Olmesartan

Olmesartan is a potent AT1 receptor blocker (sartan) with a strong blood pressure-lowering effect. It is available as a single-ingredient product and in various combinations: Olmetec®, Olmetec Plus® (with HCT), Sevikar (with amlodipine) and Vocado® HCT.

Olmesartan is often used when a substantial reduction in blood pressure is needed, and it combines well with other active ingredients.

Olmesartan blocks the AT1 receptor:

Mechanism of action:

• Selective and potent AT1 receptor blockade
• Taken as a prodrug (olmesartan medoxomil)
• Converted to active olmesartan in the intestine
• Strong and sustained lowering of blood pressure

Clinical effect:

• Duration of action: 24 hours

Olmesartan is suitable for:

• Adults with high blood pressure
• Patients who need a stronger reduction in blood pressure
• Use in combination with amlodipine and/or HCT

Particularly suitable for:

• Treatment-resistant high blood pressure
• Need for combination therapy

Not suitable:

• Pregnancy and breastfeeding
• Biliary obstruction
• Severe hepatic impairment

High blood pressure:

• Starting dose: 10 mg once daily
• Usual dose: 20 mg once daily
• Maximum dose: 40 mg daily

Available strengths:

• 10 mg, 20 mg, 40 mg tablets

Combination products:

• Olmesartan + HCT (Olmetec Plus®)
• Olmesartan + amlodipine (Sevikar)
• Olmesartan + amlodipine + HCT (Vocado® HCT)

How to take:

• Once daily, always at the same time of day
• With or without meals
• Take with water

Notes:

• Regular blood pressure checks
• Laboratory tests (kidneys, potassium)
• Do not stop taking it suddenly
• Drink enough fluids

Olmesartan must not be taken in case of:

• Hypersensitivity to olmesartan
• Pregnancy in the 2nd and 3rd trimester
• Biliary obstruction
• Concomitant use with aliskiren in diabetes or impaired kidney function (GFR below 60 ml/min/1.73 m²)

Use with caution in case of:

• Renal insufficiency
• Renal artery stenosis
• Hyperkalemia
• Dehydration
• Aortic stenosis

Special warning: In rare cases, olmesartan can cause sprue-like enteropathy (severe diarrhea with weight loss). If you have chronic diarrhea while taking olmesartan, inform your doctor.

Pregnancy and breastfeeding: Olmesartan is not recommended in the 1st trimester of pregnancy and is contraindicated in the 2nd and 3rd trimesters. Treatment should not be started during pregnancy. If pregnancy is detected, treatment must be stopped immediately and, if necessary, another therapy started. Olmesartan is not recommended during breastfeeding.

Common (1-10%):

• Dizziness
• Headache
• Elevated blood lipid levels
• Cough

Uncommon (0.1-1%):

• Fatigue
• Gastrointestinal complaints
• Hyperkalemia
• Kidney function disorders

Rare but important:

• Sprue-like enteropathy (chronic diarrhea, weight loss)
• Angioedema
• Liver function disorders

Note: In case of chronic, unexplained diarrhea while taking olmesartan, sprue-like enteropathy should be considered. The symptoms improve after discontinuation.

Contraindicated:

• Aliskiren in diabetes or renal insufficiency

Use with caution with:

• Potassium-sparing diuretics → hyperkalemia
• NSAIDs → reduced effect
• Lithium → increased levels
• Colesevelam → reduced absorption of olmesartan

Note: Colesevelam (a bile acid sequestrant) can reduce the absorption of olmesartan. A time gap between taking the two is recommended.