Telmisatan 40 mg +Cilnidipine 10 mg +Chlorthalidone 6.25 mg

Z-Cili TC 6.25 is a fixed-dose triple combination of:

• Telmisartan 40 mg → Angiotensin II Receptor Blocker (ARB)

• Cilnidipine 10 mg → Calcium Channel Blocker (L-type + N-type)

• Chlorthalidone 6.25 mg → Thiazide-like diuretic

It is prescribed for hypertension (high blood pressure) when single or dual therapy is inadequate.
This triple therapy provides synergistic blood pressure reduction and cardiovascular protection.

🔹 Indications

• Essential Hypertension (moderate to severe)

• Hypertension not controlled with dual therapy (ARB + CCB / ARB + Diuretic)

• Patients requiring reduction of cardiovascular risk (stroke, heart attack, kidney damage due to high BP)

🔹 Dosage

• Adult dose: 1 tablet once daily (Telmisartan 40 mg + Cilnidipine 10 mg + Chlorthalidone 12.5 mg).

• Taken with or without food, preferably at the same time every day.

• Dose adjustments may be needed based on renal/hepatic function and blood pressure response.

🔹 Mechanism of Action (MoA)

• Telmisartan (ARB): Blocks angiotensin II AT1 receptors → vasodilation, reduced aldosterone secretion → lowers BP.

• Cilnidipine (CCB): Inhibits L-type calcium channels (vascular smooth muscle relaxation → vasodilation) and N-type calcium channels (reduces sympathetic outflow → less tachycardia).

• Chlorthalidone (Diuretic): Inhibits sodium-chloride reabsorption in the distal convoluted tubule → increases sodium & water excretion → decreases blood volume → reduces BP.

✅ Together, they control BP by vasodilation + reduced blood volume + suppressed renin–angiotensin system.

🔹 Pharmacology

1. Absorption

• Telmisartan: Bioavailability ~40–60%, peak plasma levels in 0.5–1 hr.

• Cilnidipine: Well absorbed, peak levels in 1–2 hrs.

• Chlorthalidone: Absorption is slow but nearly complete.

2. Distribution

• Telmisartan: >99% protein bound.

• Cilnidipine: Highly protein bound (~98%).

• Chlorthalidone: ~75% protein bound, widely distributed.

3. Metabolism

• Telmisartan: Metabolized by glucuronidation (non-CYP pathway).

• Cilnidipine: Metabolized by liver (CYP3A4).

• Chlorthalidone: Minimally metabolized.

4. Excretion

• Telmisartan: Excreted mostly unchanged in feces.

• Cilnidipine: Excreted in urine and feces as metabolites.

• Chlorthalidone: Excreted mainly unchanged in urine.

5. Half-life

• Telmisartan: ~24 hrs (long-acting).

• Cilnidipine: ~7–9 hrs.

• Chlorthalidone: ~40–60 hrs (prolonged effect).

🔹 Contraindications

• Hypersensitivity to any component.

• Pregnancy & lactation (Telmisartan – teratogenic).

• Severe renal impairment or anuria (chlorthalidone).

• Severe hepatic impairment.

• Patients with hypokalemia, hyponatremia, or hypercalcemia.

🔹 Precautions

• Renal function monitoring (risk of renal impairment).

• Electrolyte monitoring (chlorthalidone may cause hypokalemia, hyponatremia, hyperuricemia).

• Risk of postural hypotension, especially in elderly.

• Avoid in patients with severe dehydration or on high-dose diuretics.

• Use cautiously with NSAIDs (reduced antihypertensive effect, risk of kidney injury).

• Avoid alcohol (may enhance hypotensive effect).