olmesartan


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Related to olmesartan: Olmesartan medoxomil

olmesartan

(ole-me-sar-tan me-dox-o-mil) ,

Benicar

(trade name),

Olmetec

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: angiotensin ii receptor antagonists
Pregnancy Category: D

Indications

Hypertension (alone or with other agents).

Action

Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II at various receptor sites including vascular smooth muscle and the adrenal glands.

Therapeutic effects

Lowering of BP.

Pharmacokinetics

Absorption: Olmesartan medoxomil is a prodrug that is converted to olmesartan (the active component); 26% bioavailability of olmesartan.
Distribution: Crosses the placenta.
Protein Binding: 99%.
Metabolism and Excretion: No further metabolism following conversion of pro-drug to active drug; 35–50% excreted unchanged in urine; remainder eliminated in feces via bile.
Half-life: 13 hr.

Time/action profile (antihypertensive effect with chronic dosing)

ROUTEONSETPEAKDURATION
POwithin 1 wk2 wk24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Bilateral renal artery stenosis; Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min) Obstetric: Can cause injury or death of fetus – if pregnancy occurs, discontinue immediately. Lactation: Discontinue drug or use formula. Pediatric: Children <1 yr (may have effects on development of immature kidneys)
Use Cautiously in: Volume- or salt-depleted patients or patients receiving high doses of diuretics (correct deficits before initiating therapy or initiate at lower doses); Black patients (may not be as effective); Impaired renal function due to primary renal disease or HF (may worsen renal function); Patients with childbearing potential; Pediatric: Children 1–6 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • dizziness

Cardiovascular

  • hypotension

Fluid and Electrolyte

  • hyperkalemia

Gastrointestinal

  • sprue-like enteropathy

Genitourinary

  • impaired renal function

Miscellaneous

  • angioedemA (life-threatening)

Interactions

Drug-Drug interaction

Additive hypotension with other antihypertensives .NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.Excessive hypotension may occur with concurrent use of diuretics.↑ risk of hyperkalemia with concurrent use of potassium supplements,potassium-containing salt substitutes, or potassium-sparing diuretics.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of ACE inhibitors or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min↑ levels and may ↑ risk of lithium toxicity.Colesevelam may ↓ levels; administer olmesartan ≥4 hr before colesevelam

Route/Dosage

Oral (Adults) 20 mg once daily; may be ↑ up to 40 mg daily (initiate therapy at a lower dose in patients receiving diuretics or who are volume depleted).
Oral (Children 6–16 yr) ≥35 kg-20 mg once daily; may be ↑ after 2 wk up to 40 mg once daily; 20–34.9 kg-10 mg once daily; may be ↑ after 2 wk up to 20 mg once daily.

Availability

Tablets: 5 mg, 20 mg, 40 mg
In combination with: hydrochlorothiazide (Benicar HCT), amlodipine (Azor); amlodipine and hydrochlorothiazide (Tribenzor); seecombination drugs.

Nursing implications

Nursing assessment

  • Assess BP (sitting, lying, standing) and pulse periodically during therapy.
  • Monitor frequency of prescription refills to determine adherence to therapy.
  • Assess patient for signs of angioedema (dyspnea, facial swelling). May rarely cause angioedema.
  • Monitor patient for signs and symptoms of sprue-like enteropathy (severe, chronic diarrhea with substantial weight loss). May develop months or years after start of olmesartan. May require hospitalization and discontinuation of therapy.
  • Lab Test Considerations: Monitor renal function. May cause ↑ BUN and serum creatinine.May rarely cause slight ↓ in hemoglobin and hematocrit.
    • May occasionally cause ↑ AST, ALT, and total serum bilirubin.

Potential Nursing Diagnoses

Risk for injury (Adverse Reactions)
Noncompliance (Patient/Family Teaching)

Implementation

  • Do not confuse Benicar with Mevacor.
  • Correct volume depletion, if possible, before initiation of therapy.
    • Doses greater than 40 mg do not appear to have a greater effect. Twice daily dosing offers no advantage over the same total dose given once daily.
  • Oral: Administer once daily without regard to food.

Patient/Family Teaching

  • Emphasize the importance of continuing to take as directed, even if feeling well. Take missed doses as soon as remembered if not almost before next dose; do not double doses. Medication controls but does not cure hypertension. Instruct patient to take medication at the same time each day. Warn patient not to discontinue therapy unless directed by health care professional.
  • Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional. See.
  • Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
  • Instruct patient and family on proper technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes.
  • Caution patient to avoid sudden position changes to decrease orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
  • May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of Rx, OTC, and herbal products, especially NSAIDs and cough, cold, or allergy medications, without consulting health care professional.
  • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
  • Instruct patient to notify health care professional if swelling of face, eyes, lips, or tongue or if difficulty swallowing or breathing occur.
  • Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Olmesartan should be discontinued as soon as possible when pregnancy is detected.
  • Emphasize the importance of follow-up exams to evaluate effectiveness of medication.

Evaluation/Desired Outcomes

  • Decrease in BP without excessive side effects.

olmesartan

(ŏl′mə-sär′tən)
n.
An angiotensin II receptor blocker drug, C24H26N6O3, used in the form of its medoxomil ester to treat hypertension.
References in periodicals archive ?
Indian multinational drug firm Alembic Pharmaceuticals (NSE: APLLTD) has received approval from the US health regulator for its generic Olmesartan Medoxomil and Amlodipine tablets, the company reported on Tuesday.
Mumbai, India-based Glenmark Pharmaceuticals (NSE: GLENMARK) has received final approval from the US Food and Drug Administration (FDA) for its Olmesartan Medoxomil Tablets, a blood pressure treatment, the company reported on Friday.
Amlodipine + Olmesartan Medoxomil Tablets is part of an ever growing portfolio of products that Ajanta has developed for the US market.
In the present study, we examined patients without previous history of AF, who were implanted dual-chamber (DDD) pacemakers, to assess the effectiveness of olmesartan in the prevention of new-onset AF and AF burden in AVB patients with high VP% (≥40%).
Rubio-Tapia et al (3) were the first to report an association between olmesartan use and the development of unexplained severe enteropathy in 2012.
This active metabolite, olmesartan, is a potent and selective AT1 receptor antagonist, with no agonist activity.
23 In other studies olmesartan improved peripheral insulin sensitivity in human sub-jects after 6 months24 and 12 months of treatment.
Major products, including flagship antihypertensive agent olmesartan, antiplatelet agent prasugrel, ulcer treatment NEXIUM, and the Alzheimer's disease treatment Memary, also contributed.
He discovered the connection in a retrospective analysis of patients after treating two women with collagenous celiac disease whose patient history included olmesartan therapy.
And all 22 of them were taking the angiotensin receptor blocker olmesartan (Benicar).
The FDA used queries previously to test the validity of a culmination of incidents reported in the Adverse Event Reporting System of patients using hypertension medication Olmesartan and who were developing celiac disease.
A rare but hazardous association has been found between common blood pressure drug olmesartan (Benicar) and celiac disease which may lead to misdiagnosis and unnecessary treatment.