin II receptor blocker (ARB), a dihydropyridine calcium channel blocker (CCB), and a thiazide diuretic. It provides synergistic blood pressure reduction by targeting multiple pathways of hypertension: the renin-angiotensin-aldosterone system (RAAS), vascular smooth muscle calcium channels, and sodium/fluid volume. This combination is indicated for patients whose blood pressure is not adequately controlled on dual therapy, offering improved compliance and adherence.
Adult: One tablet (Telmisartan 40mg/Amlodipine 5mg/Hydrochlorothiazide 12.5mg) orally once daily. Dose may be increased to Telmisartan 80mg/Amlodipine 5mg/Hydrochlorothiazide 12.5mg after 2-4 weeks if BP remains uncontrolled. Not for initial therapy.
Note: Take orally, with or without food, but preferably at the same time each day (morning to avoid nocturia). Swallow whole with a glass of water. Do not crush or chew. Dose is not influenced by food, but taking consistently with respect to meals is advised.
The combination exerts a complementary and synergistic effect on blood pressure. Telmisartan selectively and competitively blocks the AT1 receptor, inhibiting angiotensin II-mediated vasoconstriction, aldosterone secretion, and sympathetic activation. Amlodipine inhibits transmembrane calcium influx into vascular smooth muscle and cardiac muscle, causing peripheral arterial vasodilation. Hydrochlorothiazide inhibits sodium reabsorption in the distal convoluted tubule, promoting natriuresis and diuresis, reducing plasma volume and peripheral vascular resistance.
Pregnancy: CONTRANDICATED in second and third trimesters (Pregnancy Category D). Drugs that act directly on the RAAS can cause injury and death to the developing fetus, including oligohydramnios, renal failure, skull hypoplasia, and death. Discontinue as soon as pregnancy is detected. First-trimester use should be avoided unless no alternative exists.
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation or dose escalation. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Other Antihypertensives (ACEi, Beta-blockers, Alpha-blockers) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Eplerenone), Potassium supplements, Salt substitutes | Increased risk of hyperkalemia due to telmisartan. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect, increase risk of renal impairment and hyperkalemia. | Major |
| Lithium | HCTZ reduces renal clearance of lithium, leading to toxicity. | Major |
| Digoxin | Hypokalemia/hypomagnesemia from HCTZ can increase risk of digoxin toxicity. | Moderate |
| Corticosteroids, ACTH | Intensify electrolyte depletion (hypokalemia). | Moderate |
| Cholestyramine, Colestipol | Reduce absorption of HCTZ. Separate administration by at least 4 hours. | Moderate |
| Strong CYP3A4 inhibitors (e.g., Ketoconazole, Itraconazole, Ritonavir) | Increase amlodipine levels, risk of hypotension and edema. | Moderate |
| Alcohol, Barbiturates, Narcotics | Potentiation of orthostatic hypotension. | Moderate |
| Antidiabetic drugs (Insulin, Sulfonylureas) | HCTZ may decrease glucose tolerance, requiring dose adjustment. | Moderate |
Same composition (Telmisartan (40mg) + Amlodipine (5mg) + Hydrochlorothiazide (12.5mg)), different brands: