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 thevasoconstricting effect of the renin–angiotensin system as well as the release of aldosterone leading to decreased BP; 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, 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 T; reflexes, affect; BP; R, respiratory auscultation; LFTs, renal 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.
· WARNING: 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 BP secondary to reduction in fluid volume—excessive perspiration, dehydration, vomiting, diarrhea; excessive hypotension can occur.
· 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.
· You may experience these side effects: Dizziness (avoid driving a car or performing hazardous tasks); headache (medications may be available to help); nausea, vomiting, diarrhea (proper nutrition is important, consult a dietitian to maintain nutrition); symptoms of upper respiratory tract, cough (do not self-medicate, consult with your health care provider if this becomes uncomfortable).
· Report fever, chills, dizziness, pregnancy, swelling.
Adverse effects in Italic are most common; those in Bold are life-threatening.
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