Aliskiren
Contraindicated
Textbook
Increased risk of hypotension, hyperkalemia, and renal impairment.
Avoid concomitant use.
Source: G&G 14e · p603
Drug reference
Olmesartan + Amlodipine
ARB · Antihypertensive
Also known as Olmezest AM, Olmy AM, Olmat AM, Telsartan AM
ARBAntihypertensive
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AliskirenContraindicatedTextbookG&G 14e · p603
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- Angiotensin Converting Enzyme InhibitorsSevereTextbookHarrison 22e · p2396
- BenazeprilSevereTextbookG&G 14e
Mechanism
Olmesartan is an angiotensin II receptor blocker (ARB) that selectively blocks the binding of angiotensin II to the AT1 receptor, thereby inhibiting vasoconstriction and aldosterone secretion. Amlodipine is a dihydropyridine calcium channel blocker (CCB) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, resulting in peripheral vasodilation and reduced peripheral vascular resistance. The combination provides additive blood pressure lowering effects by targeting different pathways involved in blood pressure regulation. Combination rationale: This fixed-dose combination provides enhanced antihypertensive efficacy by combining two agents with complementary mechanisms of action. Olmesartan, an ARB, blocks the renin-angiotensin system, while amlodipine, a CCB, causes peripheral vasodilation. This synergistic action allows for greater blood pressure reduction and may improve patient adherence by simplifying the dosing regimen, particularly for patients who require more than one agent to achieve target blood pressure.
Indications
Treatment of essential hypertension in adult patients whose blood pressure is not adequately controlled on olmesartan or amlodipine monotherapy, or as initial therapy in patients likely to need multiple drugs to achieve blood pressure goals.
Dosing
- Adult
- Initial dose is typically 20 mg olmesartan with 5 mg amlodipine orally once daily. Dosage can be titrated after 1-2 weeks, up to 40 mg olmesartan with 10 mg amlodipine once daily, based on blood pressure response. Administer with or without food.
- Pediatric
- Safety and efficacy have not been established in pediatric patients. Not recommended.
- Renal adjustment
- For patients with moderate to severe renal impairment (creatinine clearance <40 mL/min), initiate with caution and consider lower doses. Amlodipine does not require dose adjustment in renal impairment. Olmesartan dose reduction may be necessary in severe renal impairment. Regular monitoring of renal function is advised.…
Pharmacokinetics
Onset
Olmesartan: Within 2 hours; Amlodipine: Gradual, within 6-12 hours.
Peak effect
Olmesartan: 1-2 hours; Amlodipine: 6-12 hours.
Protein binding
Olmesartan: Approximately 99%; Amlodipine: Approximately 97.5%. Both are highly protein bound.
Contraindications
- Hypersensitivity to olmesartan, amlodipine, dihydropyridine derivatives, or any excipients.
- Second and third trimesters of pregnancy.
- Bilateral renal artery stenosis (for olmesartan).
- Severe hepatic impairment.
- Obstructive biliary disorders.
- Shock (including cardiogenic shock).
- Severe hypotension.
- Left ventricular outflow tract obstruction (e.g., severe aortic stenosis).
- Hemodynamically unstable heart failure after acute myocardial infarction.
Side effects
Common
HeadacheDizzinessPeripheral edemaFatigueNauseaPalpitationsAbdominal painFlushingNasal congestionUpper respiratory tract infection
Serious
- Angioedema
- Hypotension (especially with volume depletion)
- Hyperkalemia (due to olmesartan)
- Acute renal failure (due to olmesartan)
- Hepatic dysfunction/jaundice
- Myocardial infarction or worsening angina (rare, with amlodipine initiation/dose increase)
- Anaphylactic reactions
- Rhabdomyolysis
Drug interactions
Sacubitril Valsartan
Contraindicated
Textbook
Potentially excessive hypotension, increased risk of adverse effects.
Do not use in conjunction with other ARBs.
Source: G&G 14e · p602
Angiotensin Converting Enzyme Inhibitors
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Benazepril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Captopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalapril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Enalaprilat
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Fosinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Imidapril
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Lisinopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Moexipril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Perindopril
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Other ARB drugs
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