A triple-drug, single-pill combination (SPC) antihypertensive therapy containing an angiotensin II receptor blocker (ARB), a dihydropyridine calcium channel blocker (CCB), and a thiazide-like diuretic. This SPC is designed for the effective management of essential hypertension, particularly in patients requiring more than two drugs to achieve blood pressure control, as per Indian and international guidelines. It offers complementary mechanisms, synergistic efficacy, improved compliance, and a favorable side effect profile by using lower doses of individual components.
Adult: One tablet (Telmisartan 40mg + Amlodipine 5mg + Chlorthalidone 6.25mg) orally once daily, with or without food. Dose may be titrated after 2-4 weeks based on response and tolerability. Maximum: One tablet daily.
Note: Swallow the tablet whole with a glass of water, preferably at the same time each day (morning is common to avoid nocturia). Can be taken with or without food. Do not crush or chew. If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose.
This combination exerts a multi-pronged attack on hypertension: 1) Telmisartan selectively blocks the binding of angiotensin II to the AT1 receptor, inhibiting vasoconstriction, aldosterone secretion, and sympathetic outflow. 2) Amlodipine inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, causing peripheral arterial vasodilation and reduced peripheral vascular resistance. 3) Chlorthalidone inhibits sodium reabsorption in the distal convoluted tubule of the nephron, promoting natriuresis, diuresis, and a reduction in plasma volume. The combination results in synergistic vasodilation and volume reduction.
Pregnancy: CONTRANDICATED, especially 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, fetal renal failure, hypoplastic skull bones, and contractures. Discontinue as soon as pregnancy is detected.
Driving: Caution advised, especially during initiation of therapy and dose adjustments. Dizziness, lightheadedness, fatigue, or vertigo may occur, which could impair the ability to drive or operate machinery.
| Other Antihypertensives (Diuretics, Beta-blockers, ACEi) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Potassium supplements, Potassium-sparing diuretics (Spironolactone, Amiloride), 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 | Chlorthalidone reduces renal clearance of lithium, increasing risk of lithium toxicity. | Major |
| Digoxin | Chlorthalidone-induced hypokalemia may potentiate digoxin toxicity. | Moderate |
| Corticosteroids, ACTH | Intensify electrolyte depletion (hypokalemia). | Moderate |
| Cholestyramine, Colestipol | May reduce absorption of chlorthalidone. | Moderate |
| Strong CYP3A4 inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) | May increase amlodipine levels, increasing risk of hypotension and edema. | Moderate |
| Simvastatin | Amlodipine may increase simvastatin levels, slightly increasing risk of myopathy. | Minor |
| Alcohol | Potentiates orthostatic hypotension. | Moderate |
Same composition (Telmisartan (40mg) + Amlodipine (5mg) + Chlorthalidone (6.25mg)), different brands: