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Drug Safety-related Labeling Changes (SrLC)

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TWYNSTA (NDA-022401)

(AMLODIPINE BESYLATE; TELMISARTAN)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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02/01/2018 (SUPPL-19)

Approved Drug Label (PDF)

8 Use in Specific Populations

8.1 Pregnancy

(PLLR conversion, please refer to label)

8.2 Lactation

(PLLR conversion)

Risk Summary

There is no information regarding the presence of TWYNSTA or telmisartan in human milk, the effects on the breastfed infant, or the effects on milk production. Limited published studies report that amlodipine is present in human milk. However, there is insufficient information to determine the effects of amlodipine on the breastfed infant. There is no available information on the effects of amlodipine on milk production. Telmisartan is present in the milk of lactating rats (see Data). 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 TWYNSTA.

Data

Telmisartan was present in the milk of lactating rats at concentrations 1.5 to 2 times those found in plasma from 4 to 8 hours after administration.

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

PATIENT COUNSELING INFORMATION

(additions underlined)

Advise the patient to read the FDA-approved patient labeling (Patient Information).

Pregnancy

Advise female patients of childbearing age about the consequences of exposure to TWYNSTA during pregnancy. Discuss treatment options with women planning to become pregnant. Tell patients to report pregnancies to their physicians as soon as possible.

Lactation

Advise nursing women not to breastfeed during treatment with TWYNSTA.

Symptomatic Hypotension

Advise patients that lightheadedness can occur, especially during the first days of therapy, and to report it to their healthcare provider. Inform patients that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to an excessive fall in blood pressure, with the same consequences of lightheadedness and possible syncope. Advise patients to contact their healthcare provider if syncope occurs.

Patient Information

(additions underlined)

What should I tell my doctor before taking TWYNSTA tablets?

    • are breast-feeding or plan to breast-feed. TWYNSTA can pass into your breast milk and may harm your baby. You and your doctor should decide if you will take TWYNSTA tablets or breast-feed. You should not do both. Talk with your doctor about the best way to feed your baby if you take TWYNSTA tablets.

      Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal supplements.

  • lithium (Lithobid®, lithium carbonate, lithium citrate)

  • aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs

    How should I store TWYNSTA tablets?

    • Store TWYNSTA tablets at room temperature 68° to 77°F (20° to 25°C).

01/13/2016 (SUPPL-18)

Approved Drug Label (PDF)

6 Adverse Reactions

Postmarketing Experience

Amlodipine

  • … Postmarketing reporting has also revealed a possible association between extrapyramidal disorder and amlodipine.

7 Drug Interactions

Drug Interactions with Amlodipine

Immunosuppressants: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. Frequent monitoring of trough blood levels of cyclosporine and tacrolimus is recommended and adjust the dose when appropriate.

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

PATIENT PACKAGE INSERT

What are the possible side effects of Twynsta tablets?

  • Muscle rigidity, tremor and/or abnormal muscle movement.