Olmesartan
Mechanism :
Olmesartan is an ARB that selectively inhibits the binding of angiotensin II to AT1, which is found in many tissues such as vascular smooth muscle and the adrenal glands. This effectively inhibits the AT1-mediated vasoconstrictive and aldosterone-secreting effects of angiotensin II and results in a decrease in vascular resistance and blood pressure. Olmesartan is selective for AT1 and has a 12,500 times greater affinity for AT1 than the AT2 receptor. Also, unlike the well-known ARB losartan, olmesartan does not have an active metabolite or possess uricosuric effects.
Indication :
Contraindications :
Dehydrated patients, Liver disease, CHF, Diabetics taking medication containing aliskiren.
Dosing :
Use in children 6 to 16 years of age.
20 to <35 kg: Initial:
10 mg orally once daily; Maximum 20 mg/day.
>35 kg:
20 mg orally once daily; Maximum: 40 mg/day.
Adverse Effect :
Blood in the urine, body aches or pain, runny nose, nasal congestion, sinusitis, sore throat, chills, fever, headache, bronchitis, difficulty with breathing, cough, sneezing, dizziness, fatigue, hyperglycemia, hypertriglyceridemia.
Interaction :
Drospirenone: Increased risk of hyperkalemia.
Tobramycin: Increased risk of nephrotoxicity.
Trandolapril: The angiotensin II receptor blocker, Olmesartan, may increase the adverse effects of Trandolapril.
Treprostinil: Additive hypotensive effect. Monitor antihypertensive therapy during concomitant use.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function. Start with low doses |
| <10 | Dose as in normal renal function Initial dose 10 mg daily and gradually increase |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | Not dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Unlikely to be dialysed. Dose as in GFR<10 mL/min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
based on experience in adult patients, no initial dosage adjustment may be necessary; however, in adult patients with moderate hepatic impairment, an increase in AUC of ~60% was observed; use with caution.