hydrochlorothiazide + olmesartan medoxomil: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
hydrochlorothiazide + olmesartan medoxomil: clinical details
Prescribing considerations
- Not intended as initial antihypertensive therapy; confirm inadequate control on olmesartan monotherapy.
- Correct significant volume or sodium depletion before treatment and reassess during prolonged vomiting or diarrhoea.
- Use caution with mild-to-moderate renal or hepatic impairment, renal artery stenosis, heart failure, valve stenosis, diabetes, gout, systemic lupus erythematosus or previous skin cancer.
- Counsel on sun and UV protection and reporting new or changing skin lesions because cumulative hydrochlorothiazide exposure is associated with non-melanoma skin cancer.
- Investigate severe chronic diarrhoea with weight loss for olmesartan-associated sprue-like enteropathy.
Contraindications and cautions
- Hypersensitivity to either active substance, listed excipients or sulfonamide-derived substances
- Severe renal impairment
- Refractory hypokalaemia, hypercalcaemia or hyponatraemia, or symptomatic hyperuricaemia
- Severe hepatic impairment, cholestasis or biliary obstruction
- Second or third trimester of pregnancy
- Aliskiren use in patients with diabetes or relevant renal impairment
- Previous hydrochlorothiazide-associated acute respiratory distress syndrome
Monitoring
- Blood pressure
- Renal function and creatinine
- Serum sodium and potassium
- Consider calcium, magnesium, uric acid, glucose and lipids according to clinical risk
- Volume status during intercurrent illness or gastrointestinal fluid loss
- Skin examination where lesions are suspicious; reassess hydrochlorothiazide after previous non-melanoma skin cancer
Clinical pharmacology
Olmesartan medoxomil is a prodrug converted to olmesartan, a selective AT1-receptor antagonist. Hydrochlorothiazide reduces renal sodium reabsorption and increases diuresis. The components provide additive antihypertensive effects.
Formulation and product differences
- The selected products are film-coated tablets containing lactose.
- Tablet appearance and markings differ between strengths; confirm against the dispensed pack rather than colour alone.
hydrochlorothiazide + olmesartan medoxomil preparations and strengths
Tablet
Route: Oral
Strengths: 20 mg + 12.5 mg, 20 mg + 25 mg, 40 mg + 12.5 mg, 40 mg + 25 mg
hydrochlorothiazide + olmesartan medoxomil interactions
Tell the prescriber or pharmacist about prescribed, non-prescription and complementary products, particularly:
Lithium
The combination can increase lithium concentrations and toxicity; concurrent use is not recommended unless levels can be closely monitored.
NSAIDs, including ibuprofen and naproxen
They may weaken blood-pressure control and increase kidney-impairment risk, particularly during dehydration or in vulnerable patients.
ACE inhibitors, other ARBs or aliskiren
Dual renin–angiotensin system blockade increases the risks of hypotension, high potassium and kidney injury; some combinations are contraindicated.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.