olmesartan medoxomil: clinical use

Prescribing considerations

• Assess volume or sodium depletion, including recent vomiting or diarrhoea, before initiation.
• Use particular caution with renal impairment, renal artery stenosis, diabetes, older age, valve stenosis or obstructive hypertrophic cardiomyopathy.
• Severe chronic diarrhoea and weight loss arising months or years after initiation should prompt consideration of olmesartan-associated enteropathy.
• The antihypertensive response may be smaller in Black patients, consistent with other ARBs.
• Use is not recommended in severe renal or severe hepatic impairment, after recent kidney transplantation, or in primary aldosteronism.

Contraindications and cautions

• Hypersensitivity to olmesartan medoxomil or an excipient
• Second or third trimester of pregnancy
• Biliary obstruction
• Concomitant aliskiren in patients with diabetes or impaired renal function

Monitoring

• Check blood pressure, renal function, serum potassium and sodium before treatment and after clinically relevant changes.
• Monitor more closely when renal impairment, diabetes, older age, dehydration or interacting medicines increase risk.
• Reassess renal function and electrolytes during acute illness or suspected volume depletion.
• Investigate persistent diarrhoea, weight loss or unexplained villous atrophy for olmesartan-associated enteropathy.

Clinical pharmacology

Olmesartan medoxomil is an orally absorbed prodrug rapidly hydrolysed to olmesartan, a selective AT1-receptor antagonist. Active olmesartan is highly protein-bound and is cleared through both renal and hepatobiliary routes, with little involvement of cytochrome P450 metabolism.

Formulation and product differences

• The selected product is a white, oval, biconvex film-coated tablet.
• The selected product contains lactose; excipients and tablet appearance can differ between manufacturers.

Tablet

Route: Oral

Strengths: 10 mg, 20 mg, 40 mg