Comprehensive medication guide to Twynsta including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$50 copay per month with insurance; generic amlodipine is Tier 1 on virtually all plans and generic telmisartan is Tier 1–2. Prior authorization is generally not required for the separate generics. The combination tablet may be placed on Tier 2–3.
Estimated Cash Pricing
$120–$480 per month at retail for the generic combination tablet; as low as $123 with a GoodRx or SingleCare coupon for a 30-day supply. Taking generic amlodipine and telmisartan as two separate prescriptions typically costs $18–$40 per month combined.
Medfinder Findability Score
45/100
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Twynsta is a prescription combination blood pressure medication that contains two active ingredients in a single tablet: telmisartan (an angiotensin II receptor blocker, or ARB) and amlodipine (a dihydropyridine calcium channel blocker, or CCB). It was originally FDA-approved on October 16, 2009, and manufactured by Boehringer Ingelheim Pharmaceuticals.
Twynsta is FDA-approved for the treatment of hypertension (high blood pressure) in adults, alone or with other antihypertensive agents. It is prescribed for patients whose blood pressure is not adequately controlled by a single medication. The brand-name Twynsta has been discontinued by the manufacturer; the generic (telmisartan/amlodipine) is still available from a small number of manufacturers.
Twynsta comes in four strengths — 40/5 mg, 40/10 mg, 80/5 mg, and 80/10 mg — all taken once daily with or without food. The maximum recommended dose is 80/10 mg once daily.
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Twynsta lowers blood pressure through two complementary, non-redundant mechanisms. Telmisartan is an ARB that selectively blocks the AT1 receptor, preventing angiotensin II from causing blood vessel constriction and aldosterone-mediated fluid retention. At 80 mg, telmisartan inhibits the pressor response to angiotensin II by approximately 90% at peak levels, with roughly 40% inhibition persisting for 24 hours.
Amlodipine is a dihydropyridine calcium channel blocker that blocks L-type voltage-gated calcium channels in vascular smooth muscle cells. Without calcium influx, smooth muscle cannot contract as forcefully, so blood vessels relax and widen, reducing peripheral vascular resistance and lowering blood pressure. The combination of an ARB and a CCB also reduces the peripheral edema that amlodipine alone commonly causes, through the ARB's fluid-regulating properties.
The majority of the antihypertensive effect is seen within 2 weeks of starting therapy, with maximum effects typically achieved by 4 weeks. Both telmisartan and amlodipine have long plasma half-lives, providing consistent 24-hour blood pressure control with once-daily dosing.
40/5 mg — tablet
40 mg telmisartan + 5 mg amlodipine — starting dose for patients with milder hypertension or hepatic impairment
40/10 mg — tablet
40 mg telmisartan + 10 mg amlodipine
80/5 mg — tablet
80 mg telmisartan + 5 mg amlodipine — common starting strength for most patients
80/10 mg — tablet
80 mg telmisartan + 10 mg amlodipine — maximum recommended dose
Finding Twynsta in 2026 is genuinely challenging. Boehringer Ingelheim discontinued the brand-name product, and the FDA lists all four Twynsta formulations under discontinued status. The generic telmisartan/amlodipine is still produced by a small number of manufacturers, but inconsistent supply means many retail pharmacies do not regularly stock it.
Unlike widely available generics such as amlodipine alone or telmisartan alone — which have dozens of manufacturers — the combination tablet has limited generic competition. When one manufacturer has a production issue, the entire market is affected. Pharmacy availability varies significantly by region and changes frequently.
For patients trying to find the generic combination tablet, medfinder calls pharmacies near you to identify which ones currently have your medication in stock, saving you hours of calling. Many patients also choose to take generic amlodipine and telmisartan as two separate prescriptions — they are widely available and considerably less expensive.
Twynsta (telmisartan/amlodipine) is not a controlled substance, so any licensed prescriber can write for it without special DEA registration. It is routinely prescribed by a wide range of healthcare providers who manage hypertension.
Primary care physicians (PCPs) and family medicine doctors
Internal medicine physicians (internists)
Cardiologists (especially for patients with cardiovascular disease)
Nephrologists (for patients with kidney disease or diabetic nephropathy)
Nurse practitioners (NPs) and physician assistants (PAs) in most states
Telehealth providers can also prescribe Twynsta or its generic without restriction, since it is not a controlled substance. Many telehealth platforms offer same-day appointments for blood pressure management, making it convenient to obtain or renew prescriptions for telmisartan/amlodipine.
