From 1 June 2011, telmisartan with amlodipine fixed-dose combination tablets (Twynsta) can be prescribed on the PBS for people who have inadequate blood pressure control with either telmisartan or amlodipine alone.1
Consider a fixed-dose combination for people on stable doses of the individual drugs
Compared with taking each drug separately, fixed-dose combination tablets allow people to take fewer tablets each day and can result in less out-of-pocket expenses because only one co-payment is required for both drugs.
However, the usual considerations that apply to fixed-dose combination tablets remain important.2 Establish the effective dose using the individual drugs first.3 Consider whether the available strengths of the fixed-dose combination allow the same doses of each drug to be given: not all strengths of each drug are available in a fixed-dose combination tablet (see Table 1).
Current PBS-listed telmisartan-containing preparations1,4
|Drug||Brand name||Strengths available|
|telmisartan with hydrochlorothiazide||Micardis Plus||40 mg / 12.5 mg
80 mg / 12.5 mg
80 mg / 25 mg
|telmisartan with amlodipine||Twynsta||40 mg / 5 mg
40 mg / 10 mg
80 mg / 5 mg
80 mg / 10 mg
Minimise confusion about drug therapy
Show people which drugs are being replaced by the fixed-dose combination tablet. Explain that:
- the individual drugs are no longer required, and
- the risk of errors is reduced by returning unneeded drugs to a pharmacy for safe disposal.
- Pharmaceutical Benefits Advisory Committee. Recommendations made by the Pharmaceutical Benefits Advisory Committee (PBAC) in March 2011 relating to the listing of drugs on the Pharmaceutical Benefits Scheme. Canberra: Australian Government Department of Health and Ageing, 2011. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/2011-03 (accessed 3 May 2011).
- Moulds RFW. Combination products — love them or loathe them? Aust Prescr 2001;24:127–9. http://www.australianprescriber.com/magazine/24/5/127/9/
- National Blood Pressure and Vascular Disease Advisory Committee. Guide to management of hypertension 2008. Assessing and managing raised blood pressure in adults (updated December 2010). Sydney: National Heart Foundation, 2008. http://www.heartfoundation.org.au/Professional_Information/Clinical_Practice/Hypertension.htm (accessed 9 May 2011).
- Department of Health and Ageing. PBS for Health Professionals. Canberra, 2011. www.pbs.gov.au/ (accessed 9 May 2011).