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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 18.5–24.9 kg/m2 and a waist circumference of <94 cm for men and <80 cm for women.
Limit alcohol consumption
Limited alcohol consumption = 0–2 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
3
3
1
2
Chest discomfort/ Chest pain
1
1
1
2
Dizziness
5
2
4
1
Fatigue
2
0
1
1
Edema
0
3
1
2
Influenza
1
1
3
2
Muscle spasms
0
1
0
2
Peripheral edema
1
6
2
11
Upper respiratory tract infection
1
1
2
1
† 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: What’s New, What’s 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.
