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Olmesartan and hydrochlorothiazide: Drug information

Olmesartan and hydrochlorothiazide: Drug information
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For additional information see "Olmesartan and hydrochlorothiazide: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Fetal toxicity:

When pregnancy is detected, discontinue olmesartan/hydrochlorothiazide as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Brand Names: US
  • Benicar HCT
Brand Names: Canada
  • Olmetec Plus
Pharmacologic Category
  • Angiotensin II Receptor Blocker;
  • Diuretic, Thiazide
Dosing: Adult
Hypertension

Hypertension: Oral:

Replacement therapy: Combination product may be substituted for individual titrated agents.

Initiation of combination therapy when monotherapy has failed to achieve desired effects:

Patients currently on olmesartan monotherapy: Initial: Olmesartan 40 mg/hydrochlorothiazide 12.5 mg once daily; may titrate dose after 2 to 4 weeks (maximum: olmesartan 40 mg/hydrochlorothiazide 25 mg per day).

Patients currently on hydrochlorothiazide monotherapy: Initial: Olmesartan 20 mg/hydrochlorothiazide 12.5 mg once daily; may titrate dose after 2 to 4 weeks (maximum: olmesartan 40 mg/hydrochlorothiazide 25 mg per day).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

CrCl >30 mL/minute: No dosage adjustment necessary.

CrCl ≤30 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling for the combination product. In patients with moderate hepatic impairment, a maximum of olmesartan 20 mg/hydrochlorothiazide 12.5 mg per day has been recommended (Ref).

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see individual agents.

1% to 10%:

Endocrine & metabolic: Hyperuricemia (4%)

Gastrointestinal: Nausea (3%)

Nervous system: Dizziness (9%)

Renal: Increased blood urea nitrogen (3%), increased serum creatinine (2%)

Respiratory: Upper respiratory tract infection (7%)

<1%: Hypersensitivity: Facial edema

Frequency not defined:

Cardiovascular: Chest pain, peripheral edema

Dermatologic: Skin rash

Gastrointestinal: Abdominal pain, diarrhea, dyspepsia, gastroenteritis

Genitourinary: Hematuria

Hepatic: Increased gamma-glutamyl transferase, increased serum alanine aminotransferase, increased serum aspartate aminotransferase

Nervous system: Vertigo

Neuromuscular & skeletal: Arthralgia, arthritis, back pain, increased creatine phosphokinase in blood specimen, myalgia

Respiratory: Cough

Postmarketing:

Dermatologic: Alopecia, pruritus

Endocrine & metabolic: Hyperkalemia

Gastrointestinal: Vomiting

Hypersensitivity: Angioedema

Nervous system: Asthenia

Neuromuscular & skeletal: Rhabdomyolysis

Contraindications

Hypersensitivity to olmesartan, hydrochlorothiazide, or any component of the formulation; concomitant use with aliskiren in patients with diabetes mellitus; anuria.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to other sulfonamide-derived drugs; concomitant use with aliskiren in patients with moderate to severe renal impairment (GFR <60 mL/minute/1.73 m2); pregnancy; breastfeeding.

Warnings/Precautions

Concerns related to adverse effects:

• Angioedema: Angioedema has been reported rarely with some angiotensin II receptor antagonists (ARBs) and may occur at any time during treatment (especially following first dose). It may involve the head and neck (potentially compromising airway) or the intestine (presenting with abdominal pain). Patients with idiopathic or hereditary angioedema or previous angioedema associated with ACE-inhibitor therapy may be at an increased risk. Prolonged frequent monitoring may be required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. Intramuscular (IM) administration of epinephrine may be necessary. Do not readminister to patients who have had angioedema with ARBs.

• Electrolyte disturbances: Hyperkalemia may occur with angiotensin II receptor antagonists; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts. Use cautiously, if at all, with these agents and monitor potassium closely. Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia.

• Gastrointestinal effects: Symptoms of sprue-like enteropathy (ie, severe, chronic diarrhea with significant weight loss) has been reported with olmesartan; may develop years after treatment initiation with villous atrophy commonly found on intestinal biopsy. Once other etiologies have been excluded, discontinue treatment and consider other antihypertensive treatment. Clinical and histologic improvement was noted after treatment was discontinued in a case series of 22 patients (Rubio-Tapia 2012).

• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated by hydrochlorothiazide. This risk may be increased with doses ≥25 mg (Gurwitz 1997).

• Hypersensitivity reactions: Hypersensitivity reactions may occur with hydrochlorothiazide. Risk is increased in patients with a history of allergy or bronchial asthma.

• Hypotension: Symptomatic hypotension may occur upon initiation in patients who are salt- or volume-depleted (eg, those treated with high-dose diuretics); correct volume depletion prior to administration. This transient hypotensive response is not a contraindication to further treatment with olmesartan/hydrochlorothiazide.

• Ocular effects: Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma, typically occurring within hours to weeks following initiation; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain. Additional treatments may be needed if uncontrolled intraocular pressure persists. Risk factors may include a history of sulfonamide or penicillin allergy.

• Photosensitivity: May occur with hydrochlorothiazide.

• Renal function deterioration: May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in patients with low renal blood flow (eg, renal artery stenosis, heart failure) whose glomerular filtration rate (GFR) is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute renal failure, and progressive azotemia. Small increases in serum creatinine may occur following initiation; consider discontinuation only in patients with progressive and/or significant deterioration in renal function.

• Skin cancer, nonmelanoma: Prolonged use (≥3 years) may increase the risk for squamous cell carcinoma up to 4 times and increase the risk for basal cell carcinoma up to 1.25 times compared to patients not treated with hydrochlorothiazide (Pedersen 2018; Pottegård 2017).

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Aortic/mitral stenosis: Use olmesartan with caution in patients with significant aortic/mitral stenosis.

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).

• Diabetes: Use hydrochlorothiazide with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.

• Hepatic impairment: Use caution in patients with severe hepatic impairment. In progressive or severe hepatic disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.

• Hypercalcemia: Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia.

• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; increased cholesterol and triglyceride levels have been reported with thiazides.

• Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use; should be discontinued prior to testing for parathyroid function.

• Renal artery stenosis: Use olmesartan with caution in patients with unstented unilateral/bilateral renal artery stenosis. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in renal function unless possible benefits outweigh risks.

• Renal impairment: Use with caution in patients with renal impairment. Cumulative effects of hydrochlorothiazide may develop, including azotemia, in patients with impaired renal function. Avoid hydrochlorothiazide in severe renal disease (ineffective). Contraindicated in patients with anuria.

• Systemic lupus erythematosus (SLE): Hydrochlorothiazide can cause SLE exacerbation or activation.

Special populations:

• Pregnancy: [US Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected.

• Surgical patients: In patients on chronic angiotensin receptor blocker (ARB) therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent (Hillis 2011).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Benicar HCT 20/12.5: Olmesartan 20 mg and hydrochlorothiazide 12.5 mg

Benicar HCT 40/12.5: Olmesartan medoxomil 40 mg and hydrochlorothiazide 12.5 mg

Benicar HCT 40/25: Olmesartan medoxomil 40 mg and hydrochlorothiazide 25 mg

Generic: 20/12.5: Olmesartan 20 mg and hydrochlorothiazide 12.5 mg; 40/12.5: Olmesartan 40 mg and hydrochlorothiazide 12.5 mg; 40/25: Olmesartan 40 mg and hydrochlorothiazide 25 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Benicar HCT Oral)

20-12.5 mg (per each): $12.83

40-12.5 mg (per each): $17.84

40-25 mg (per each): $17.84

Tablets (Olmesartan Medoxomil-HCTZ Oral)

20-12.5 mg (per each): $6.28 - $6.91

40-12.5 mg (per each): $8.73 - $9.61

40-25 mg (per each): $8.73 - $9.61

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Oral: Administer with or without food.

Use: Labeled Indications

Hypertension: Management of hypertension.

Medication Safety Issues
Older Adult: High-Risk Medication:

Beers Criteria: Diuretics (hydrochlorothiazide) are identified in the Beers Criteria as a potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Clinically Relevant Anticholinergic Effects: May increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Ajmaline: Sulfonamides may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor

Alcohol (Ethyl): May increase orthostatic hypotensive effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Aliskiren: May increase nephrotoxic effects of Angiotensin II Receptor Blockers. Aliskiren may increase hyperkalemic effects of Angiotensin II Receptor Blockers. Aliskiren may increase hypotensive effects of Angiotensin II Receptor Blockers. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. Risk D: Consider Therapy Modification

