Drug Class: Miscellaneous antihypertensive combinations
Usual Adult Dose for Hypertension
Amlodipine 5 to 10 mg/Hydrochlorothiazide 12.5 to 25 mg/Olmesartan 20 to 40 mg orally once a day
Maximum dose: Amlodipine 10 mg/Hydrochlorothiazide 25 mg/Olmesartan 40 mg per day
Comments: Maximum antihypertensive effects are observed within 2 weeks of initial dose or dose change; dosage may be increased after 2 weeks.
Use: Treatment of hypertension as substitution for the individually titrated components or in patients not adequately controlled on maximally tolerated, labeled, or usual doses of any two of the following antihypertensive classes: angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics.
Usual Geriatric Dose for Hypertension
75 Years or Older:
Initial dose: Amlodipine should start at 2.5 mg in these patients, which is not available with this combination product.
Maintenance dose: Amlodipine 5 to 10 mg/Hydrochlorothiazide 12.5 to 25 mg/Olmesartan 20 to 40 mg orally once a day
Maximum dose: Amlodipine 10 mg/Hydrochlorothiazide 25 mg/Olmesartan 40 mg per day
Comments: Full antihypertensive effect is observed within 2 weeks of initial dose or dose change; dosage may be increased after 2 weeks.
Use: Treatment of hypertension as substitution for the individually titrated components or in patients not adequately controlled on maximally tolerated, labeled, or usual doses of any two of the following antihypertensive classes: angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics.
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl greater than 30 mL/min): No adjustment recommended
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended
If progressive renal impairment becomes evident: Consider withholding or discontinuing either the diuretic or angiotensin receptor blocker (ARB) therapy.
Liver Dose Adjustments
Mild to moderate liver dysfunction: Use with caution
Severe liver dysfunction: Not recommended
Precautions
US BOXED WARNING:
- FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin angiotensin system (RAS) can cause injury and death to the developing fetus.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Monitoring:
- Metabolic: Serum electrolytes periodically
Patient advice:
- Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.
- Encourage patients to report any lightheadedness that may occur during treatment initiation and to stop taking this drug until consulting a physician if syncope occurs.
- Dehydration may lead to excess blood pressure reduction; inform patients to contact their healthcare provider if they experience excessive perspiration, vomiting, or diarrhea.
