BLACK BOX WARNING
- fetal toxicity
olmesartan medoxomil
Brand: Benicar
⚠ BBW Prototype: losartan
Drug Class: angiotensin II receptor blocker (ARB)
Drug Family: antihypertensive
Subclass: AT1 receptor antagonist
Organ Systems: cardiovascular
Mechanism of Action
Prodrug hydrolyzed to olmesartan; potent, long-acting AT1 receptor blockade.
AT1 receptor
Indications
- hypertension
Contraindications
- pregnancy
- concomitant aliskiren in DM or CKD
Adverse Effects
Common
- dizziness
- hyperkalemia
Serious
- sprue-like enteropathy
- teratogenicity
- AKI
Pharmacokinetics (ADME)
| Absorption | 26% bioavailability; not affected by food |
| Distribution | high protein binding |
| Metabolism | prodrug (medoxomil) hydrolyzed to olmesartan in GI/plasma |
| Excretion | fecal 50-65%, renal 35-50% |
| Half-life | 13 hours |
| Onset | 1-2 hours |
| Peak | 1-2 hours |
| Duration | 24 hours |
| Protein Binding | >99% |
| Vd | 17 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| colesevelam | reduces olmesartan AUC by 40% | moderate |
| potassium-sparing diuretics | additive hyperkalemia | major |
Nursing Considerations
- Unique risk of sprue-like enteropathy (severe diarrhea, weight loss) — often months to years after initiation; discontinue and refer for GI evaluation
- Monitor BP, K+
- Do not co-administer with colesevelam (separate by 4+ hours)
Clinical Pearls
- Most potent AT1 affinity among ARBs
- Sprue-like enteropathy: distinctive, potentially severe GI adverse effect
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.