Brand and Other Names:Benicar
- Classes: ARBs
Dosing & Uses
Dosage Forms & Strengths
20 mg/day PO initially; may be increased to 40 mg/day PO after 2 weeks; a diuretic may be added
- CrCl <40 mL/min: No adjustment needed
- CrCl <20 mL/min: Consider using lower initial dosage and not exceeding 20 mg/day
- No need for initial dosage adjustment
Volume-depleted patients: Consider lower initial dosage
Also given in combination with hydrochlorothiazide (Benicar HCT)
Dosage Forms & Strengths
- Safety and efficacy not established (see Cautions)
- <20 kg: Safety and efficacy not established
- 20-35 kg: 10 mg/day PO initially; after 2 weeks, may be increased if response is inadequate; dosage range: 10-20 mg/day
- >35 kg: 20 mg/day PO initially; after 2 weeks, may be increased if response is inadequate; dosage range: 20-40 mg/day
A lower starting dosage may be used
5-10 mg/day PO initially; may be increased to 40 mg/day PO after 2 weeks (with monitoring of blood pressure); a diuretic may be added
Serious - Use Alternative
Significant - Monitor Closely
Upper respiratory tract infection (URTI)
Frequency Not Defined (selected)
Black Box Warnings
Discontinue as soon as possible when pregnancy is detected; drug affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury or death
Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)
Angioedema, severe congestive heart failure (CHF), surgery or anesthesia, volume depletion (consider lower dosage)
Coadministration with mTOR inhibitors (eg, temsirolimus) may increased risk for angioedema
Risk of hypotension, especially in patients with volume or salt depletion secondary to salt restriction or prolonged diuretic treatment
Risk of hyperkalemia
Use with caution in renal artery stenosis; avoid in bilateral renal artery stenosis
Renal impairment reported
Intestinal problems (ie, sprue-like enteropathy) reported; symptoms may include severe, chronic diarrhea with substantial weight loss
Dual blockade of the renin-angiotensin system with angiotensin-receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, or aliskiren is associated with increased risk of hypotension, hyperkalemia, and altered renal function (including acute renal failure) in comparison with monotherapy; closely monitor blood pressure
Children <1 year of age must not receive olmesartan for hypertension; drugs that act directly on the renin-angiotensin-aldosterone system can have adverse effects on the development of immature kidneys
Pregnancy & Lactation
Pregnancy category: 1st trimester, C; 2nd and 3rd trimesters, D
Lactation: No human data; use with caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Blocks binding of angiotensin II to type 1 angiotensin II receptors; blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II
Onset: <2 weeks
Peak response: 4-6 weeks
Duration: 24 hr
Peak plasma time: 1-2 hr
Protein bound: 99%
Vd: 17 L; does not cross blood-brain barrier
Rapidly and completely deesterified to active olmesartan in intestinal wall; no further metabolism occurs
Metabolites: RNH-6270 (deesterified olmesartan; active)
Half-life: 13 hr
Renal clearance: 0.5-0.8 L/hr
Total body clearance: 1.3 L/hr
Excretion: Bile (50-65%), urine (35-50%)
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