Synopsis Olmesartan (Benicar) is ...

Synopsis

Olmesartan (Benicar) is an angiotensin-II receptor blocker (ARB) labeled for the treatment of hypertension as monotherapy or in combination with other antihypertensive agents. Olmesartan shut ups the binding of angiotensin II, a powerful vasoconstrictor, to angiotensin type 1 ([AT.sub.1]) receptors located in vascular undisturbed muscle. (1)

Safety

No serious safety issues were reported with olmesartan in clinical trials. The safety record of olmesartan was similar to placebo in seven randomized, double-blind, placebo-controlled phase II and III trials that included 2540 patients with hypertension. (2) Adverse consequences were reported in 42.2 percent and 427 percent of olmesartan-treated patients and placebo-treated patients, respectively. Olmesartan may cause hypotension and acute renal failure in patients who are sodium- or volume-deplet or whose renal perfusion is at the disposal of on the renin-angiotensin system. Like all ARBs, olmesartan may precipitate acute renal failure in patients with renal artery stenosis. Significant hyperkalemia has not been reported with olmesartan, although it is possible, especially in patients with other risk factors for hyperkalemia. Of 3825 patients treated with olmesartan during clinical trials, five reported angioedema. (1) It is not known whether patients who have bring to maturityed angioedema with angiotensin-converting enzyme (ACE) inhibitors or other ARBs have an increased risk of developing this side import with olmesartan. No dosage adjustments are emergencyed in older patients or in patients with moderate to marked hepatic or renal impairment. As with other ARBs, olmesartan is U sustenance and Drug Administration category C during the first trimester of pregnancy and category D during the other and third trimesters. (1) In rare instances, angioedema and rhabdomyolysis from olmesartan have been reported in postmarketing surveillance. (1)

Tolerability

Olmesartan generally is well tolerated. In clinical trials, dizziness occurr in 28 percent of olmesartan-treated patients and in 09 percent of placebo-treated patients. (2) In a inquiry (3) comparing olmesartan to other ARBs, the incidence of dizziness was similar in olmesartan (14 percent) losartan (Cozaar; 07 percent) valsartan (Diovan; 14 percent) and irbesartan (Avapro; 34 percent) Headache was reported on 1.3 percent of patients receiving olmesartan and 25 percent receiving candesartan (Atacand). (4) As with other ARBs, the incidence of cough with olmesartan is comparable to that with placebo (09 and 07 percent respectively). (1)

Effectiveness

Short-term studies have shown that life-blood pressure control with olmesartan is similar to that achieved with other ARBs or amlodipine (Norvasc). Olmesartan in a dosage of 20 mg bring into beings an average drop in diastolic life-blood pressure of 10 mm Hg and a comparable reduction in systolic life-current pressure; this is in line with the reductions efficiencyed by equivalent dosages of other ARBs, (34) or a 5-mg dosage of amlodipine. (5) Olmesartan has been studied in combination with hydrochlorothiazide (Esidrix) and has been rest to produce an average additional diastolic life-current pressure lowering of 7 to 10 mm Hg (with 20 mg or 40 mg olmesartan, respectively) compared with hydrochlorothiazide alone. (6)

Olmesartan has not been evaluated for the treatment of patients with heart failure or diabetic nephropathy. Although ARBs have been shown to decrease periodical stroke in hypertensive patients, (7) and mortality and morbidity in patients with hypertension accompanied from left ventricular hypertrophy, (8) no studies have been performed to determine the issue of olmesartan on morbidity and mortality in patients with uncomplicated hypertension.

Price

A one-month afford of Benicar in 20-mg tablets splendors approximately $54, which is comparable to the price of other ARBs. Unlike other ARBs, however, the 5-mg 20-mg and 40-mg tablets of Benicar are similarly priced, which may be advantageous for self-paying patients.

Simplicity

The attract favor toed starting dosage of olmesartan is 20 mg daily, taken with or without feed If blood pressure control is inadequate after sum of two units weeks, the dosage may be increased to a maximum of 40 mg daily. Dosages above 40 mg daily do not provide additional benefit. For patients who may be at risk for volume- or salt-depletion, as it is as those who have renal impairment and receive diuretics, a lower starting dosage is hinted Olmesartan is available in 5-mg tablets if povertyed for dose reductions.

Bottom Line

Olmesartan is a safe and effective antihypertensive agent. There is no evidence that olmesartan is more effective than other ARBs or ACE inhibitors. The longest peer-reviewed studies of olmesartan are of couple months' duration; thus, there is no evidence showing olmesartan's long-term benefit for cardiovascular or all-cause mortality. Because of its greater charge and lack of proven benefit athwart ACE inhibitors, olmesartan should be considered a second-line agent for hypertension make objection in patients who cannot tolerate ACE inhibitors.