OLMESARTAN MEDOXOMIL

OLMESARTAN MEDOXOMIL
(ol-me-sar'tan)
Benicar
Classifications: angiotensin ii receptor antagonist, antihypertensive;
Therapeutic: antihypertensive, angiotensin ii receptor antagonist

Prototype: Losartan
Pregnancy Category: C first trimester; D second and third trimester

Availability

5 mg, 20 mg, 40 mg tablets

Action

Angiotensin II receptor (type AT1) antagonist acts as a potent vasodilator and primary vasoactive hormone of the renin-angiotensin-aldosterone system. Selectively blocks the binding of angiotensin II to the AT1 receptors found in many tissues (e.g., vascular smooth muscle, adrenal glands). Antihypertensive effect results from blocking the vasoconstricting and aldosterone-secreting effects of angiotensin II.

Therapeutic Effect

Antihypertensive effect is due to its potent vasodilation effect.

Uses

Treatment of hypertension.

Contraindications

Hypersensitivity to pimecrolimus or components in the cream; Netherton's syndrome; application to active cutaneous viral infection; pregnancy (category C first trimester, and category D in second and third trimester); lactation, children.

Cautious Use

Renal artery stenosis; heart failure; severe renal impairment; hypovolemia.

Route & Dosage

Hypertension
Adult: PO 20 mg q.d., may increase to 40 mg q.d. Start with 5–10 mg q.d. if volume depleted.

Administration

Oral
  • Determine if patient is volume depleted (e.g., patients treated with diuretics) prior to first administration of drug. If volume depletion is suspected, a lower starting dose is recommended.
  • Store at 20°–25° C (68°–77° F).

Adverse Effects (≥1%)

Body as a Whole: Back pain, flu-like symptoms. CNS: Headache. CV: Hypotension (especially if dehydrated). GI: Diarrhea. Metabolic: Increased CPK, hyperglycemia, hypertriglyceridemia. Respiratory: Bronchitis, pharyngitis, rhinitis, sinusitis, upper respiratory infection. Urogenital: Hematuria.

Interactions

Drug: May increase hypotensive effect of other antihypertensives; may cause hyperkalemia with potassium-sparing diuretics, potassium supplements; increase risk of lithium toxicity. Herbal: Ephedra, ma-huang may antagonize antihypertensive effects.

Pharmacokinetics

Absorption: Rapidly absorbed, 26% reaches systemic circulation. Peak: 1–2 h. Distribution: 99% protein bound. Metabolism: Not metabolized by CYP 450 system. Elimination: 50% in urine, 50% in feces. Half-Life: 13 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor closely any volume-depleted patient following initial drug doses. If serious hypotension occurs, place patient in supine position and notify physician immediately.
  • Monitor BP and HR at drug trough (prior to a scheduled dose). Report hypotension or bradycardia.
  • Monitor drug effectiveness, especially in African Americans, when olmesartan is used as monotherapy.
  • Lab tests: Monitor baseline and periodic renal functions; monitor CBC, electrolytes, and liver function with long-term therapy.

Patient & Family Education

  • Discontinue drug and notify physician if you experience swelling of the face, tongue, or throat, or if you believe you are pregnant.
  • Notify physician of symptoms of hypotension (e.g., dizziness, fainting).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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