Allopurinol: Thiazide and Thiazide-Like Diuretics may increase hypersensitivity effects of Allopurinol. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin II: Angiotensin II Receptor Blockers may decrease therapeutic effects of Angiotensin II. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Angiotensin II Receptor Blockers may increase adverse/toxic effects of Angiotensin-Converting Enzyme Inhibitors. Angiotensin II Receptor Blockers may increase serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives when possible. Monitor blood pressure, renal function, and potassium if combined. Risk D: Consider Therapy Modification

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Thiazide and Thiazide-Like Diuretics. Management: Separate administration of bile acid sequestrants and oral thiazide diuretics by at least 4 hours. Monitor for decreased therapeutic effects of thiazide diuretics if coadministered with a bile acid sequestrant. Risk D: Consider Therapy Modification

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Calcium Salts: Thiazide and Thiazide-Like Diuretics may increase serum concentration of Calcium Salts. Risk C: Monitor

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor

Colesevelam: May decrease serum concentration of Olmesartan. Management: Administer olmesartan 4 hours prior to colesevelam. Risk D: Consider Therapy Modification

Corticosteroids (Systemic): May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor

Dapoxetine: May increase orthostatic hypotensive effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Desmopressin: Hyponatremia-Associated Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Dexketoprofen: May increase adverse/toxic effects of Sulfonamides. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diacerein: May increase therapeutic effects of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor

Diazoxide Choline: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the hyperglycemic and hyperuricemic effects may be increased. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Diazoxide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Diazoxide. Risk C: Monitor

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Dipeptidyl Peptidase-IV Inhibitors: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Specifically, the risk for angioedema may be increased with this combination. Risk C: Monitor

Dofetilide: HydroCHLOROthiazide may increase QTc-prolonging effects of Dofetilide. HydroCHLOROthiazide may increase serum concentration of Dofetilide. Risk X: Avoid

Drospirenone-Containing Products: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor

Finerenone: Angiotensin II Receptor Blockers may increase hyperkalemic effects of Finerenone. Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Heparin: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Heparins (Low Molecular Weight): May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Ipragliflozin: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor

Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid

Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid

Ivabradine: Thiazide and Thiazide-Like Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levosulpiride: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid

Licorice: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Lithium: Angiotensin II Receptor Blockers may increase serum concentration of Lithium. Management: Initiate lithium at lower doses in patients receiving an angiotensin II receptor blocker (ARB). Consider lithium dose reductions in patients stable on lithium therapy who are initiating an ARB. Monitor lithium concentrations closely when combined. Risk D: Consider Therapy Modification

Lithium: Thiazide and Thiazide-Like Diuretics may decrease excretion of Lithium. Management: Reduce the lithium dose if coadministered with thiazide or thiazide-like diuretics. Monitor serum lithium levels during coadministration with thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Loop Diuretics: May increase hypotensive effects of Angiotensin II Receptor Blockers. Loop Diuretics may increase nephrotoxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mecamylamine: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider Therapy Modification

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methenamine: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Methenamine. Risk C: Monitor

Methotrexate: HydroCHLOROthiazide may increase nephrotoxic effects of Methotrexate. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Multivitamins/Fluoride (with ADE): May increase hypercalcemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Angiotensin II Receptor Blockers may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Opioid Agonists: May increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Palopegteriparatide: Thiazide and Thiazide-Like Diuretics may increase therapeutic effects of Palopegteriparatide. Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Palopegteriparatide. Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Angiotensin II Receptor Blockers may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Potassium Salts: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Potassium-Sparing Diuretics: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Promazine: Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Ranolazine: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Reboxetine: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Sacubitril: Angiotensin II Receptor Blockers may increase adverse/toxic effects of Sacubitril. Risk X: Avoid

Selective Serotonin Reuptake Inhibitor: May increase hyponatremic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sodium Phosphates: Angiotensin II Receptor Blockers may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sodium Phosphates: Diuretics may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sotagliflozin: HydroCHLOROthiazide may decrease therapeutic effects of Sotagliflozin. Sotagliflozin may decrease serum concentration of HydroCHLOROthiazide. Risk C: Monitor

Sparsentan: May increase adverse/toxic effects of Angiotensin II Receptor Blockers. Risk X: Avoid

Tacrolimus (Systemic): Angiotensin II Receptor Blockers may increase hyperkalemic effects of Tacrolimus (Systemic). Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Tolvaptan: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Topiramate: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Topiramate. Thiazide and Thiazide-Like Diuretics may increase serum concentration of Topiramate. Risk C: Monitor

Toremifene: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Toremifene. Risk C: Monitor

Trimethoprim: May increase hyperkalemic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Vitamin D Analogs. Risk C: Monitor

Pregnancy Considerations

[US Boxed Warning]: Drugs that act on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible once pregnancy is detected. See individual monographs for additional information.

