Twynsta (as a combination product containing Amlodipine, Telmisartan)

Telmisartan comes as a tablet to take by mouth. It is usually taken once a day with or without food. To help you remember to take telmisartan, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take telmisartan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Telmisartan tablets come in individual blister packs that can be opened by peeling back the paper layer from the foil and pushing the tablet through the foil. Do not open a blister pack until you are ready to swallow the tablet it contains.

Your doctor may start you on a low dose of telmisartan and gradually increase your dose.

Telmisartan controls high blood pressure but does not cure it. Your blood pressure may decrease during the first 2 weeks of your treatment, but it may take 4 weeks for you to notice the full benefit of telmisartan. Continue to take telmisartan even if you feel well. Do not stop taking telmisartan without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Telmisartan is also used sometimes to treat heart failure (condition in which the heart is unable to pump enough blood to the rest of the body) and diabetic nephropathy (kidney disease in people with diabetes and high blood pressure). Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking telmisartan,

• tell your doctor and pharmacist if you are allergic to telmisartan, any other medications, or any of the ingredients in telmisartan tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor if you have diabetes (high blood sugar) and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take telmisartan if you have diabetes and you are also taking aliskiren.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril (Captoten, in Capozide), enalapril (Vasotec), fosinopril, lisinopril (in Prinzide), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), and selective COX-2 inhibitor such as celecoxib (Celebrex); digoxin (Lanoxin); diuretics ('water pills') including spironolactone (Aldactone, in Aldactazide); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had heart failure; blockage of the bile duct (condition when bile can not flow from the liver to the gallbladder and small intestine, which can occur with gallstones, tumors, or injury); or kidney or liver disease.
• tell your doctor if you are breast-feeding.
• you should know that telmisartan may cause drowsiness, dizziness, lightheadedness, or fainting. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting. Tell your doctor if you have any of these problems or develop them during your treatment.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• dizziness
• fainting
• fast or slow heartbeat

Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to telmisartan.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Micardis^®