Triplixam is a single tablet combining three blood pressure medicines: perindopril, indapamide and amlodipine. It is used for high blood pressure that needs more than one or two medicines to control. It comes in four strength combinations, and it is taken once daily, long term.
What is Triplixam?
Triplixam is Schedule 3 in South Africa:
| Product | Perindopril | Indapamide | Amlodipine |
|---|---|---|---|
| Triplixam 5/1.25/5 | 5 mg | 1.25 mg | 5 mg |
| Triplixam 5/1.25/10 | 5 mg | 1.25 mg | 10 mg |
| Triplixam 10/2.5/5 | 10 mg | 2.5 mg | 5 mg |
| Triplixam 10/2.5/10 | 10 mg | 2.5 mg | 10 mg |
The numbers on the pack are perindopril / indapamide / amlodipine, in that order. Knowing which you have matters, since four combinations exist.
Three medicines, three different mechanisms — which is the entire logic of the tablet:
- Perindopril is an ACE inhibitor. It blocks the enzyme producing angiotensin II, a powerful vessel constrictor, so blood vessels relax. It also reduces salt and water retention and protects the kidneys.
- Indapamide is a thiazide-like diuretic. It makes the kidneys excrete more salt and water, and over time relaxes blood vessel walls.
- Amlodipine is a calcium channel blocker. It blocks calcium entry into artery wall muscle, so the arteries widen.
Why combine rather than increase one? Blood pressure is regulated by several independent systems, and pushing one medicine to its maximum brings diminishing returns with rising side effects. Three medicines at moderate doses control blood pressure better, with fewer side effects, than one at a high dose — a well-established principle.
The combination is also chosen because the components offset each other. The diuretic tends to lower potassium; the ACE inhibitor tends to raise it, so together they partly balance. Amlodipine commonly causes ankle swelling; an ACE inhibitor reduces that effect.
A single tablet also improves adherence, and taking treatment consistently is one of the biggest factors in whether blood pressure is actually controlled.
Triplixam is not a starting treatment. It is used where blood pressure is already known to need three medicines, usually after stepping up from one or two.
What is Triplixam commonly used for?
- High blood pressure (hypertension) requiring three medicines — its registered use.
- Replacing three separate tablets with one, in someone already stabilised on the same components.
- Reducing cardiovascular risk, since controlling blood pressure lowers the risk of stroke, heart attack, heart failure, kidney damage and vision loss.
High blood pressure has no symptoms in almost everyone who has it. This is the most important thing to understand: you will feel no different on Triplixam, and feeling well is not a reason to stop. It is treating a risk, not a sensation.
Blood pressure medicines control rather than cure. For most people treatment continues indefinitely, though weight loss, reduced salt, exercise and less alcohol genuinely lower the amount needed.
How Triplixam fits into this medicine category
| Group | Examples | What it does |
|---|---|---|
| ACE inhibitors | Perindopril, enalapril | Relax vessels; protect heart and kidneys |
| ARBs | Losartan, valsartan | Similar, without the cough |
| Calcium channel blockers | Amlodipine | Relax and widen blood vessels |
| Thiazide-like diuretics | Indapamide, hydrochlorothiazide | Remove salt and water |
| Beta-blockers | Bisoprolol | Slow the heart, reduce its workload |
| Combination tablets | Triplixam, Bilocor Co | Two or three medicines in one |
See the blood pressure, heart and circulation medicines hub.
What to check before using Triplixam
Take it in the morning, before food, at the same time each day. Morning dosing matters because of the diuretic — taken later, it will wake you at night.
Expect blood tests. Kidney function, sodium and potassium are checked before starting, after changes, and periodically. This is not a formality — a three-medicine combination affects all of these, and problems are usually silent until significant.
Do not use potassium supplements or potassium-based salt substitutes unless specifically advised. Most “low-sodium” salt substitutes are potassium chloride, and with an ACE inhibitor they can raise potassium dangerously.
