olmesartan medoxomil

(ol ma sar' tan)

Benicar

Pregnancy Category C (first trimester)

Pregnancy Category D (second and third trimesters)

Drug classes
Angiotensin II receptor antagonist
Antihypertensive

Therapeutic actions
Selectively blocks the binding of angiotensin II to specific tissue receptors found in the
vascular smooth muscle and adrenal gland; this action blocks the vasoconstricting effect
of the renin–angiotensin system as well as the release of aldosterone leading to decreased
blood pressure; may prevent the vessel remodeling associated with the development of
atherosclerosis.

Indication
• Treatment of hypertension, alone or in combination with other antihypertensives

Contraindications and cautions

• Contraindicated with hypersensitivity to any component of the drug; pregnancy
(use during the second or third trimester can cause injury or even death to the
fetus), lactation.
• Use cautiously with renal dysfunction, hypovolemia, salt depletion.

Available forms
Tablets—5, 20, 40 mg

Dosages
ADULTS
20 mg/day PO as a once daily dose; may titrate to 40 mg/day if needed after 2 wk.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak
Oral Varies 1–2 hr

Metabolism: Hydrolyzed in GI tract; T1/2: 13 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Feces and urine

Adverse effects
• CNS: Headache, dizziness, syncope, muscle weakness
• CV: Hypotension, tachycardia
 • Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
• GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain
• Hematologic: Increased CPK, hyperglycemia, hypertriglyceridemia
• Respiratory: URI symptoms, bronchitis, cough, sinusitis, rhinitis, pharyngitis
• Other: Back pain, flulike symptoms, fatigue, hematuria, arthritis, angioedema

Nursing considerations
Assessment
• History: Hypersensitivity to any component of the drug, pregnancy, lactation,
hepatic or renal dysfunction, hypovolemia, salt depletion
• Physical: Skin lesions, turgor; body temperature; reflexes, affect; BP; R,
respiratory auscultation; liver and kidney function tests, serum electrolytes

Interventions
• Administer without regard to meals.
• Ensure that patient is not pregnant before beginning therapy; suggest the use of
barrier birth control while using olmesartan; fetal injury and deaths have been
reported.
• Find an alternate method of feeding the infant if given to a nursing mother.
Depression of the renin–angiotensin system in infants is potentially very
dangerous.
• Alert surgeon and mark patient's chart with notice that olmesartan is being taken.
The blockage of the renin–angiotensin system following surgery can produce
problems. Hypotension may be reversed with volume expansion.
• Monitor patient closely in any situation that may lead to a decrease in blood
pressure secondary to reduction in fluid volume—excessive perspiration,
dehydration, vomiting, diarrhea; excessive hypotension can occur.

Teaching points
• Take drug without regard to meals. Do not stop taking this drug without
consulting your health care provider.
• Use a barrier method of birth control while on this drug; if you become pregnant
or desire to become pregnant, consult with your health care provider.
• Take special precautions to maintain your fluid intake and provide safety
precautions in any situation that might cause a loss of fluid volume—excessive
perspiration, dehydration, vomiting, diarrhea—excessive hypotension can occur.
• These side effects may occur: Dizziness (avoid driving a car or performing
hazardous tasks); headache (medications may be available to help); nausea,
vomiting, diarrhea (proper nutrition is important, consult with your dietitian to
maintain nutrition); symptoms of upper respiratory tract, cough (do not self-
medicate, consult with your nurse or physician if this becomes uncomfortable).
• Report fever, chills, dizziness, pregnancy, swelling.

Adverse effects in Italic are most common; those in Bold are life-threatening.