Aliskiren
Contraindicated
Textbook
Increased risk of hypotension, hyperkalemia, and renal impairment.
Avoid concomitant use.
Source: G&G 14e · p603
Drug reference
Telmisartan + Amlodipine
Antihypertensive fixed-dose combination (ARB + DHP calcium channel blocker) · Antihypertensive
Also known as Telma AM, Telmikind AM, Telsartan AM, Amtel
START
Telmisartan 40 / amlodipine 5 mg PO once daily
TYPICAL MAX
Telmisartan 80 mg + amlodipine 10 mg once daily
STOP IF
Pregnancy, angioedema, severe hyperkalaemia, or symptomatic hypotension
WATCH
K, creatinine, BP, peripheral oedema; baseline + after dose changes
CDSCO approvedSchedule HATC C09DB04
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption
- PEAK
- 6h · combined
- t½
- 1.7d · amlod t½
- DURATION
- 1d · once-daily
EXCRETION
Telmisartan biliary; amlodipine hepatic / renal metabolites
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated (ARB component).
FDA category + note
Top interactionssee all 12 →
- AliskirenContraindicatedTextbookG&G 14e · p603
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- Aliskiren In DiabetesContraindicatedDatabaseKimi deep-research + Cla
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
Mechanism
Telmisartan blocks AT1 angiotensin II receptors (reducing vasoconstriction and aldosterone); amlodipine blocks L-type calcium channels in vascular smooth muscle (peripheral arteriolar vasodilation) — complementary BP-lowering mechanisms with strong evidence base.
Indications
Hypertension (when both components appropriate)
Dosing
- Adult
- Telmisartan 40 mg / amlodipine 5 mg PO once daily; titrate to 80/5, 40/10, or 80/10 PO once daily.
- Pediatric
- Not established for combination.
- Renal adjustment
- No specific adjustment (telmisartan biliary; amlodipine hepatic).
- Hepatic adjustment
- Severe hepatic impairment: avoid.
- Geriatric
- Start low (e.g., 40/2.5 or 40/5); monitor BP.
- Max dose
- Telmisartan 80 mg + amlodipine 10 mg once daily
Pharmacokinetics
Onset
BP effect within hours
Peak effect
Telmisartan Tmax ~0.5–1 h; amlodipine ~6–12 h
Duration
~24 h (once-daily)
Half-life
Telmisartan ~24 h; amlodipine ~30–50 h
Bioavailability
Telmisartan ~50%; amlodipine ~64%
Protein binding
Telmisartan >99%; amlodipine ~93%
Metabolism
Telmisartan glucuronidation; amlodipine CYP3A4
Excretion
Telmisartan biliary/faecal; amlodipine hepatic metabolites + renal
Contraindications
- Pregnancy (RAAS-blocker fetotoxicity 2nd–3rd trimester)
- Bilateral renal artery stenosis
- Concomitant aliskiren in diabetes
- Significant aortic stenosis
- Severe hepatic impairment
- Cardiogenic shock
- Hypersensitivity
Side effects
Common
Peripheral oedema (amlodipine)DizzinessHeadacheFlushingHyperkalaemiaFatigue
Serious
- Severe hypotension (volume-depleted)
- Hyperkalaemia
- Angioedema (rare with ARB)
- Acute kidney injury (volume depletion / RAS)
- Severe peripheral oedema
Pregnancy & lactation
Pregnancy
Contraindicated (ARB component).
Lactation
Limited combination data; alternatives preferred.
Drug interactions
Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Aliskiren In Diabetes
Contraindicated
Database
Dual RAAS blockade
Avoid combination
Source: Kimi deep-research + Cla
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Benazepril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Captopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalapril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Fosinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Lisinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Moexipril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
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