Olmesartan / hydrochlorothiazide

Class
Antihypertensives
Subclass
Angiotensin receptor blocker / thiazide combination
Substance name
Olmesartan / hydroCHLOROthiazide
Brand names
Benicar HCT®
Contains
Hydrochlorothiazide
Olmesartan
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Treatment of hypertension
•
Start at: 20-40/12.5 mg PO daily
•
Maintenance: 20-40/12.5-25 mg PO daily
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
Safety risks
Boxed warnings
Fetal toxicity
•
Do not use in pregnant patients. Discontinue olmesartan as soon as possible when pregnancy is detected.
Contraindications
Hypersensitivity to olmesartan medoxomil/hydrochlorothiazide or its components
Anuria
Concomitant use of aliskiren in patients with diabetes
Warnings and precautions
Acute angle-closure glaucoma, acute transient myopia
•
Use caution in patients with hypersensitivity to sulfonamide or penicillin.
•
Maintain a high level of suspicion, as hydrochlorothiazide has been associated with an increased risk of acute transient myopia and acute angle-closure glaucoma, especially in patients with a history of sulfonamide or penicillin hypersensitivity.
Electrolyte and metabolic abnormalities
•
Maintain a high level of suspicion, as hydrochlorothiazide can cause hyperglycemia, hyperlipidemia, hypercalcemia, and hyperuricemia, potentially precipitating a gout attack in susceptible patients. Monitor serum electrolytes periodically.
Exacerbation of SLE
•
Use caution in patients with SLE.
Hypotension
•
Use caution in patients with volume or salt depletion, including receiving high doses of diuretics.
Increased serum potassium, decreased serum potassium, decreased serum sodium, decreased serum magnesium
•
Maintain a high level of suspicion, as olmesartan/hydrochlorothiazide can cause hypokalemia, hyperkalemia, hyponatremia, and hypomagnesemia.
Renal failure
•
Use caution in patients with renal artery stenosis, CKD, severe congestive HF, or volume depletion.
Sprue-like enteropathy
•
Maintain a high level of suspicion, as an increased incidence has been reported in patients receiving olmesartan.
Specific populations
Renal impairment
CrCl > 30 mL/min
•
No dose adjustment required. Use with caution. Monitor renal function. Monitor serum potassium.
CrCl ≤ 30 mL/min
•
No guidance available.
Renal replacement therapy
Any modality
•
No guidance available.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required. Monitor for electrolyte disturbances.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Do not use. Evidence of fetal harm in humans. Discontinue olmesartan when pregnancy is detected.
•
Use of RAAS inhibitors during the second and third trimesters can cause reduced fetal renal function leading to anuria and renal failure, oligohydramnios, fetal lung hypoplasia, and skeletal deformations, including skull hypoplasia, hypotension, and death.
Breastfeeding
Do not use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Gastroenteritis, ↑ BUN, ↑ serum creatinine, ↑ serum uric acid, chest pain, back pain, peripheral edema, vertigo, abdominal pain, dyspepsia, diarrhea, ↑ serum AST, ↑ serum ALT, ↑ serum ALP, ↑ serum gamma-glutamyltransferase, arthritis, arthralgia, ↑ serum CK, cough, myalgia, skin rash, hematuria, dizziness, nausea, upper respiratory tract infections
Uncommon < 1%
•
Facial edema
Unknown frequency
•
Acute pancreatitis, aplastic anemia, hemolytic anemia, cutaneous vasculitis, pneumonitis, anaphylaxis, renal failure, interstitial nephritis, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute angle-closure glaucoma, sprue-like enteropathy, ↓ serum potassium, ↑ serum potassium, weakness, jaundice, abdominal cramps, ↓ WBC count, ↓ platelet count, agranulocytosis, anemia, photosensitivity of skin, purpura, urticaria, fever, pulmonary edema, ↑ urine glucose, muscle spasms, restlessness, erythema multiforme, blurred vision, color vision impairment, ↑ blood glucose, ↓ serum magnesium, ↑ serum triglycerides, ↑ serum cholesterol, ↑ serum calcium, hypotension
Interactions
Drug(s)
Check Interactions
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