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TWYNSTATM
85% of patients achieved DBP control
(<90 mmHg) with Twynsta 80/10 mg.1,2
Twynsta demonstrated similar efficacy
irrespective of age, gender or concomitant
diabetes.1
What is the mechanism of action of
Twynsta?**
The combination of telmisartan and amlodipine has an additive antihypertensive
effect, reducing blood pressure to a greater
degree than either component alone.1

p<0.05 vs. monotherapies

Adapted from Product Monograph and Littlejohn et al.

TwynstaTM:
Combined for control
What is Twynsta?
Pr
Twynsta (telmisartan/amlodipine tablets) is a
combination of an angiotensin II AT1 receptor
blocker and a calcium channel blocker.
Twynsta is the first and only ARB/CCB
single-pill combination* that combines
telmisartan and amlodipine for effective
BP control.
Twynsta is indicated for the treatment of mild
to moderate essential hypertension in patients
for whom combination therapy is appropriate.1

Twynsta 80/10 mg (n=136)

achieved the greatest overall BP
reduction vs. monotherapies.1,2

(SBP/DBP reduction with amlodipine 10 mg (n=124)

-20.7/-17.1 mmHg; p<0.05)

The majority of the antihypertensive effect

was attained within 2 weeks of therapy
initiation.1
BP monitoring in a subset of 562 patients
confirmed that BP reductions were
maintained over the entire 24-hour
dosing period.1
How effective was TwynstaTM at
controlling BP?
Twynsta 80/5 mg demonstrated higher
control rates vs. monotherapy with
telmisartan or amlodipine.1,2

Twynsta is not indicated for initial therapy.

Patients should be titrated on individual drugs.
If the fixed dose combination represents the
dose and dosing frequency determined by this
titration, the use of Twynsta may be more
convenient in the management of patients. If
during maintenance therapy dosage adjustment is necessary, it is advisable to use the
individual drugs.1

Adapted from Product Monograph.

** Clinical significance has not been established.

Are there any side effects with

Twynsta?
Twynsta demonstrated an excellent safety
and tolerability profile. Almost all events were
of mild or moderate intensity, and the majority
of patients continued treatment.1

* Comparative clinical significance has not been established.

How effective was TwynstaTM at

reducing BP?
Twynsta 80/5 mg demonstrated superior
BP reductions vs. monotherapy with
telmisartan or amlodipine.1

Both telmisartan and amlodipine lower blood

pressure by reducing peripheral resistance, but
do so through different mechanisms.1

60.6

52.6

74.8
DBP Control = DBP <90 mmHg

Adapted from Product Monograph and Littlejohn et al.

Adverse events occurred with similar frequency

across the combination and monotherapy
treatment groups.1

Most commonly reported adverse events

( 2% vs. placebo)1

Lifestyle recommendations3
Increase physical activity

In addition to everyday activities, include 30-60 minutes of

dynamic exercise of moderate intensity (walking, cycling,
swimming) four to seven days a week. A healthcare professional should be consulted before starting any exercise
program. Exercise only as recommended appropriate.

Reduce weight

Attain/maintain a BMI of 18.524.9 kg/m2 and a waist

circumference of <94 cm for men and <80 cm for women.

Limit alcohol consumption

Limited alcohol consumption = 02 drinks/day

Men: <14 drinks/week
Women: <9 drinks/week

Eat healthy

A healthy diet includes plenty of fresh fruits, vegetables, dietary

fibre, non-animal protein (e.g., soy) and low-fat dairy products,
and is low in saturated fat and cholesterol.

Reduce sodium intake

Adults 50 years of age = 1500 mg/day

51-70 years = 1300 mg/day
>70 years = 1200 mg/day

Reduce stress

Relaxation techniques may be effective in stress management.

Stop smoking

This includes avoiding environments that are not smoke free.

Twynsta
40/5
mg
(n=143)

40/10
mg
(n=129)

80/5
mg
(n=146)

80/10
mg
(n=142)

Back pain

Chest
discomfort/
Chest pain

Dizziness

Fatigue

Edema

Influenza

Muscle
spasms

Peripheral
edema

11

Upper
respiratory
tract
infection

placebo, n=46

How is Twynsta dosed?

Twynsta has convenient dosing: one tablet
once a day. Twynsta should be taken with or
without food the same way and at the same
time, preferably in the morning, every day.
Twynsta: 80/5 mg QD
Also available in: 80/10 mg, 40/5 mg, 40/10 mg
Patients receiving telmisartan and amlodipine from separate tablets can instead
receive Twynsta containing the same
component doses in one tablet once daily.1
How is Twynsta packaged?
Twynsta is conveniently supplied in aluminium
blister cards in cartons of 28 tablets as 4 cards
containing 7 tablets each. The dosage forms
are 40/5 mg, 40/10 mg, 80/5 mg, 80/10 mg.
The Twynsta tablet should be removed from
the blister just prior to intake.
How can pharmacists help patients
with their Twynsta medication?
Remind your patients that Twynsta can be
taken with or without food the same way.
Emphasize that Twynsta should be taken
at the same time every day, preferably in
the morning.

Advise your patients to combine taking their

medication with a daily routine, such as
eating breakfast or brushing their teeth, to
help them remember.
Counsel your patients about the importance
of adhering to their treatment regimen to
maintain BP control.
Encourage your patients to use the inpharmacy BP machine to monitor their
blood pressure regularly, and to discuss
any concerns or questions they may have
with you.
Educate your patients about hypertension
and the importance of lifestyle modifications.
Fair balance
Twynsta is contraindicated in patients with:
hypersensitivity to the active substances or to
any of the excipients or other components;
hypersensitivity to dihydropyridine derivatives;
biliary obstructive disorders; severe hepatic
impairment; cardiogenic shock; rare hereditary
conditions that may be incompatible with an
excipient of the product; fructose intolerance.
When pregnancy is detected, Twynsta should
be discontinued as soon as possible. Twynsta
should not be given to nursing mothers.1
Please refer to the Product Monograph for
important information regarding contraindications, warnings, precautions, adverse reactions,
dosing, and patient selection.

Randomized, double-blind, placebo-controlled, 8-week factorial design

trial (n=1461) comparing free dose combination telmisartan including
T40 and T80 mg and amlodipine including A5 and A10 mg to its
monotherapy components and placebo. SBP = Systolic Blood Pressure.
DBP = Diastolic Blood Pressure.
Automated ambulatory blood pressure monitoring (ABPM)
DBP control rate with amlodipine 10 mg 73.4%.

References:
1. Twynsta Product Monograph. Boehringer Ingelheim (Canada) Ltd.
December 8, 2011. 2. Littlejohn TW, Majul CR, Olvera R, et al. Results
of Treatment with Telmisartan-Amlodipine in Hypertensive Patients. J Clin
Hypertens 2009;11(4):1-7. 3. The 2011 CHEP Canadian Recommendations for the Management of Hypertension: Whats New, Whats Old But
Still Important. Summary booklet. Available at www.hypertension.ca/images/
stories/dls/2011gl/CHEPbooklet_2011.pdf (accessed November 14, 2011).

See prescribing summary on page

This Q&A is published by Rogers Publishing Ltd., One Mount Pleasant Rd., Toronto, Ontario M4Y 2Y5. Telephone: (416) 764-2000 Fax: (416) 764-3931.
No part of this Q&A may be reproduced, in whole or in part, without the written permission of the publisher. 2012.