Adults

The usual starting dose is 20 mg once daily. If blood pressure is not adequately controlled, the dose can be increased to 40 mg once daily after 2 weeks. Doses above 40 mg are generally not recommended.

Elderly

No initial dosage adjustment is typically required in elderly patients, but monitoring of renal function is advisable.

Renal_impairment

For patients with moderate to severe renal impairment (creatinine clearance <40 mL/min), a lower starting dose (e.g., 10 mg once daily) should be considered. Careful monitoring of blood pressure and potassium levels is recommended.

Onset

Blood pressure reduction is noticeable within 1 week, with maximal reduction usually achieved after 2 weeks of therapy.

Excretion

Approximately 35-50% of the absorbed dose is excreted in the urine and the remainder is eliminated in feces via bile.

Half life

The terminal elimination half-life of olmesartan is approximately 13 hours.

Absorption

Olmesartan medoxomil is rapidly and completely converted to olmesartan by esterase in the gastrointestinal tract during absorption. The absolute bioavailability of olmesartan is approximately 26%.

Metabolism

Olmesartan is not further metabolized. It is primarily eliminated unchanged.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect of olmesartan and increase the risk of renal impairment, especially in dehydrated or elderly patients.

Lithium

Concomitant use with lithium may increase serum lithium concentrations and lead to lithium toxicity. Monitor serum lithium levels carefully.

Aliskiren

Concomitant use with aliskiren is contraindicated in diabetic patients due to an increased risk of hypotension, hyperkalemia, and renal impairment.

Potassium-sparing diuretics/Potassium supplements

Concomitant use may lead to hyperkalemia. Monitor serum potassium levels.