Breastfeeding Considerations

It is not known if olmesartan is excreted in breast milk; thiazide diuretics are excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother. See individual agents.

Monitoring Parameters

Blood pressure, serum electrolytes, BUN, creatinine

Mechanism of Action

Olmesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II. Hydrochlorothiazide inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions.

Pharmacokinetics (Adult Data Unless Noted)

See individual agents.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Co-olmepress | Olmetec plus;
  • (AR) Argentina: Iltux hct | Olmetec d;
  • (AT) Austria: Olmeblo HCT | Olmesarcomp | Olmesartan/hct 1a pharma | Olmesartan/hct actavis | Olmesartan/hct krka | Olmesartan/hct ratiopharm | Olmesartan/hct stada;
  • (AU) Australia: APO OLMESARTAN HCTZ | Apotex olmesartan hctz | Olmertan combi | Olmesartan hct an | Olmesartan hct myl | Olmesartan/hct sandoz | Olmetec plus | Pharmacor olmesartan hctz;
  • (BD) Bangladesh: Abetis Plus | Olmecar plus | Olmefast h | Olmesafe ht | Olmesan Plus | Olmesta plus | Olmetic | Olmevas hz | Olmezest H | Olpres HZ | Olsart hz | Presnor plus | Ransys plus | Sevitan htz | Tenizide | Xyotil plus;
  • (BE) Belgium: Belsar Plus | Co olmesartan ab | Co olmesartan sandoz | Olmesartan plus hct eg | Olmesartan/hctz krka | Olmetec plus;
  • (BF) Burkina Faso: Coolmetec;
  • (BG) Bulgaria: Co Olimestra | Coolsart | Neosara co | Olmesartan hctz | Olmesartan/hctz mylan | Olmesta plus | Olmezide plus | Tansidor h;
  • (BR) Brazil: Asea hct | Benicar hct | Hipoxomil hct | Holmes H | Neomesart hct | Olmedix hct | Olmegran hct | Olmesartana + hidroclorotiazida | Olmesartana medoxomila + hidroclorotiazida | Olmetec HCT | Olmy hct | Olsar h;
  • (CH) Switzerland: Co olmesartan spirig hc | Olmesartan hct mepha | Olmesartan hct mylan | Olmesartan plus sandoz | Olmetec plus | Votum plus;
  • (CI) Côte d'Ivoire: Coolmetec;
  • (CL) Chile: Cardioplus D | Carvas d | Holmes H | Iltux hct | Olmepress D | Olmesartan medoxomilo/hidroclorotiazida | Olmetec plus | Oltan d;
  • (CN) China: Olmesartan medoxomil and hydrochlorothiazide | Olmetec plus;
  • (CO) Colombia: Holmes H | Iltux hct | Olbertan | Olbertan h | Olmedoxtan H | Olmepress D | Olmesartan + hidroclorotiazida | Olmetan H | Olmetec HCT | Oltaz;
  • (CR) Costa Rica: Olmepress plus;
  • (CZ) Czech Republic: Olmetec plus h | Sarten plus h;
  • (DE) Germany: Belsar Plus | Mencord plus | Olmecor hct | Olmesartan abz comp. | Olmesartan comp 1a pharma | Olmesartan comp ratiopharm | Olmesartan hexal comp | Olmesartan/hydrochlorothiazide al | Olmesartan/hydrochlorothiazide aurobindo | Olmesartan/hydrochlorothiazide Heumann | Olmetec plus | Votum plus;
  • (DO) Dominican Republic: Benicar hct | Iltux hct | Olmedipin d | Olmedos H | Olmesar h | Olmesartan Hidroclorotiazida Calox | Olmetec plus | Oltana h;
  • (EC) Ecuador: Cardioplus D | Eukene | Eukene h | Holmes H | Iltux hct | Olmecard H | Olmedos H | Olmesartan medoxomila + hidroclorotiazida | Olmetec HCT | Olsart hct;
  • (EE) Estonia: Co Olimestra | Mesar plus;
