Olmesartan, sold under the trade name Benicar among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease.

 It is an angiotensin II receptor antagonist and works by blocking the effects of angiotensin II.

It is taken by mouth.

Versions are available as the combination olmesartan/hydrochlorothiazide and olmesartan/amlodipine.

Pregnancy category C- D if used in second or third trimester.

Bioavailability 26%

Metabolism- Liver 

Elimination half-life 13 hours


Kidney 40%, biliary 60%

Side effects include:  dizziness, headaches, diarrhea, and back pain.

Serious side effects include kidney problems, low blood pressure, and angioedema.

Use in pregnancy may harm the fetus and use when breastfeeding is not recommended.

It is used for the treatment of hypertension.

Contraindications for treatment with olmesartan include biliary obstruction, and pregnancy.

Fetal malformations may occur.

Adverse effects: Incidence similar to placebo: only adverse effect that occurred in >1% of patients treated with it and more frequently than placebo was dizziness (3% vs 1%). 

Rarely, associated with gastrointestinal issues of nausea, vomiting, diarrhea, weight loss, and electrolyte abnormalities.

Like all  drugs that act directly on the renin-angiotensin system: olmesartan is contraindicated in pregnancy and can cause injury and even death to the developing fetus.

The usual recommended starting dose of olmesartan is 20 mg once daily. 

The dose may be increased to 40 mg after two weeks of therapy.

Twice-daily dosing offers no advantage over the same total dose given once daily.Implicated in the development of severe chronic diarrhea and intestinal villous atrophy resembling celiac disease, but it is a rare event (Greywoode R et al).

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