A triple-drug, fixed-dose combination (FDC) antihypertensive medication containing an angiotensin II receptor blocker (ARB), a dihydropyridine calcium channel blocker (CCB), and a thiazide-like diuretic. It provides synergistic blood pressure lowering through complementary mechanisms, targeting the renin-angiotensin-aldosterone system (RAAS), vascular smooth muscle calcium channels, and sodium/fluid balance. This FDC is indicated for patients with hypertension not adequately controlled on dual therapy, aiming to improve adherence and achieve stringent BP targets as per Indian guidelines.
Adult: One tablet (Telmisartan 40mg + Amlodipine 5mg + Chlorthalidone 12.5mg) orally once daily. Dose may be taken with or without food. Dose titration should have been done with individual components before switching to this FDC.
Note: Swallow the tablet whole with a glass of water. Can be taken in the morning to prevent nocturia from the diuretic effect. Avoid taking in the evening. 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.
The combination exerts a multi-pronged attack on hypertension. Telmisartan selectively and competitively blocks the AT1 receptor, inhibiting the vasoconstrictor and aldosterone-secreting effects of angiotensin II. Amlodipine inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, causing peripheral arterial vasodilation and reduced peripheral vascular resistance. Chlorthalidone inhibits sodium reabsorption in the distal convoluted tubule of the nephron, promoting natriuresis and diuresis, reducing plasma volume and peripheral 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. Discontinue as soon as pregnancy is detected. First-trimester use should be avoided unless no alternative exists.
Driving: Dizziness, lightheadedness, or fatigue may occur, especially during initiation of therapy. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Other Antihypertensives (Diuretics, Beta-blockers, ACEi) | Additive hypotensive effect. Risk of severe hypotension. | Major |
| Lithium | Chlorthalidone reduces renal clearance of lithium, increasing risk of lithium toxicity. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect, increase risk of renal impairment, and worsen hyperkalemia (with telmisartan). | Major |
| Potassium supplements / Potassium-sparing diuretics (Spironolactone, Amiloride) / Salt substitutes | Increased risk of hyperkalemia due to telmisartan. | Major |
| Digoxin | Chlorthalidone-induced hypokalemia/hypomagnesemia may increase risk of digoxin toxicity. | Moderate |
| Corticosteroids (e.g., Prednisolone) | May antagonize the hypotensive effect and exacerbate hypokalemia. | Moderate |
| Antidiabetic drugs (Insulin, Sulfonylureas) | Chlorthalidone may decrease glucose tolerance, requiring dose adjustment. | Moderate |
| Strong CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) | Increase amlodipine plasma concentration, risk of hypotension and edema. | Moderate |
| Simvastatin | Amlodipine may increase simvastatin exposure, slightly increasing risk of myopathy. | Moderate |
| Allopurinol | Increased risk of hypersensitivity reactions when combined with chlorthalidone. | Moderate |
Same composition (Telmisartan (40mg) + Amlodipine (5mg) + Chlorthalidone (12.5mg)), different brands: