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Micardis Duo (Telmisartan and amlodipine)

Micardis Duo is a combination of two antihypertensive medicines - Telmisartan and amlodipine.

It is used in the treatment of hypertension, including initial treatment in patients who will require multiple antihypertensives for adequate control.

Telmisartan and amlodipine dose in Adults

Micardis Duo (Telmisartan + Amlodipine) Dosage:

The dose is individualized and titrated according to the patient's requirements.
For patients who are currently taking both medications independently or for those who are not sufficiently controlled by monotherapy, a combination product could be used in place of the individual components (using one of the agents or an agent within the same antihypertensive class).
May also be used as initial therapy in patients who are likely to need >1 antihypertensive to control blood pressure.

Dose in the treatment of Hypertension:

Initial therapy (antihypertensive naive):
- Administered once day, telmisartan 40 mg/amlodipine 5 mg
- After receiving therapy for two weeks, the dose might be raised.
- Telmisartan 80 mg/amlodipine 5 mg once daily can be begun in patients who need greater blood pressure decreases.
- The maximum daily dose is 80 mg of telmisartan and 10 mg of amlodipine.
Add-on therapy for patients not adequately controlled on antihypertensive monotherapy:
- Telmisartan 40 mg/amlodipine 5 mg
- telmisartan 40 mg/amlodipine 10 mg
- telmisartan 80 mg/amlodipine 5 mg
- telmisartan 80 mg/amlodipine 10 mg one time daily
- The dose may be increased after 2 weeks
- The maximum dose is Telmisartan 80 mg per amlodipine 10 mg per day
Replacement therapy:
- Combination product could be substituted for individual titrated agents

Telmisartan and amlodipine Dose in Children

Not recommended in children.

Pregnancy Risk Factor: D

[US Boxed Warning]

Drugs that interfere with the renin-angiotensin systems can harm or even kill a developing foetus.
Once you are aware that you are pregnant, it is important to stop immediately.

Use of telmisartan or amlodipine during breastfeeding

Breast milk contains amlodipine
Telmisartan excretion is not known.
Due to the possibility of major adverse reactions in breastfed infants, the manufacturer does not advise breastfeeding.

Telmisartan and amlodipine Dose in renal impairment:

No dosage adjustment required.
Titrate slowly in severe impairment.

Hemodialysis: Telmisartan and amlodipine:

It is Nondialyzable

Telmisartan and amlodipine Dose in liver disease:

Hepatic impairment or biliary obstructive disorders:
- It is not recommended for initial therapy.
- For add-on/replacement therapy initiate amlodipine 2.5 mg once daily (use of individual agents is necessary as appropriate combination dose is not available).
- Titrate slowly.

Common Side Effects of (Micardis Duo) Telmisartan and amlodipine Include:

Cardiovascular:
- Peripheral edema

Less Common Side Effects of Telmisartan and amlodipine Include:

Cardiovascular:
- Orthostatic Hypotension
- Edema
- Hypotension
- Syncope
Central Nervous System:
- Dizziness
Neuromuscular & Skeletal:
- Back Pain

Contraindication to Micardis Duo (Telmisartan and amlodipine Include):

Hypersensitivity to amlodipine or telmisartan (eg anaphylaxis, angioedema), or any component of the formulation
concomitant use with the direct renin inhibitor (aliskiren) in patients with diabetes mellitus.
Limited evidence exists of allergenic cross-reactivity between angiotensin II receptor blocking agents and calcium channel blocking agents.
Anaphylaxis or known hypersensitivity to angiotensin II receptor blocking agents (ARBs), are signs of anaphylaxis.
Patients with moderate to severe kidney impairment (GFR 60mL/minute/1.73m2 ) may also be prescribed aliskiren.
Biliary obstruction disorders
Grave hepatic impairment
Cardiogenic shock
pregnancy
Breast-feeding
fructose intolerance

Warnings and precautions

Angioedema
- Some angiotensin II receptor inhibitors can cause the rare adverse effect of angioedema (ARBs). Anytime during therapy, but especially after the first dose, it can happen.
- It may impact the bowel, head and neck (perhaps obstructing the airway), or both (presenting as abdominal pain).
- Patients who already have genetic angioedema, idiopathic angioedema, or angioedema that has been connected to ACE inhibitor medication run a higher risk.
- It is important to monitor your airway frequently, especially if you have a problem with the tongue, glottis or larynx.
- Patients who have had previous airway surgery may be at greater risk for obstruction.
- If angioedema develops, stop treatment immediately.
- It is crucial to be aggressive in early management.
- It is possible to administer epinephrine intramuscularly (IM).
- Patients who have angioedema caused by ARBs should not be given.
Angina/Myocardial Infarction:
- With the initiation of or the titration to amlodipine, an increase in angina and/or MI has been observed.
- Patients with obstructive heart disease may experience reflex tachycardia, which can lead to angina or MI. This is especially true if there is no concurrent beta-blockade.
Hyperkalemia:
- Telmisartan can cause side effects
- Diabetes mellitus, renal disease, and the concurrent use of potassium-sparing diuretics or potassium supplements are risk factors.
- These agents should be used with caution and potassium monitoring should be performed regularly.
Hypotension
- Patients who have been treated with high-dose diuretics or salt-depleted can develop symptoms of hypotension.
- correct volume depletion before administration.
- Patients with heart failure, volume and salt depletion, severe Aortic Stenosis, post-MI patients, patients undergoing surgery, dialysis, or patients who have had previous heart attacks should be cautious about initiating therapy.
- Further telmisartan/amlodipine medication is not contraindicated by this temporary hypotensive response.
Peripheral edema
- The most frequent adverse effect of amlodipine is peripheral edoema.
- After beginning therapy, it will be finished in 2 to 3 weeks.
Renal function deterioration:
- Telmisartan, like other ACE inhibitors and ARBs, might cause the kidneys to function worse, especially in people who already have inadequate renal blood flow (eg, renal artery stenosis, heart failure).
- High-risk patients are at high risk of developing azotemia. This is because their glomerular filter rate (GFR), primarily depends on the efferent arterial vasoconstriction, which is mediated through angiotensin 2.
- Oliguria, severe renal failure, or progressive azotemia can result from deterioration.
- Small increases in serum creatinine may happen after starting.
- Patients with progressive and severe impairment of renal function must stop taking the medication.
Aortic/mitral stenosis:
- Patients with severe aortic or mitral stenosis should be cautious.
- It can lead to decreased coronary perfusion, which could result in ischemia.
Heart failure (HF):
- Be careful when you start HF
- You might have to change your dosage or start taking a diuretic at the same time.
Hepatic impairment
- Patients with biliary obstruction disorders or hepatic impairment should be cautious.
- Telmisartan and amlodipine clearance are decreased, so it is recommended to start with the lowest dose.
- Patients with liver disease should not avoid a combination product as the correct dose is not available in the combination form.
Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)
- Patients with HCM or outflow tract obstruction should not take amlodipine. Reduced afterload can worsen the symptoms.
Renal artery stenosis
- In individuals with unilateral or bilateral renal artery stenosis that is unstented, use telmisartan with caution.
- It is advised to avoid use if there is untreated bilateral renal arterial stenosis unless the benefits may outweigh the hazards.
Renal impairment
- Patients with impaired renal function should be cautious.

Telmisartan and amlodipine: Drug Interaction

Risk Factor C (Monitor therapy)
Alfuzosin	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Alpha1-Blockers	The hypotensive effects of calcium channel blockers may be strengthened.
Amphetamines	May lessen the effectiveness of antihypertensive agents.
Angiotensin II	The therapeutic benefit of angiotensin II may be reduced by receptor blockers.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Aprepitant	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
ARIPiprazole	ARIPiprazole's serum levels may rise in response to CYP3A4 Inhibitors (Weak). Management: Keep an eye out for enhanced pharmacologic effects of aripiprazole. Depending on the concurrent therapy and/or the indication, aripiprazole dosage modifications may or may not be necessary. For detailed advice, refer to the complete interaction monograph.
Atosiban	Calcium channel blockers may intensify Atosiban's harmful or hazardous effects. Particularly, pulmonary edoema and/or dyspnea may be at higher risk.
Barbiturates	Calcium Channel Blockers' metabolic rate might be increased. Management: Keep an eye out for any diminished therapeutic effects of barbiturate medication when concurrently using calcium channel blockers. There may need to be dose modifications with calcium channel blockers. The concurrent use of phenobarbital and nimodipine is not recommended.
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Bosentan	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Brigatinib	May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Calcium Channel Blockers (Nondihydropyridine)	Dihydropyridine, a calcium channel blocker, may increase the hypotensive effects of calcium channel blockers (Nondihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may cause an increase in serum calcium channel blocker concentration (Dihydropyridine).
Calcium Salts	May reduce calcium channel blockers' therapeutic efficacy.
Cardiac Glycosides	Cardiac Glycosides' serum levels may rise in response to telmisartan.
Clofazimine	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Clopidogrel	Calcium channel blockers may reduce Clopidogrel's therapeutic efficacy.
CycloSPORINE (Systemic)	The serum concentration of CycloSPORINE may rise when Calcium Channel Blockers (Dihydropyridine) are taken (Systemic). Calcium Channel Blockers' serum levels may rise when CycloSPORINE (Systemic) is used (Dihydropyridine).
CycloSPORINE (Systemic)	CycloSPORINE's hyperkalemic impact may be enhanced by angiotensin II receptor blockers (Systemic).
CYP3A4 Inducers (Moderate):\	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	AmLODIPine serum concentration can rise.
CYP3A4 Inhibitors (Strong)	AmLODIPine serum concentration can rise.
Dapoxetine	Angiotensin II Receptor Blockers' orthostatic hypotensive action might be improved.
Dapoxetine	May intensify calcium channel blockers' orthostatic hypotensive effects.
Deferasirox	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Dexmethylphenidate	Can lessen an antihypertensive drug's therapeutic impact.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dofetilide	Dofetilide's serum levels may rise in the presence of CYP3A4 Inhibitors (Weak).
Drospirenone	Drospirenone's hyperkalemic impact may be enhanced by angiotensin II receptor blockers.
DULoxetine	The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.
Duvelisib	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Efavirenz	Calcium Channel Blockers' serum concentration can drop.
Eplerenone	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Erdafitinib	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Erdafitinib	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Flibanserin	The serum levels of Flibanserin may rise in response to CYP3A4 Inhibitors (Weak).
Fluconazole	Calcium Channel Blockers' serum levels can rise.
Fosaprepitant	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Fosnetupitant	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Heparin	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Heparins (Low Molecular Weight)	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Herbs (Hypertensive Properties)	May lessen the effectiveness of antihypertensive agents.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Ivosidenib	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Larotrectinib	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Lovastatin	AmLODIPine may make lovastatin more concentrated in the blood.
Magnesium Salts	Calcium channel blockers might make magnesium salts more harmful or poisonous. Calcium Channel Blockers' hypotensive effects may be strengthened by magnesium salts.
Melatonin	May reduce the effectiveness of calcium channel blockers as an antihypertensive (Dihydropyridine).
Methylphenidate	May lessen the effectiveness of antihypertensive agents.
Molsidomine	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Naftopidil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Netupitant	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Neuromuscular-Blocking Agents (Nondepolarizing)	The neuromuscular-blocking impact of neuromuscular-blocking agents may be enhanced by calcium channel blockers (Nondepolarizing).
Nicergoline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicorandil	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
NiMODipine	NiMODipine's serum levels may rise in the presence of CYP3A4 Inhibitors (Weak).
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Nonsteroidal Anti-Inflammatory Agents	Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be amplified by angiotensin II receptor blockers. In particular, the combination may cause a marked decline in renal function. Angiotensin II Receptor Blockers' therapeutic impact may be lessened by non-steroidal anti-inflammatory drugs. Both glomerular filtration rate and renal function may be considerably reduced by the combination of these two drugs.
Palbociclib	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Pentoxifylline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Pholcodine	Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Potassium Salts	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Potassium-Sparing Diuretics	Potassium-Sparing Diuretics may have a stronger hyperkalemic impact when used with Angiotensin II Receptor Blockers.
Prostacyclin Analogues	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Quinagolide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
QuiNIDine	The serum concentration of QuiNIDine may be lowered by calcium channel blockers (Dihydropyridine). The serum concentration of QuiNIDine may rise in response to calcium channel blockers (Dihydropyridine). Calcium Channel Blockers' serum levels may rise in response to quinine (Dihydropyridine).
Ranolazine	Angiotensin II Receptor Blockers' hazardous or harmful effects might be exacerbated.
Sarilumab	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Siltuximab	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Simeprevir	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Tacrolimus (Systemic)	Tacrolimus serum levels may rise when Calcium Channel Blockers (Dihydropyridine) are used (Systemic).
