Adult Dosing
Hypertension
- Initial dose: 20 mg PO qd when used alone in patients who are not volume-contracted
- May increase to 40 mg PO qd, if further reduction in blood pressure is required after 2 wks of therapy
- Max: 40 mg/day
- Initiate therapy at a lower dose, under close medical supervision, in patients who are volume depleted (e.g., patients on diuretics, particularly those with impaired renal function)
- A diuretic may be added if blood pressure is not controlled by olmesartan alone; may be administered with other antihypertensive agents
Heart failure (Non-FDA Approved)
- Note that similar dosing to that used for hypertension is typically used for this indication
Pediatric Dosing
Pediatric hypertension
6-16 yrs
- 20 to <35 kgs (44 to 77 lbs)
- 10 mg PO qd
- May increase to a maximum of 20 mg PO qd, if further reduction of blood pressure is required after 2 wks of initial therapy
35 kgs- 20 mg PO qd
- Titrate the dose to a maximum of 40 mg PO qd, if further reduction of blood pressure is required after 2wks of initial therapy
Note:
- In children unable to swallow tablets, the same dose can be given using an extemporaneous suspension
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Moderate to severe renal impairment (<40 mL/min): No dose adjustments
- Hemodialysis: Dose adjustments not defined
Hepatic Dose Adjustment
- Moderate to severe hepatic impairment: No dose adjustments
See Supplemental Patient Information
- Use of drugs that act directly on the renin-angiotensin system during the second and third trimesters of pregnancy are associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure and death. Discontinue therapy as soon as the pregnancy is detected [US Black Box Warning]
- Oligohydramnios associated with fetal limb contractures, craniofacial deformation and hypoplastic lung development have been reported during olmesartan therapy
- Perform serial ultrasound examinations to assess the intra-amniotic environment in pregnant mothers taking drugs acting on the renin-angiotensin system; discontinue therapy on detection of oligohydramnios
- Closely observe infants with histories of in utero exposure to an angiotensin II receptor antagonist for hypotension, oliguria, and hyperkalemia
- Watch for symptomatic hypotension after initiation of olmesartan therapy, especially in volume and/or salt-depleted patients. If hypotension occurs, place the patient in supine position and give IV infusion of normal saline if needed
- In patients whose renal function may depend upon the activity of the renin-angiotensin-aldosterone system (e.g., severe CHF), therapy may be associated with oliguria, progressive azotemia and rarely with acute renal failure and/or death
- Increases in serum creatinine or blood urea nitrogen (BUN) may be expected in patients with unilateral or bilateral renal artery stenosis
- Intestinal problems (ie, sprue-like enteropathy) reported; symptoms may include severe, chronic diarrhea with substantial weight loss, hence consider discontinuation of therapy in cases where no other etiology is identified
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Hyponatremia
Supplemental Patient Information
- Advise female patients of childbearing age about the consequences of second and third trimester exposure to drugs that act on the renin-angiotensin system; inform these patients to promptly report pregnancies to their physicians as soon as possible
Pregnancy Category:C (first trimester); D (second and third trimesters)
Breastfeeding: An alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 February 2011). Because there exists a potential for adverse effects on the nursing infant, manufacturer recommends to discontinue nursing or discontinue the drug, analyzing the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Benicar 40 MG TABS [Bottle] (SANKYO)
30 mg = $134.99
90 mg = $387.95 - Benicar 20 MG TABS [Bottle] (SANKYO)
30 mg = $95.99
90 mg = $276.96 - Benicar 5 MG TABS [Bottle] (SANKYO)
30 mg = $78.99
90 mg = $225.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
