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Widaplik®
Telmisartan, amlodipine, and indapamide (telmisartan/amlodipine/indapamide) is a fixed-combination preparation containing telmisartan (an angiotensin II receptor blocker), amlodipine (a dihydropyridine calcium channel blocker), and indapamide (a thiazide-like diuretic).1
Telmisartan, amlodipine, and indapamide has the following uses:
Telmisartan/amlodipine/indapamide is indicated for the treatment of hypertension in adult patients, to lower blood pressure.1 Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.1
Telmisartan, amlodipine, and indapamide is available in the following dosage form(s) and strength(s):
Fixed-combination tablets (telmisartan/amlodipine/indapamide) in the following strengths:
Use of drugs that act on the renin-angiotensin-aldosterone system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.1 Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.1 Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.1 When pregnancy is detected, discontinue telmisartan/amlodipine/indapamide as soon as possible.1
Telmisartan/amlodipine/indapamide can cause symptomatic hypotension.1 Patients with hypovolemia, salt depletion, or aortic stenosis are at increased risk.1 Monitor blood pressure and adjust dose as needed.1 Hypotension leading to worsening angina and acute myocardial infarction can develop after starting or increasing the dose of telmisartan/amlodipine/indapamide because of the amlodipine component, particularly in patients with severe obstructive coronary artery disease.1
Electrolyte and Glucose Imbalances
Thiazide-like diuretics can cause hyponatremia, hypomagnesemia, and hypokalemia and can also alter serum glucose and affect insulin requirements.1 Drugs that inhibit the renin angiotensin-aldosterone system can cause hyperkalemia.1 Patients with renal impairment or heart failure are at increased risk for hyperkalemia.1 Monitor serum electrolytes and glucose periodically.1
Inhibiting the renin-angiotensin-aldosterone system or diuresis can precipitate renal dysfunction, oliguria and acute renal failure.1 Patients with severe congestive heart failure or renal dysfunction are at increased risk.1 Monitor renal function periodically and adjust dose as needed.1
Acute Angle-Closure Glaucoma, Acute Myopia, and Choroidal Effusion
Sulfonamide or sulfonamide-derivative drugs, like indapamide, can cause an idiosyncratic reaction resulting in acute angle-closure glaucoma and elevated intraocular pressure with or without a noticeable acute myopic shift and/or choroidal effusions.1 Symptoms may include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation.1 Untreated, the angle-closure glaucoma may result in permanent visual field loss.1 The primary treatment is to discontinue telmisartan/amlodipine/indapamide as rapidly as possible.1 Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled.1 Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy.1
Hyperuricemia may occur or frank gout may be precipitated in certain patients receiving thiazide-like diuretics.1
Telmisartan/amlodipine/indapamide can cause fetal harm when administered to a pregnant woman.1 Use of drugs that act on the renin-angiotensin-aldosterone system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.1 Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin-aldosterone system from other antihypertensive agents.1 Studies in rats and rabbits showed fetotoxicity only at maternally toxic doses of telmisartan.1 When pregnancy is detected, discontinue telmisartan/amlodipine/indapamide as soon as possible1 The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.1 All pregnancies have a background risk of birth defect, loss, or other adverse outcomes.1 In the U.S. general population, the estimated background risk of major malformations and miscarriage in clinically recognized pregnancies is 2% to 4%, and 15% to 20%, respectively.1
There is no information regarding the presence of telmisartan/amlodipine/indapamide in human milk, the effects on the breastfed infant, or the effects on milk production.1 Limited published studies report that amlodipine is present in human milk at an estimated median relative infant dose of 4.2%.1 No adverse effects of amlodipine on the breastfed infant have been observed.1 There is no available information on the effects of amlodipine on milk production.1 There is no information regarding the presence of telmisartan in human milk.1 Telmisartan is present in the milk of lactating rats.1 It is not known whether indapamide is excreted in human milk.1 Because of the potential for serious adverse reactions in the breastfed infant including hypotension, hyperkalemia and renal impairment, advise a nursing woman not to breastfeed during treatment with telmisartan/amlodipine/indapamide.1
Safety and effectiveness of telmisartan/amlodipine/indapamide in pediatric patients have not been established.1
In subgroup analysis in subjects ≥65 years of age (n= 176), the antihypertensive effect of telmisartan/amlodipine/indapamide was not substantially different compared to younger subjects; however, the number of elderly patients enrolled in both telmisartan/amlodipine/indapamide studies was small.1
Because telmisartan, amlodipine and indapamide are hepatically cleared, initiate therapy at the lowest dose and titrate slowly.1 The use of thiazide-like diuretics may precipitate hepatic coma because of fluid shifts.1
Renal impairment does not increase the AUC of telmisartan.1 Telmisartan is not removed from blood by hemodialysis.1 The pharmacokinetics of amlodipine are not significantly influenced by renal impairment.1 The effect of renal impairment on the pharmacokinetics of indapamide is unknown.1
The most common adverse reaction is symptomatic hypotension.1 Low sodium and potassium values were recorded more often with telmisartan/amlodipine/indapamide compared to placebo.1
It is essential that the manufacturer's labeling be consulted for more detailed information on interactions with this drug, including possible dosage adjustments. Interaction highlights:
The active ingredients of telmisartan/amlodipine/indapamide target 3 separate mechanisms involved in blood pressure regulation.1 Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland.1 Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure.1 Indapamide is a thiazide-like diuretic.1 Although the mechanism of action is not clear, indapamide appears to act principally on the distal convoluted tubules of the nephron.1 The drug enhances the excretion of sodium, chloride, and water by inhibiting the transport of sodium ions across the renal tubule.1
Additional Information
AHFSfirstRelease™. For additional information until a more detailed monograph is developed and published, the manufacturer's labeling should be consulted. It is essential that the manufacturer's labeling be consulted for more detailed information on usual uses, dosage and administration, cautions, precautions, contraindications, potential drug interactions, laboratory test interferences, and acute toxicity.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral | Tablets | 10 mg telmisartan, 1.25 mg amlodipine, and 0.625 mg indapamide | WIDAPLIK® | George Medicines Pty Limited |
20 mg telmisartan, 2.5 mg amlodipine, and 1.25 mg indapamide | WIDAPLIK® | George Medicines Pty Limited | ||
40 mg telmisartan, 5 mg amlodipine, and 2.5 mg indapamide | WIDAPLIK® | George Medicines Pty Limited |
AHFS® Drug Information. © Copyright, 1959-2025, Selected Revisions September 10, 2025. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, MD 20814.