  • (EG) Egypt: Angiosartan plus | Erastapex plus | Lezberg plus | Medosartan | Olmespironova;
  • (ES) Spain: Atolme plus | Ixia plus | Olmesartan/hidroclorotiazida alter | Olmesartan/hidroclorotiazida aurovitas | Olmesartan/hidroclorotiazida combix | Olmesartan/hidroclorotiazida krka | Olmesartan/hidroclorotiazida mabo | Olmesartan/hidroclorotiazida mylan | Olmesartan/hidroclorotiazida normon | Olmesartan/hidroclorotiazida pensa | Olmesartan/hidroclorotiazida qualigen | Olmesartan/Hidroclorotiazida vir | Olmesartan/Hidroclorotiazida viso | Olmetec plus | Openvas plus;
  • (FI) Finland: Benetor Comp | Olmesartan Medoxomil/Hydrochlorothiazide Accord | Olmesartan medoxomil/hydrochlorothiazide krka | Olmestad comp;
  • (GB) United Kingdom: Olmesartan/hydrochlorothiazide | Olmetec plus;
  • (GR) Greece: Co ipertas | Olartan Plus | Olmesartan+hctz/mylan | Olmesartan+hctz/sandoz | Olmetec plus;
  • (HU) Hungary: Laresin plus | Olmetec plus;
  • (ID) Indonesia: Olmetec plus;
  • (IE) Ireland: Benetor Plus | Olmesartan hydrochlorothiazide rowex | Olmesartan/hctz krka | Olmesartan/hydrochlorothiazide clonmel | Omesar plus;
  • (IN) India: Benitec h | Hybreed H | O relate h | Olarbi-h | Olcure 20 h | Olkem h | Olmark H | Olmat h | Olmax h | Olmean h | Olmeblu h | Olmecip-H | Olmeflex h | Olmeglare H | Olmegraf H | Olmesar h | Olmetime h | Olmetor H | Olmetrack H | Olmetrol h | Olmezest H | Olmighty-H | Olmin H | Olmy H | Olraas H | Olsavas H | Olsertain H | Oltab h | Olvance-h | Olvas H | Olways h | Olzox h | Omesvio h | Ortan H | Pinom H | Rasotan H | Winbp H | Xirtam H | Zoltab H;
  • (IT) Italy: Idalazide | Olmegan | Olmesartan e idroclorotiazide Aurobindo | Olmesartan E Idroclorotiazide EG | Olmesartan e idroclorotiazide pensa | Olmesartan e idroclorotiazide sandoz | Olmesartan Idroclorotiazide Doc Generici | Olmesartan medoxomil e idroclorotiazide Alter | Olmesartan medoxomil e idroclorotiazide mylan | Olmesartan medoxomil e idroclorotiazide teva | Olprezide | Plaunazide | Presdiur;
  • (JO) Jordan: Oletran plus | Olvans plus | Votum plus;
  • (KE) Kenya: Olmat h | Olme h | Olmesar h | Olvance hct | Orion Diu;
  • (KR) Korea, Republic of: Arb sd | Bellmetec plus | Biol plus | Cellmetec plus | Eseuolplus | Etex olmesartan plus | Gemetec plus | J metec plus | Jmetec plus | Lowtan plus | Lowteck plus | Mesar plus | Newmesartan plus | Ohmesortan plus | Olcotan plus | Olesartan plus | Oleten plus | Olgotan plus | Olle plus | Olme plus | Olmeact plus | Olmec plus | Olmecan plus | Olmedil plus | Olmehid plus | Olmepam plus | Olmeren plus | Olmerin plus | Olmertan plus | Olmesartan plus etex | Olmesin plus | Olmetec plus | Olmeten plus | Olmexetil m plus | Olmezaltan plus | Olmezide | Olmos plus | Olotan plus | Olpre plus | Olsan plus | Olsartan plus | Olsartec plus | Olsarten plus | Olstec plus | Oltamax plus | Oltan plus | Olten plus | Olwinner plus | Omertec plus | Ometan plus | Omexortan plus | Ormetan plus | Ortec plus | Prisartan plus;
  • (KW) Kuwait: Co-olmepress | Olmetec plus;
  • (LB) Lebanon: Olmetec plus | Votum plus;