Tacrolimus (Systemic	Tacrolimus's hyperkalemic impact may be enhanced by angiotensin II receptor blockers (Systemic).
Tocilizumab	May lower the serum level of CYP3A4 substrates (High risk with Inducers).
Tolvaptan	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Trimethoprim	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened.
Yohimbine	May lessen the effectiveness of antihypertensive agents.
Risk Factor D (Consider therapy modification)
Aliskiren	Angiotensin II Receptor Blockers' hyperkalemic impact might be strengthened. The hypotensive effects of angiotensin II receptor blockers may be strengthened by aliskiren. Angiotensin II Receptor Blockers' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels.
Amifostine	Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped.
Angiotensin-Converting Enzyme Inhibitors	Angiotensin II Receptor Blockers may make angiotensin-converting enzyme inhibitors more harmful or toxic. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: Use of telmisartan and ramipril is not advised according to US labelling. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When feasible, think about alternatives to the mix.
Antifungal Agents (Azole Derivatives, Systemic)	Calcium Channel Blockers' harmful or toxic effects could be exacerbated. In particular, itraconazole may make verapamil or diltiazem's unfavourable inotropic effects worse. Calcium Channel Blockers' metabolism may be slowed down by antifungal agents (systemic azole derivatives). Fluconazole and isavuconazonium, which are covered in different monographs, probably have less powerful effects than those of other azoles.
Antihepaciviral Combination Products	AmLODIPine serum concentration can rise. Management: If an antihepaciviral combo treatment is started, reduce the dose of amlodipine by at least 50% and watch for any increased amlodipine side effects (such as hypotension).
CarBAMazepine	Calcium Channel Blockers' metabolism could be accelerated (Dihydropyridine). In individuals receiving concurrent carbamazepine, consider adjusting the dosage of calcium channel blockers (CCBs) or switching to an alternative form of treatment. The Canadian labelling for nimodipine expressly forbids taking it alongside carbamazepine.
CYP3A4 Inducers (Strong)	May speed up CYP3A4 substrate metabolism (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label.
Dabrafenib	May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: When possible, look for substitutes for the CYP3A4 substrate. If concurrent therapy cannot be avoided, pay special attention to the substrate's clinical consequences (particularly therapeutic effects).
Enzalutamide	May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP3A4 substrates that have a limited therapeutic index. Enzalutamide use, like with the use of any other CYP3A4 substrate, should be done cautiously and under close observation.
Fosphenytoin	Calcium channel blockers may raise the level of fosphenytoin in the blood. Monitoring for phenytoin toxicity while using a calcium channel blocker (CCB) at the same time or reduced phenytoin effects while stopping the CCB are the two management options. Check for diminished therapeutic effects of CCB.
Lithium	It's possible that angiotensin II receptor blockers will raise the level of lithium in the blood. Management: After adding an angiotensin II receptor antagonist, it will probably be necessary to lower the dosage of lithium.
Lomitapide	The blood levels of lomitapide may rise in the presence of CYP3A4 Inhibitors (Weak). Treatment: Patients taking 5 mg/day of lomitapide may continue doing so. Patients taking 10 mg or more of lomitapide per day should cut their dosage in half. A maximum adult dose of 30 mg/day may then be reached by titrating the lomitapide dose.
Lorlatinib	May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Avoid taking lorlatinib at the same time as any CYP3A4 substrates for which even a small drop in serum levels of the substrate could result in therapeutic failure and negative clinical outcomes.
Macrolide Antibiotics	Calcium Channel Blockers' metabolic rate might be decreased. Use a noninteracting macrolide as a possible management strategy. The Canadian labelling for felodipine expressly advises against using it in conjunction with clarithromycin. Exceptions: Fidaxomicin, Roxithromycin, Spiramycin, and systemic azithromycin.
MiFEPRIStone	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: During and two weeks after mifepristone treatment, reduce doses of CYP3A4 substrates and keep an eye out for elevated amounts or toxicity. Fentanyl, pimozide, quinidine, sirolimus, and tacrolimus should all be avoided. Cyclosporine should also be avoided.
Mitotane	May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: When administered in individuals receiving mitotane, doses of CYP3A4 substrates may need to be significantly modified.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished.
Phenytoin	The serum levels of phenytoin may rise when calcium channel blockers are used. Calcium Channel Blockers' serum levels may be reduced by phenytoin. Avoid combining nimodipine or nifedipine with phenytoin for management. With any concurrent use, keep an eye out for phenytoin toxicity and/or diminished calcium channel blocker effects.
Rifamycin Derivatives	Calcium Channel Blockers' serum concentration can drop. This predominantly affects calcium channel blockers used orally. Management: Using rifampin with certain calcium channel blockers is not advised according to the labelling in the US and Canada. Look up the relevant labelling.
Simvastatin	Simvastatin's serum levels may rise in response to AmLODIPine. Management: When at all feasible, refrain from taking simvastatin and amlodipine together. If combined, stay away from simvastatin doses higher than 20 mg per day (for adults).
Sincalide	The therapeutic benefit of Sincalide may be reduced by medications that affect gallbladder function. Prior to using sincalide to induce gallbladder contraction, you should think about stopping any medications that can impair gallbladder motility.
Sodium Phosphates	Angiotensin II Receptor Blockers may make sodium phosphates more nephrotoxic. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ARBs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided.
St John's Wort	May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label.
Stiripentol	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: Due to the increased potential for side effects and toxicity, stiripentol should not be used with CYP3A4 substrates that are thought to have a narrow therapeutic index. Use of stiripentol with any CYP3A4 substrate necessitates closer observation.
Risk Factor X (Avoid combination)
Bromperidol	The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.
Conivaptan	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Fusidic Acid (Systemic)	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Idelalisib	May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).
Pimozide	Pimozide's serum levels may rise in response to CYP3A4 Inhibitors (Weak).
Ramipril	Telmisartan may intensify Ramipril's harmful or hazardous effects. Ramipril's serum levels may be raised by telmisartan. Ramiprilat, the active metabolite, may also have higher concentrations.

