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Twinnebi Tablet

Manufactured byZydus Cadila
ContainsCilnidipine (10 mg) + Nebivolol (5 mg)
Description

Twinnebi Tablet is a combination medicine used for the treatment of high blood pressure. Patients are advised to maintain a strict exercise and diet regimen along with this medicine for the best possible effect. This medicine is not recommended for use in patients below 18 years of age.

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Side effects

Major & minor side effects for Twinnebi Tablet

  • Dizziness
  • Diarrhea
  • Increase in body fat and cholesterol
  • Sleeplessness
  • Difficulty in breathing
  • Weight gain
  • Burning, numbness, tingling in the arms and feet
  • Low blood pressure (hypotension)
  • Swelling of face, lips, eyelids, tongue, hands and feet
  • Muscle pain
  • Shaking of hands or feet
  • Skin rash
  • Decreased sexual urge
  • Stomach pain
  • Flushing or redness of skin
  • Headache
  • Unusual tiredness and weakness
  • Increased urination frequency

Uses of Twinnebi Tablet

What is it prescribed for?

  • Hypertension (increased blood pressure)
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Concerns

Commonly asked questions

  • How long does it take for this medicine to take effect?
    The effect of this medicine can be observed within 1-2 hours of administration of the dose.
  • How long do the effects of this medicine last?
    The amount of time for which this medicine remains effective in the body is not clinically established.
  • Is it safe to consume alcohol while taking this medicine?
    Consumption of alcohol is not recommended during treatment of this medicine due to the increased risk of dizziness, fainting, and a very low blood pressure. It is advised that you do not perform any activities that require high mental alertness like driving a vehicle or operating machinery if you consume alcohol during treatment with this medicine.
  • Is this a habit forming medicine?
    No habit-forming tendencies were reported.
  • Can this medicine be taken during pregnancy?
    This medicine is not recommended for use in pregnant women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before taking this medicine. Your doctor may prescribe a safer alternative based on your clinical condition.
  • Can this medicine be taken while breast-feeding?
    This medicine is not recommended for use in breastfeeding women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before taking this medicine.

Allergy

This medicine is not recommended for use in patients with a known allergy to cilnidipine, nebivolol, any other medicines belonging to the group Beta blockers, or any other inactive ingredients present in the formulation.

Heart diseases

This medicine is not recommended for use in patients having heart conditions like heart attack, rhythm disorders, angina, narrowing of blood vessels, Sick Sinus Syndrome, especially if no pacemaker has been implanted to correct the defect. etc.

Liver impairment

This medicine is not recommended for use in patients with moderate to severe liver impairment due to the increased risk of worsening of the patient's condition.

Bronchial asthma

This medicine is not recommended for use in people having a history of bronchial asthma and bronchospasm or any other condition in which the airway is obstructed due to the increased risk of worsening of the patient's condition.

Heart rhythm disorders

This medicine is not recommended for use in people having heart rhythm disorders like Bradycardia (heart rate < 50 beats/min) due to the increased risk of worsening of the patient's condition.

Circulatory Disorders

This medicine is not recommended for use in people suffering from blood circulation disorders or cardiogenic shock due to the increased risk of worsening of the patient's condition.
Warnings for special population

Pregnancy

This medicine is not recommended for use in pregnant women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before taking this medicine. Your doctor may prescribe a safer alternative based on your clinical condition.

Breast-feeding

This medicine is not recommended for use in breastfeeding women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before taking this medicine.
General warnings

Hypotension

This medicine should be used with extreme caution in patients suffering from aortic stenosis due to the increased risk of very low blood pressure. Close monitoring of blood pressure is recommended for such patients. An alternative treatment option should be considered in some cases based on the clinical condition.

Heart attack

This medicine should be used with caution while starting or increasing the dose in patients with coronary artery diseases as it may worsen the symptoms of a heart attack.

Liver Disease

This medicine should be used with extreme caution in patients having an impaired liver function due to the increased risk of adverse effects. Regular monitoring of liver function tests is necessary for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.

Drug Withdrawal

Abrupt discontinuation of this medicine may increase the risk of increased chest pain (angina). A gradual dose reduction is recommended to avoid these reactions. Do not stop the use of this medicine without consulting your doctor.

Use in Children

This medicine should be used with caution in patients below 18 years of age since the safety and efficacy of use are not clinically established.

Anesthetics

This medicine should be used with caution while a patient is given anesthesia as the risk of adverse effects on the heart and blood circulation is high.

Major surgery

This medicine should be given with caution to patients who are going to undergo major surgery. The dose should be very carefully monitored in such cases both before and after the surgical procedure.

Peripheral vascular disease

This medicine should be used with caution in patients having narrowed blood vessels in the body due to any underlying reason. Dose adjustment and safety monitoring might be required in such cases.

Other medicines

This combination medicine may interact with many other medicines and may cause severe adverse effects. Hence, it is advised that you inform the doctor about all your current medicines including any herbs and supplements before beginning treatment with this medicine.

Sports

It is advised to not indulge in certain sports while this medicine is consumed. Archery, racing, shooting and other high-risk sports should be avoided. Sports-persons should refer to the list of medicine published by World Anti-Doping Agency which is not to be taken while participating in specific sports events.