No. Twynsta (telmisartan/amlodipine) is not a controlled substance and is not scheduled by the DEA. Neither telmisartan nor amlodipine has abuse potential or dependence liability. Prescribers do not need any special DEA registration to prescribe it, and patients face no restrictions on prescription quantity, refills by phone or mail, or early fills.
Any licensed physician, nurse practitioner, or physician assistant in all 50 states can prescribe Twynsta or generic telmisartan/amlodipine. Telehealth providers can also prescribe blood pressure medications including Twynsta without restriction. Patients can receive a 90-day supply and mail-order refills, making it a flexible option for ongoing hypertension management.
Most common side effects are mild and often improve over time:
Peripheral edema (ankle and leg swelling) — most common
Dizziness, especially when standing up quickly
Upper respiratory infection symptoms (runny nose, sore throat)
Fatigue and back pain
Flushing or sensation of warmth in the face
Fetal toxicity: Contraindicated during pregnancy; can cause injury or death to the unborn baby
Hyperkalemia (high potassium): Muscle weakness, irregular heartbeat — monitor potassium especially in kidney disease
Kidney impairment: Decreased urination, swelling — especially in volume-depleted patients
Angioedema: Rapid facial/throat swelling — call 911 immediately
Severe hypotension: Fainting or extreme lightheadedness
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Amlodipine/Valsartan (Exforge)
Closest single-tablet equivalent — same ARB+CCB mechanism with valsartan instead of telmisartan; widely available generic; $20–$60/month with discount card
Amlodipine/Olmesartan (Azor)
ARB+CCB combination with olmesartan; good generic availability; $30–$80/month with discount card; may be preferred for resistant hypertension
Amlodipine/Benazepril (Lotrel)
ACE inhibitor + CCB combination; widely available; $10–$40/month generic; may cause dry cough in 10–15% of patients
Separate Generic Amlodipine + Telmisartan
Identical active ingredients in two pills instead of one; $18–$40/month combined — cheapest and most available option
Prefer Twynsta? We can find it.
Aliskiren (Tekturna)
majorContraindicated in patients with diabetes; avoid in patients with GFR <60 mL/min. Combined RAAS blockade significantly increases risk of hypotension, hyperkalemia, and renal failure.
ACE Inhibitors (lisinopril, ramipril, enalapril, etc.)
majorDual RAAS blockade causes significantly higher rates of renal dysfunction, hypotension, and hyperkalemia including deaths and dialysis requirements. Avoid combination.
Digoxin (Lanoxin)
moderateTelmisartan increases digoxin peak levels by ~49% and trough levels by ~20%. Monitor digoxin levels when initiating, adjusting, or discontinuing telmisartan.
Lithium
moderateARBs can reversibly increase serum lithium levels, causing potential lithium toxicity. Monitor lithium levels closely.
NSAIDs (ibuprofen, naproxen, celecoxib, etc.)
moderateReduce antihypertensive effect of Twynsta; increase risk of acute kidney injury especially in dehydrated or elderly patients. Use with caution.
Potassium-Sparing Diuretics / Potassium Supplements
moderateAdditive hyperkalemia risk with ARB component. Monitor potassium levels, especially in patients with CKD.
Simvastatin
moderateAmlodipine increases simvastatin exposure, raising risk of myopathy. Limit simvastatin to 20 mg/day in patients on amlodipine.
Grapefruit Juice
minorInhibits CYP3A4 metabolism of amlodipine, increasing blood levels and risk of excessive vasodilation. Avoid grapefruit while taking Twynsta.
Twynsta (telmisartan/amlodipine) is an effective combination blood pressure medication that targets hypertension through two complementary mechanisms. The brand has been discontinued, but the generic remains available — albeit inconsistently — and continues to be a valid treatment option for many hypertension patients.
If you're having trouble finding the combination tablet, the most practical solution is asking your doctor for separate prescriptions for generic amlodipine and generic telmisartan — identical active ingredients, widely available, and significantly less expensive. If you prefer the combination pill, compare prices across pharmacies using GoodRx or SingleCare, and start looking for refills early.
For help finding generic telmisartan/amlodipine at a pharmacy near you, medfinder can call pharmacies on your behalf and text you the results. Never go without your blood pressure medication — the cardiovascular risks of untreated hypertension are serious and preventable.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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