Monitor:

Baseline and periodic electrolyte panels (especially serum potassium)
renal function (serum creatinine, BUN, urinalysis)
hepatic function
heart rate, blood pressure, symptomatic hypotension, peripheral edema

How to administer Micardis DUO (Telmisartan and amlodipine)?

Administer orally without regard to meals.

Mechanism of action of Micardis DUO (Telmisartan and amlodipine):

Telmisartan, a nonpeptide AT1 receptor antagonist (angiotensin type II type 1) is called Telmisartan.
Angiotensin II acts like a vasoconstrictor.
Angiotensin II causes vasoconstriction and stimulates aldosterone release.
Aldosterone can be released and sodium and water are absorbed, resulting in an increase in blood pressure.
TelmisartanAngiotensin II is inhibited by binding to AT1.
Amlodipine relaxes the coronary vascular smooth muscles by preventing calcium ions from accessing the "slow channels" or certain voltage-sensitive regions of vascular smooth muscle and myocardium during depolarization. This results in coronary vasodilation.
It enhances the myocardial oxygen supply in those with vasospastic gina.
Amlodipine works directly on the vascular smooth muscle to promote peripheral arterial vasodilation, which lowers blood pressure and lowers peripheral vascular resistance.

See individual agents Amlodipine & Telmisartan.

International Brands of Telmisartan and amlodipine:

Amlotel
Cardotel
Micamlo
Micardis Amlo
Micardis Anlo
Micardis Duo
Telamlo
Telminovo
Twynsta

Telmisartan and amlodipine Brands in Pakistan:

Telmisartan [Tabs 40 mg]
Am-Telsan	Hilton Pharma (Pvt) Limited
Amtas	Getz Pharma Pakistan (Pvt) Ltd.
Telepine	Wilsons Pharmaceuticals
Telmis-A	Genix Pharma (Pvt) Ltd

Telmisartan [Tabs 80 mg]
Am-Telsan	Hilton Pharma (Pvt) Limited
Amtas	Getz Pharma Pakistan (Pvt) Ltd.
Misar-Am	Highnoon Laboratories Ltd.
Telepine	Wilsons Pharmaceuticals
Telmis-A	Genix Pharma (Pvt) Ltd