  • (LT) Lithuania: Co Olimestra | Mesar plus | Olmesartan medoxomil/hydrochlorothiazide actavis | Omten h | Osaver hct | Polmepur;
  • (LU) Luxembourg: Belsar Plus | Olmesartan comp ratiopharm | Olmesartan plus hct eg | Olmetec plus;
  • (LV) Latvia: Co Olimestra | Mesar plus | Osaver hct;
  • (MA) Morocco: Co Olmetec;
  • (MX) Mexico: Almetec co | Iltux hct | Iltux2hct | Mitzoratta hid | Norsat duo | Olmesartan/hidroclorotiazida | Openvas co;
  • (MY) Malaysia: Olmetec plus;
  • (NG) Nigeria: Bexatan plus;
  • (NL) Netherlands: Olmesartan medoxomil/hct cf | Olmesartan medoxomil/hct teva | Olmesartan medoxomil/hydrochloorthiazide krka | Olmesartanmedoxomil/hydrochloorthiazide aurobindo | Olmesartanmedoxomil/hydrochloorthiazide sandoz | Olmetec hctz;
  • (NO) Norway: Benetor Comp | Olmetec Comp;
  • (PA) Panama: Iltux hct;
  • (PE) Peru: Cardioplus D | Eukene h | Holmes H | Iltux hct | Morass plus | Olmecard H | Olmetec plus;
  • (PH) Philippines: Alzor hct | Olmestal h | Olmexl h | Olmezar Plus;
  • (PK) Pakistan: Benicar h | Co Olesta | Olmetab h | Olmis h | Olmisan h | Olra h | Olsarb d | Olzide h | Omsana diu | Orion Diu | Pacivan t;
  • (PL) Poland: Revival plus;
  • (PR) Puerto Rico: Olmesartan medoxomil and hydrochlorothiazide;
  • (PT) Portugal: Olmesartan + Hidroclorotiazida Sandoz | Olmesartan medoxomilo + Hidroclorotiazida | Olmesartan medoxomilo + Hidroclorotiazida Alter | Olmesartan medoxomilo + Hidroclorotiazida Atolme | Olmesartan medoxomilo + Hidroclorotiazida Aurobindo | Olmesartan medoxomilo + Hidroclorotiazida Ciclum | Olmesartan medoxomilo + Hidroclorotiazida Farmoz | Olmesartan medoxomilo + hidroclorotiazida generis | Olmesartan medoxomilo + Hidroclorotiazida Krka | Olmesartan medoxomilo + Hidroclorotiazida Mylan | Olmesartan medoxomilo + Hidroclorotiazida Pentafarma | Olmesartan medoxomilo + Hidroclorotiazida Pharmakern | Olmesartan medoxomilo + Hidroclorotiazida ratiopharm | Olmesartan medoxomilo + Hidroclorotiazida Teva | Olmesartan medoxomilo + Hidroclorotiazida toLife | Olmesartan medoxomilo + hidroclorotiazida zentiva | Olmesartan medoxomilo + Hidroclorotizida Azevedos | Olmetec plus | Olsar Plus;
  • (PY) Paraguay: Caditar d | Iltux hct;
  • (QA) Qatar: Co-Olmepress | Olmetec Plus | Olmysar Plus;
  • (RU) Russian Federation: Cardosal plus;
  • (SA) Saudi Arabia: Co-olmepress | Normatec plus | Olcontro hct | Olmazide | Olsar Plus;
  • (SG) Singapore: Olmetec plus;
  • (SI) Slovenia: Co tensiol;
  • (SK) Slovakia: Tenzar plus;
  • (TH) Thailand: Olmetec plus;
  • (TN) Tunisia: Coolmetec | Olmecard plus;
  • (TR) Turkey: Hipersar Plus | Improve plus | Olgen Plus | Olmeday plus | Olmetec plus | Olmysar plus | Ometan plus | Oxap Plus;
  • (TW) Taiwan: Olmetec plus;
  • (UA) Ukraine: Cardosal plus | Olmetec plus;
  • (UG) Uganda: Olmat h | Olmesar h | Olmetan H;
  • (VE) Venezuela, Bolivarian Republic of: Aresan hct | Biocor hct | Dropten hct | Iltux hct | Olmesartan hidroclorotiazida | Olmesartan medoxomil hidroclorotiazida;
  • (ZM) Zambia: Olvance hct
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