- Treatment of hypertension
Note: This combination drug is not indicated for initial treatment of hypertension
Renal Dose Adjustment (Based on CrCl)
Hepatic Dose Adjustment
- Mild-moderate impairment: Use with caution
- Severe impairment: Avoid use
See Supplemental Patient Information
- Drugs acting directly on the renin-angiotensin-aldosterone system can cause fetal and neonatal morbidity and death when administered to pregnant women. On detecting pregnancy, advise patients to discontinue therapy at the earliest [US Black Box Warning]
- Angioedema of the face, extremities, lips, tongue, glottis and/or larynx requiring hospitalization and intubation may occur in patients treated with this drug. This may occur at any time during the course of therapy and may occur in patients with and without a history of angioedema with ACE inhibitors or angiotensin receptor antagonists. Airway obstruction, which could be fatal, may occur if angioedema involves the throat, tongue, glottis or larynx, or if the patient has a history of upper respiratory surgery. Immediately discontinue this drug in patients who develop angioedema, and do not re-administer
- Symptomatic hypotension may occur after initiation of therapy in volume- and/or salt-depleted patients receiving high doses of diuretics; correct these conditions prior to administration of this drug or initiate the treatment under close medical supervision. On excessive fall in blood pressure, place the patient in supine position and administer IV infusion of normal saline if required
- Patients with severe obstructive coronary artery disease may occasionally develop increased frequency, duration, or severity of angina or acute myocardial infarction on start of a calcium channel blocker or at the time of dose titration
- This drug is not recommended in patients with severe renal impairment (GFR <30 mL/min). Slowly uptitrate this drug; thiazide component is associated with precipitation of azotemia in patients with renal disease. Patients with impaired renal function may experience cumulative effects of the drug
- Avoid usage in patients with severe hepatic impairment. Titrate hydrochlorothiazide gradually, as minor changes in fluid and electrolyte balance may precipitate hepatic coma
- This combination drug is not evaluated in patients with heart failure
- Hypersensitivity reactions to hydrochlorothiazide may occur more likely in patients with a history of allergy or bronchial asthma
- Therapy with thiazide diuretics may cause exacerbation or activation of systemic lupus erythematosus
- Avoid concomitant use with lithium
- Periodically monitor serum electrolytes to detect possible electrolyte imbalance at appropriate intervals. Concomitant use with potassium supplements, potassium-sparing diuretics, salt substitutes containing potassium, or other drugs that increase potassium levels may cause increases in serum potassium
- Information is unavailable regarding the use of this drug in patients with unilateral or bilateral renal artery stenosis or stenosis of the artery to a solitary kidney; however, increases in serum creatinine or BUN may occur in such patients
- Avoid concurrent use of this drug with cyclosporine or itraconazole
- Idiosyncratic reaction, resulting in transient myopia and acute angle-closure glaucoma, may occur with the use of hydrochlorothiazide-containing drugs. Immediately discontinue treatment on development of such reactions. Permanent vision loss may result if acute angle-closure glaucoma is untreated. Prompt medical or surgical treatment may be essential if intraocular pressure is uncontrolled. Those having a history of sulfonamide or penicillin allergy are at a higher risk for developing acute angle-closure glaucoma
Cautions: Use cautiously in
- Renal impairment
- Renal artery stenosis
- History of renal disease
- Hepatic impairment
- Progressive hepatic disease
- Diabetes mellitus
- Volume depletion
- CHF
- Post-MI
- Severe CAD
- Severe aortic stenosis
- Post-sympathectomy
- History of asthma
- History of gout
- Geriatric patients
Supplemental Patient Information
- Apprise female patients of childbearing age about the adverse effects of the drug on the fetus if used during pregnancy; discuss other treatment options with female patients planning to become pregnant
- Caution patients that lightheadedness may occur during therapy, especially during the first few days of therapy; advise patients to promptly consult their physician if syncope occurs
- Warn all patients that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can also lead to an excessive fall in blood pressure with the same consequences of lightheadedness
- Advise patients receiving therapy to avoid using potassium supplements or salt substitutes containing potassium without consulting their prescribing physician
Pregnancy Category:D
Breastfeeding: No information is available regarding the use of amlodipine during breastfeeding; hence, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production. This information is (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 8 August 2011). As per the manufacturer's data, it is unknown whether aliskiren or amlodipine is excreted in human milk, although thiazides appear in human milk. Due to the potential for serious adverse effects in the nursing infant from this combination drug, a decision should be made whether to discontinue nursing or discontinue the drug, analyzing the importance of the drug to the mother.
US Trade Name(s)
US Availability
Amturnide (aliskiren/amlodipine/hydrochlorothiazide)
- TABS:
- 150 mg/5 mg/12.5 mg
- 300 mg/5 mg/12.5 mg
- 300 mg/5 mg/25 mg
- 300 mg/10 mg/12.5 mg
- 300 mg/10 mg/25 mg
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Amturnide 300-10-25 MG TABS [Bottle] (NOVARTIS)
30 mg = $109.99
90 mg = $305.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