Tell your doctor or pharmacist if you:
- Are pregnant, planning pregnancy, or might become pregnant. ACE inhibitors can seriously harm a developing baby and are contraindicated in pregnancy. If you become pregnant, contact your doctor immediately rather than waiting for your next appointment.
- Are breastfeeding.
- Have kidney disease, or narrowing of the arteries to the kidneys.
- Have liver disease.
- Have had angioedema — swelling of the face, lips or tongue — on any medicine.
- Have gout, or raised uric acid, which the diuretic can worsen.
- Have diabetes, or low potassium or sodium.
- Have heart failure, or severe narrowing of the aortic valve.
- Are elderly, where low sodium and dizziness on standing are more likely.
- Are on dialysis, or having allergy desensitisation treatment.
- Take lithium, whose levels rise dangerously with both ACE inhibitors and diuretics.
- Take potassium-sparing diuretics, potassium supplements, or trimethoprim.
- Take anti-inflammatories such as ibuprofen. An NSAID with an ACE inhibitor and a diuretic is a recognised cause of acute kidney injury — this is the interaction to know about.
- Take simvastatin, whose dose is usually capped because amlodipine raises its levels.
If you become unwell with vomiting, diarrhoea or fever, or in very hot weather, ask whether to pause it — dehydration on this combination can affect the kidneys quickly.
Possible cautions and when to ask a pharmacist or doctor
Common effects are ankle swelling, dizziness on standing, a dry persistent cough, headache, flushing, tiredness and passing more urine early on.
The dry cough comes from the perindopril, affects a meaningful minority, is worse at night, and does not respond to cough medicine. It is easily mistaken for a lingering cold, sometimes for months. It is worth reporting — switching the ACE inhibitor to an ARB usually resolves it while keeping the benefits.
Ankle swelling comes from the amlodipine, is dose-related, and is not usually a sign of heart or kidney trouble.
Seek medical attention urgently if you develop:
- Swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing — angioedema. Call emergency services. It can occur at any time, including after years of use.
- Severe dizziness or fainting.
- Muscle weakness, palpitations or an irregular heartbeat — possible potassium disturbance.
- Confusion, marked drowsiness, headache or nausea — possible low sodium.
- Much less urine than usual, or marked swelling of the legs.
- A painful, hot, swollen joint — a gout attack.
- Unusual or severe sunburn, or a rash on sun-exposed skin.
- Yellowing of the eyes or skin.
- Chest pain, breathlessness, or sudden one-sided weakness.
Stand up slowly, particularly when starting, and take care with alcohol and in hot weather. Use sun protection, as indapamide can cause photosensitivity.
Contact your doctor if you become pregnant, before starting any new medicine including over-the-counter anti-inflammatories, and if the cough is affecting your sleep.
Related medicine guides
- Browse Blood Pressure, Heart & Circulation Medicines guides
- Read: Ciplavasc used for
- Read: Ridaq used for
Frequently asked questions
What is Triplixam used for? High blood pressure requiring three medicines. It combines perindopril, indapamide and amlodipine in one daily tablet.
What do the numbers mean? They are the three ingredients in order — perindopril / indapamide / amlodipine. Four combinations exist, so check your pack.
Why three medicines in one tablet? Blood pressure is regulated by several systems. Three medicines at moderate doses work better, with fewer side effects, than one at a high dose — and one tablet is easier to take consistently.
Will I feel different on it? Usually not. High blood pressure has no symptoms, so feeling no change is normal and not a sign it is not working.
Why do I have a dry cough? That is the perindopril, an ACE inhibitor. It affects a meaningful minority and does not respond to cough medicine. Report it — an ARB usually resolves it.
Why are my ankles swollen? That is the amlodipine, and it is dose-related rather than a sign of heart or kidney failure. Mention it, as alternatives exist.
Can I take it in pregnancy? No. ACE inhibitors can seriously harm a developing baby. Contact your doctor immediately if you become pregnant.
Can I take ibuprofen with it? Ask a pharmacist. An anti-inflammatory with an ACE inhibitor and a diuretic can cause acute kidney injury.