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Indications and Dosage
Oral
Hypertension Adult: Initial: 10-20 mg once daily may then be increased up to max 40 mg once daily if needed.
Child: 6-16 yr <35 kg: 10 mg once daily; ≥35 kg: 20 mg once daily. Doses may be doubled once if necessary after 2 wk. Elderly: No dosage adjustment necessary. |
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Renal Impairment
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Hepatic Impairment
Moderate: Initial: 10 mg once daily may increase up to max 20 mg once daily.
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Contraindications
Biliary obstruction. Pregnancy.
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Special Precautions
Patients w/ aortic or mitral valve stenosis, renal artery stenosis; at risk for hypotension (e.g. patients w/ volume or salt depletion); history of angioedema; at risk for hyperkalaemia (e.g. patients w/ DM). Severe renal and hepatic impairment. Lactation.
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Adverse Reactions
May cause sprue-like enteropathy (Symptoms: Severe, chronic diarrhoea w/ substantial wt loss). Dizziness, headache, abdominal pain, dyspepsia, diarrhoea, gastroenteritis, nausea, bronchitis, pharyngitis, rhinitis, arthritis, back pain, skeletal pain, fatigue, flu-like symptoms, angioedema, peripheral oedema, haematuria, UTI, hyperkalaemia, hypertriglyceridemia, hyperuricaemia, hyperglycaemia, elevated liver enzymes.
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Monitoring Parameters
Monitor BP, serum creatinine and K levels periodically.
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Overdosage
Symptoms: Hypotension and tachycardia. Management: Symptomatic and supportive treatment.
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Drug Interactions
Increased risk of hyperkalaemia w/ ACE inhibitors, K-sparing diuretics, K salts or K supplements and drugs that may increase serum K (e.g. ciclosporin, eplerenone). May potentiate BP lowering effects w/ other antihypertensives. May decrease glomerular filtration w/ NSAIDs which can cause acute renal failure. May increase serum concentrations and toxicity of lithium.
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Action
Description: Olmesartan is a selective and competitive angiotensin II Type 1 (AT1) receptor antagonist that blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. As a result, olmesartan relaxes blood vessels, hence lowering BP and increases blood supply and oxygen to the heart.
Pharmacokinetics: Absorption: Bioavailability: Approx 26%. Time to peak plasma concentration: Approx 1-2 hr. Distribution: Volume of distribution: 17 L. Plasma protein binding: ≤99%. Metabolism: Olmesartan medoxomil undergoes ester hydrolysis in the GI tract to active form olmesartan. Excretion: Via faeces (50-65%) and urine (35-50%) both as olmesartan. Terminal half-life: Approx 10-15 hr. |
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Storage
Store between 20-25°C.
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MIMS Class
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References
Anon. Olmesartan. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 18/11/2013. Buckingham R (ed). Olmesartan Medoxomil. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/11/2013. Joint Formulary Committee. Olmesartan medoxomil. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 18/11/2013. McEvoy GK, Snow EK, Miller J et al (eds). Olmesartan medoxomil. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 18/11/2013. Olmesartan Medoxomil: Drug Safety Communication - Label Changes To Include Intestinal Problems (Sprue-Like Enteropathy). U.S. FDA. https://www.fda.gov/. Accessed 18/11/2013.
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