Adults

Usually 20 mg once daily. May be increased to 40 mg once daily if blood pressure is not adequately controlled. Doses above 40 mg daily are not typically recommended.

Elderly

No initial dosage adjustment usually required unless severe renal impairment. Careful monitoring is advised.

Renal_impairment

For moderate to severe renal impairment (CrCl < 40 mL/min), starting dose 10 mg once daily, maximum 20 mg once daily. Not recommended for patients on dialysis.

Onset

Initial blood pressure reduction within 1 week, maximal effect typically within 2 weeks.

Excretion

Primarily excreted unchanged, about 35-50% renally and 50-65% hepatobiliary (feces).

Half life

Terminal elimination half-life is approximately 13 hours.

Absorption

Rapidly and completely absorbed from the GI tract after oral administration, converted to active olmesartan. Absolute bioavailability approx. 26%. Peak plasma concentration (Tmax) in 1-2 hours. Food does not significantly affect bioavailability.

Metabolism

Olmesartan medoxomil is a prodrug and is rapidly and completely hydrolyzed to olmesartan during absorption from the gastrointestinal tract. Olmesartan itself is not further metabolized.

Lithium

Increased serum lithium concentrations and toxicity; monitor lithium levels carefully.

Aliskiren

Increased risk of hypotension, hyperkalemia, and renal impairment (contraindicated in patients with diabetes or renal impairment).

NSAIDs (Non-Steroidal Anti-inflammatory Drugs)

Reduced antihypertensive effect; increased risk of worsening renal function and hyperkalemia, especially in dehydrated or elderly patients.

Potassium-sparing diuretics/Potassium supplements

Increased risk of hyperkalemia; monitor serum potassium levels.