Olmesartan Brand Name– Benicar
What is Olmesartan
Olmesartan is an angiotensin II receptor antagonist, indicated for the treatment of hypertension.
Compared to other angiotensin II receptor antagonists, olmesartan medoxomil is a prodrug which is administered orally and converted to olmesartan during gastrointestinal absorption. Olmesartan does not undergo further metabolism by the liver, lacks cytochrome P-450 interactions, and is eliminated via biliary and renal excretion.
Studies have shown that 20 mg of olmesartan given once a day results in an average reduction of systolic blood pressure by 15 mm Hg and diastolic blood pressure by 12 mm Hg. Olmesartan 20—40 mg once daily provides significantly greater reductions in diastolic blood pressure compared to losartan daily doses of 50—100 mg.
Another comparative study suggests that the starting dose of olmesartan is more effective in reducing diastolic blood pressure versus recommended starting doses of other angiotensin II receptor antagonists including losartan (50 mg), irbesartan (150 mg), and valsartan (80 mg).
Whether these differences would persist after further dosage titration has not been determined. Olmesartan has also been studied to determine its effect on the progression of atherosclerosis.
The OLIVUS (Impact of OLmesartan on progression of coronary atherosclerosis: evaluation by IntraVascular UltraSound) study showed a significantly decreased total atheroma volume (TAV) and percent atheroma volume (PAV) in patients treated with 10—40 mg olmesartan compared to the control group (0.6% vs 5.4% for TAV and -0.7% vs. 3.1% for percent change in PAV, respectively, p < 0.05 for all). All patients were also treated with a combination of beta-blockers, calcium-channel blockers, diuretics, nitrates, glycemic control agents, and/or statins. Although there was no atheroma progression in the olmesartan group, there was also no difference in major cardiovascular events (i.e., cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, hospital stay for CHF, or deterioration for chronic renal failure) between the two groups. Because there was also no significant difference in blood pressure control between the two groups, these study results do not show a correlation between blood pressure reduction and atheroma progression rate.
Because olmesartan does not inhibit angiotensin converting enzyme (ACE), it does not result in bradykinin accumulation which is theorized to cause the cough and angioedema associated with ACE inhibitors. However, angioedema has been rarely associated with angiotensin II receptor antagonists.
Like other angiotensin II receptor antagonists, olmesartan does not significantly affect blood glucose or lipid metabolism.
Olmesartan (Benicar) was approved by the FDA for the treatment of hypertension in adults in April 2002 and for the treatment of hypertension in pediatric patients 6—16 years of age in February 2010.
Indications
- hypertension
Side Effects
- abdominal pain
- alopecia
- anaphylactoid reactions
- angioedema
- arthralgia
- asthenia
- azotemia
- back pain
- chest pain (unspecified)
- cough
- diarrhea
- dizziness
- dyspepsia
- elevated hepatic enzymes
- headache
- hematuria
- hypercholesterolemia
- hyperglycemia
- hyperkalemia
- hyperlipidemia
- hypertriglyceridemia
- hyperuricemia
- hypotension
- myalgia
- nausea
- oliguria
- orthostatic hypotension
- peripheral edema
- pharyngitis
- pruritus
- rash
- renal failure (unspecified)
- rhabdomyolysis
- rhinitis
- sinus tachycardia
- sinusitis
- syncope
- teratogenesis
- urticaria
- vertigo
- vomiting
- weight loss
Monitoring Parameters
- blood pressure
- serum electrolytes
Contraindications
- ACE-inhibitor induced angioedema
- angioedema
- Black patients
- breast-feeding
- diabetes mellitus
- geriatric
- heart failure
- hepatic disease
- hyperkalemia
- hypotension
- hypovolemia
- infants
- neonates
- pregnancy
- renal artery stenosis
- surgery
Interactions
- Acarbose
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Pseudoephedrine
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- Aliskiren; Valsartan
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- Clozapine
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- Ibritumomab Tiuxetan
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- Iloperidone
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- Indapamide
- Insulins
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- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
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- Tetracaine
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- Trazodone
- Triamterene
- Trimethoprim
- Yohimbine
- Ziprasidone
