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Tribenzor (olmesartan medoxomil, amlodipine, hydrochlorothiazide) is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including the class to which this drug principally belongs. There are no controlled trials demonstrating risk reduction with Tribenzor.
Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).
Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.
Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.
This fixed combination drug is not indicated for the initial therapy of hypertension [see DOSAGE AND ADMINISTRATION].
DOSAGE AND ADMINISTRATION
Dose once daily.
Dosage may be increased after 2 weeks. The full blood pressure lowering effects are attained within 2 weeks after a change in dose. The maximum recommended dose of Tribenzor is 40/10/25 mg. Tribenzor may be taken with or without food.
Tribenzor may be administered with other antihypertensive agents.
The usual regimens of therapy with Tribenzor may be followed if the patient's creatinine clearance is > 30 mL/min. In patients with more severe renal impairment, loop diuretics are preferred to thiazides, so avoid use of Tribenzor [see WARNINGS AND PRECAUTIONS].
Patients ≥ 75 years of age should start amlodipine at 2.5 mg, which is not available with Tribenzor.
Patients with severe hepatic impairment should start amlodipine at 2.5 mg, which is not available with Tribenzor [see WARNINGS AND PRECAUTIONS].
Tribenzor may be substituted for its individually titrated components.
Tribenzor may be used to provide additional blood pressure lowering for patients not adequately controlled on maximally tolerated, labeled, or usual doses of any two of the following antihypertensive classes: angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and diuretics.
A patient who experiences dose-limiting adverse reactions to an individual component while on any dual combination of the components of Tribenzor may be switched to Tribenzor containing a lower dose of that component to achieve similar blood pressure reductions.
Dosage Forms And Strengths
Tribenzor tablets are formulated for oral administration in the following strength combinations: (olmesartan medoxomil/amlodipine/hydrochlorothiazide) 20 /5 /12.5 mg, 40 /5 / 12.5 mg, 40 /5 /25 mg, 40 /10 /12.5 mg, and 40 /10 /25 mg.
Storage And Handling
Tribenzor tablets contain olmesartan medoxomil, amlodipine besylate at a dose equivalent to 5 or 10 mg amlodipine, and hydrochlorothiazide in the strengths described below.
Tribenzor tablets are differentiated by tablet color/size and are debossed with an individual product tablet code on one side. Tribenzor tablets are supplied for oral administration in the following strength and package configurations:
|Tablet Strength (OM/AML equivalent/ HCTZ)||Package Configuration||NDC#||Product Code||Tablet Color|
|20 /5 /12.5 mg||Bottle of 30||65597-114-30||C51||Orange white|
|Bottle of 90||65597-114-90|
|10 blisters of 10||65597-114-10|
|40 /5 /12.5 mg||Bottle of 30||65597-115-30||C53||Light yellow|
|Bottle of 90||65597-115-90|
|10 blisters of 10||65597-115-10|
|40 /5 /25 mg||Bottle of 30||65597-116-30||C54||Light yellow|
|Bottle of 90||65597-116-90|
|10 blisters of 10||65597-116-10|
|40 /10 /12.5 mg||Bottle of 30||65597-117-30||C55||Grayish red|
|Bottle of 90||65597-117-90|
|10 blisters of 10||65597-117-10|
|40 /10 /25 mg||Bottle of 30||65597-118-30||C57||Grayish red|
|Bottle of 90||65597-118-90|
|10 blisters of 10||65597-118-10|
Store at 25°C (77°F); excursions permitted to 15°C-30°C (59°F-86°F) [see USP Controlled Room Temperature].
Manufactured for Daiichi Sankyo, Inc., Parsippany, New Jersey 07054. Manufactured by Daiichi Sankyo Europe GmbH, Germany. Revised: Sep 2014.
Last reviewed on RxList: 10/27/2014
This monograph has been modified to include the generic and brand name in many instances.
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