Twynsta pills 5mg + 40mg №28

antihypertensive drug.
Release form: tablets are oval, biconvex, without shell, two-layer, one layer from white to almost white color, the other - gray-blue color; on the white surface - the company logo and engraving "A1", the other side of the pill is smooth.
Composition: amlodipine besylate - 6.935 mg, which corresponds to the content of Amlodipine - 5 mg; telmisartan - 40 mg;
excipients: sodium hydroxide - 3.36 mg, povidone K25 - 12 mg, meglumin - 12 mg, sorbitol - 168.64 mg, Magnesium stearate - 6 mg, microcrystalline cellulose - 125.765 mg, pregelled starch - 53 mg, corn starch - 10 mg, silicon colloidal dioxide - 2 mg, a mixture of dyes - 0.3 mg.
Packaging: 7 pieces - blisters (4) - packs cardboard.

Pharmachologic effect: combined drug containing two antihypertensive substances with a complementary effect, which allows to control blood pressure in patients with arterial (essential) hypertension: angiotensin II receptor antagonist, telmisartan, and slow Calcium channel blocker, a derivative of dihydropyridine, amlodipine. The combination of these substances has an additive antihypertensive effect, reducing blood pressure to a greater extent than each individual component. The drug Tvinsta®, taken 1 time / day, leads to an effective and sustainable decrease in blood pressure within 24 hours.

Indications:
- arterial hypertension (for patients whose blood pressure is not sufficiently controlled by telmisartan or amlodipine in monotherapy);
- arterial hypertension (for patients for whom combination therapy is indicated);
- in patients with arterial hypertension, receiving telmisartan and amlodipine in the form of separate tablets, as a substitute for this therapy.

Dosage and administration: adults - Tvinsta® should be taken 1 time per day, by mouth, regardless of the meal.
Twinsta® can be administered to patients who receive the same doses of telmisartan and amlodipine as separate pills for ease of therapy and increased adherence to treatment.
Tvinsta® can be administered to patients in whom the use of amlodipine alone or telmisartan alone does not lead to adequate blood pressure control. Patients taking amlodipine at a dose of 10 mg, in which there are adverse reactions limiting the drug, for example, peripheral edema, can switch to taking Tvinsta® at a dose of 40/5 mg once a day, which will reduce the dose of amlodipine, will not reduce the overall expected antihypertensive effect.
Treatment of arterial hypertension in a patient may begin with the use of the drug Tvinsta® in the case when it is assumed that the achievement of BP control with the help of any one drug is unlikely. The usual initial dose of Tvinsta® is 40/5 mg 1 time per day. Patients who need a more significant reduction in blood pressure can start taking Tvinsta® at a dose of 80/5 mg 1 time / day.
If, at least after 2 weeks of treatment, an additional reduction in blood pressure is required, the dose of the drug can be gradually increased to a maximum dose of 80/10 mg 1 time / day.
Tvinsta® can be used with other antihypertensive drugs.

Contraindications:
- obstructive diseases of the biliary tract;
- severe hypotension;
- obstruction of the outgoing tract of the left ventricle (including a high degree of aortic stenosis);
- hemodynamically unstable heart failure after acute myocardial infarction;
- severe liver failure;
- shock;
- fructose intolerance and glucose / galactose absorption absorption syndrome or sucrase / isomaltase deficiency;
- pregnancy;
- breastfeeding period;
- age up to 18 years (efficiency and safety have not been established);
- Hypersensitivity to active ingredients or auxiliary substances;
- Hypersensitivity to other dihydropyridine derivatives.

The drug should be prescribed with caution to patients with:
- obstructive diseases of the biliary tract or liver failure;
- bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
- condition after kidney transplantation;
- reduced bcc and / or hyponatremia;
- double blockade of the renin-angiotensin-aldosterone system (RAAS);
- other conditions characterized by activation of the RAAS;
- primary aldosteronism;
- aortic and mitral valve stenosis, obstructive hypertrophic cardiomyopathy;
- heart failure;
- hyperkalemia;
- diabetes mellitus with additional cardiovascular risk (i.e., concomitant coronary artery disease (IHD) /);
- after 1 month after acute myocardial infarction and unstable angina pectoris.

Pregnancy and lactation: special studies of the drug Tvinsta® during pregnancy and during lactation have not been conducted.

Storage conditions: the drug should be stored in its original packaging, out of the reach of children at a temperature not exceeding 25 ° C.