Driving or Operating machinery

Use of this medicine may cause blurred vision or dizziness in some patients. It is advised that you do not perform any activities such as driving a vehicle or operating machinery if you experience any of these symptoms during treatment with this medicine.

Kidney Disease

This medicine should be used with extreme caution in patients having an impaired kidney function due to the increased risk of adverse effects. Regular monitoring of kidney function tests is necessary for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.

Missed Dose

Take the missed dose as soon as you remember. If it is almost time for your next scheduled dose, skip the missed dose. Do not double your dose to make up for the missed one.

Overdose

Seek emergency medical treatment or contact the doctor in case of an overdose.
All drugs interact differently for person to person. You should check all the possible interactions with your doctor before starting any medicine.
Interaction with Alcohol

Description

N/A

Instructions

Consumption of alcohol is not recommended during treatment of this medicine due to the increased risk of dizziness, fainting, and a very low blood pressure. It is advised that you do not perform any activities that require high mental alertness like driving a vehicle or operating machinery if you consume alcohol during treatment with this medicine.
Interaction with Medicine

Amlodipine

Carbamazepine

Diltiazem

Fluoxetine

Amiodarone

Aminophylline

Ergotamine

Primaquine

Cimetidine

Disease interactions

Asthma

This medicine is not recommended for use in patients with bronchial asthma or chronic obstructive pulmonary disease since it may worsen the patient's condition. Replacement with a suitable alternative should be done under your doctor's supervision.

Heart Block

This medicine is not recommended for use in patients with a greater than first-degree heart block unless a permanent pacemaker is present due to the increased risk of worsening of the patient's condition. An alternative treatment option should be considered based on the clinical condition.

Diabetes

This medicine should be used with caution in patients with diabetes mellitus due to the increased risk of altered blood glucose levels. Close monitoring of blood glucose levels is advised for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.

Liver Disease

This medicine should be used with extreme caution in patients suffering from liver diseases due to the increased risk of severe adverse effects. Regular monitoring of liver function tests is necessary for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.

High cholesterol and fat

This medicine should be administered with caution in patients having high levels of cholesterol and fat since it may worsen the patient's condition. Close monitoring of lipid levels, appropriate dose adjustments, or replacement with a suitable alternative may be required based on the clinical condition.

Hyperthyroidism

This medicine should be used with caution in patients having high thyroid hormone levels due to the increased risk of worsening of the patient's condition. Special caution should be taken while withdrawing this medicine due to the increased risk of thyrotoxicosis. The dosing and effects of the medicine should be closely monitored. An alternative treatment option should be considered in some cases based on the clinical condition.

Myasthenia Gravis

This medicine should be used with extreme caution in patients who are suffering from myasthenia gravis due to the increased risk of worsening of the condition. Report any unusual symptoms to the doctor on priority. Appropriate dose adjustments or replacement with a suitable alternative may be required based on the clinical condition.

Congestive heart failure

This medicine should be used with extreme caution in patients with congestive heart failure since it may worsen the patient's condition. Close monitoring of blood pressure, electrolytes level, and heart function are recommended for such patients. Appropriate dose adjustments or replacement with a suitable alternative may be required in some cases based on the clinical condition.
Food interactions
Consumption of grapefruit juice is not recommended while taking this medicine due to the increased risk of adverse effects. Symptoms like dizziness, headache, swelling of hands and feet should be reported to the doctor on priority.
Lab interactions

Urinary vanillylmandelic acid

Report the use of this medicine if you have been asked to undergo this test for the presence of adrenal gland tumor. Use of this medicine is likely to give false value that might be higher than normal.
Take this medicine exactly as advised by your doctor. It can be taken with or without food. Do not take in larger amounts than advised/prescribed. Consult the doctor if you experience any undesirable side effects. Ensure that the treatment course is completed. Do not stop the use of this medicine without consulting your doctor.
Miscelleneous

Can be taken with or without food, as advised by your doctor

To be taken as instructed by doctor

May cause sleepiness

How it works
Cilnidipine acts by blocking the influx of calcium (responsible for contraction of blood vessels) and causes relaxation, thereby promoting the smooth flow of blood. Nebivolol works by relaxing the blood vessels and slowing the heartbeat. This results in an improved blood flow to the heart and the blood pressure is lowered.
Legal Status

Approved

Unknown

Unknown

Unknown

Classification

Category

Cardioselective beta blockers, Calcium channel blocking agents, Antihypertensive combinations

Schedule

Schedule H

Cilnidipine | C27H28N2O7 - PubChem [Internet]. Pubchem.ncbi.nlm.nih.gov. 2017 [cited 23 March 2017]. Available from:

https://pubchem.ncbi.nlm.nih.gov/compound/cilnidipine#section=Top

[Internet]. Centaurpharma.com. 2017 [cited 16 November 2017]. Available from:

http://www.centaurpharma.com/newwebsite/downloads/CENTAPRES.pdf

Nebivolol - DrugBank [Internet]. Drugbank.ca. 2017 [cited 16 November 2017]. Available from:

https://www.drugbank.ca/drugs/DB04861

DailyMed - Nebivolol tablet [Internet]. Dailymed.nlm.nih.gov. 2017 [cited 16 November 2017]. Available from:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8f98d499-f68f-4148-8ec3-8c66ef184a83
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Information on this page was last updated on 23 Apr 2019

Disclaimer

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