Can you take Cyclosporine with Twynsta?

The telmisartan in Twynsta has a major potential interaction with Angioedema.

The use of these agents is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) therapy or in patients with hereditary angioedema. Patients with a history of angioedema unrelated to these agents may be at increased risk of angioedema while receiving angiotensin II receptor (AR) antagonists. Patients should be advised to immediately report any signs or symptoms suggestive of angioedema (swelling of face, extremities, eyes, lips, or tongue, or difficulty swallowing or breathing) and to stop taking the medication until otherwise directed by their physician. Emergency therapy and/or measures to prevent airway obstruction are required for angioedema involving the tongue, glottis, or larynx. Treatment with angiotensin II receptor (AR) antagonists should be discontinued permanently if angioedema develops in association with therapy.

The amLODIPine in Twynsta has a major potential interaction with Aortic Stenosis.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

The telmisartan in Twynsta has a moderate potential interaction with Biliary Obstruction.

Telmisartan is primarily eliminated by biliary excretion, and only a minute amount is excreted in the urine. Dosage adjustments are not necessary in patients with renal impairment unless they are also volume-depleted, in which case therapy should be initiated under medical supervision. Patients with hepatic impairment or biliary obstruction may require a dosage adjustment. The manufacturer recommends administering telmisartan therapy with caution in patients with liver disease or biliary obstruction.

The amLODIPine in Twynsta has a major potential interaction with Cardiogenic Shock.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

The telmisartan in Twynsta has a major potential interaction with Dehydration.

Angiotensin II receptor (AR) antagonists can cause symptomatic hypotension in patients with an activated renin-angiotensin system, such as volume- and/or sodium-depleted patients. Therapy with AR antagonists should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if recently instituted; those on dietary salt restriction; renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased.

The telmisartan in Twynsta has a major potential interaction with Diabetes Mellitus.

The coadministration of some angiotensin II receptor blocker agents with aliskiren is contraindicated in patients with diabetes.

The amLODIPine in Twynsta has a moderate potential interaction with Heart Attack.

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

The telmisartan in Twynsta has a moderate potential interaction with Heart Failure.

Angiotensin II receptor (AR) antagonists can cause renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic hypotension can occur in susceptible individuals, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with AR antagonists has been associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia, and death. Therapy with AR antagonists should be initiated cautiously in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. In patients who experience a decline in renal function, discontinuation of AR antagonist therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with AR antagonists, since therapy can usually be reinstated without difficulty after blood pressure stabilizes.

The amLODIPine in Twynsta has a moderate potential interaction with Heart Failure.

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

The telmisartan in Twynsta has a major potential interaction with Hemodialysis.

Angiotensin II receptor (AR) antagonists can cause symptomatic hypotension in patients with an activated renin-angiotensin system, such as volume- and/or sodium-depleted patients. Therapy with AR antagonists should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if recently instituted; those on dietary salt restriction; renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased.

cycloSPORINE has a major potential interaction with High Blood Pressure.

The use of cyclosporine is contraindicated in patients with rheumatoid arthritis or psoriasis with uncontrolled hypertension. Hypertension, possibly due to renal vasoconstriction, has occurred in 50% of patients receiving cyclosporine. Antihypertensive therapy may be necessary for kidney, liver, and heart transplant recipients treated with cyclosporine. Hypertension may decline with continued used, but has persisted in some patients.

The telmisartan in Twynsta has a moderate potential interaction with Hyperkalemia.

Drugs that inhibit the renin-angiotensin, such as angiotensin II receptor antagonist system can cause hyperkalemia. Concomitant use of these agents with drugs that increase potassium levels may increase the risk of hyperkalemia. Use caution when using these agents together and monitor serum potassium periodically.

The telmisartan in Twynsta has a major potential interaction with Hyponatremia.

Angiotensin II receptor (AR) antagonists can cause symptomatic hypotension in patients with an activated renin-angiotensin system, such as volume- and/or sodium-depleted patients. Therapy with AR antagonists should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if recently instituted; those on dietary salt restriction; renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased.

The amLODIPine in Twynsta has a major potential interaction with Hypotension.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

The amLODIPine in Twynsta has a major potential interaction with Ischemic Heart Disease.

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

The amLODIPine in Twynsta has a major potential interaction with Liver Disease.

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, some patients have developed cholestasis or hepatocellular injury. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function is advised.

cycloSPORINE has a moderate potential interaction with Liver Disease.

Cyclosporine is extensively metabolized by CYP450 3A enzymes in the liver (some GI and renal metabolism) and primarily eliminated in the bile and feces. Cyclosporine can induce dose-related nephrotoxicity and hepatotoxicity. Hepatotoxicity, usually noted during the first month of therapy (high dosages) is characterized by elevations of hepatic enzymes and bilirubin. Reduction in chemistry levels usually results with dosage reduction. Therapy with cyclosporine should be administered cautiously and dosages modifications considered in patients with or predisposed to hepatic dysfunction. Clinical monitoring of hepatic function, particularly during administration of high dosages, is recommended.

The telmisartan in Twynsta has a moderate potential interaction with Liver Disease.

Telmisartan is primarily eliminated by biliary excretion, and only a minute amount is excreted in the urine. Dosage adjustments are not necessary in patients with renal impairment unless they are also volume-depleted, in which case therapy should be initiated under medical supervision. Patients with hepatic impairment or biliary obstruction may require a dosage adjustment. The manufacturer recommends administering telmisartan therapy with caution in patients with liver disease or biliary obstruction.

cycloSPORINE has a moderate potential interaction with Malabsorption Syndrome.

Patients with malabsorption syndromes may have difficulty achieving therapeutic serum concentrations with the Sandimmune formulations (capsules or solution) of cyclosporine. An alternative formulation, Neoral (capsule or solution for microemulsion), has increased bioavailability compared to Sandimmune. Sandimmune and Neoral are not bioequivalent and should not be used interchangeably without physician supervision.

cycloSPORINE has a major potential interaction with Renal Dysfunction.

The use of cyclosporine is contraindicated in patients with rheumatoid arthritis or psoriasis with abnormal renal function. Cyclosporine causes a reversible reduction in renal blood flow and glomerular filtration rate resulting in increased serum creatinine and blood urea nitrogen. Mild nephrotoxicity generally responds to reductions in cyclosporine doses. Persistent, chronic, and progressive nephrotoxicity has occurred. Renal biopsies from these patients can demonstrate interstitial fibrosis, tubular atrophy, global or segmental glomerulosclerosis, or smooth vascular muscle damage. Larger cumulative doses or elevated cyclosporine trough levels may be associated with the development of interstitial fibrosis. Clinical monitoring of renal function is necessary and differentiation between cyclosporine-induced nephrotoxicity, allograft rejection, and other causes of impaired renal function should be determined prior to cyclosporine dosage adjustments.

The telmisartan in Twynsta has a moderate potential interaction with Renal Dysfunction.

Telmisartan is primarily eliminated by biliary excretion, and only a minute amount is excreted in the urine. Dosage adjustments are not necessary in patients with renal impairment unless they are also volume-depleted, in which case therapy should be initiated under medical supervision. Patients with hepatic impairment or biliary obstruction may require a dosage adjustment. The manufacturer recommends administering telmisartan therapy with caution in patients with liver disease or biliary obstruction.

The telmisartan in Twynsta has a moderate potential interaction with Renal Dysfunction.

Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure with these agents. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function with these agents.