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Indications
To reduce blood pressure, it's used to treat hypertension alone or in combination with other antihypertensive drugs. This combination medicine is recommended as the first treatment for individuals who are likely to require numerous antihypertensive medications to reach their blood pressure objectives. Considerations such as baseline blood pressure, the objective goal, and the incremental chance of attaining a goal with a combination vs monotherapy should all be considered when deciding whether to employ a combination as initial therapy. Depending on the patient's risk, blood pressure targets may differ.
Pharmacology
Amlodipine is a dihydropyridine calcium channel blocker that prevents calcium ions from crossing the blood-brain barrier and entering vascular smooth muscle and cardiac muscle. Compared to cardiac muscle cells, amlodipine has a stronger effect on vascular smooth muscle cells. Amlodipine is a peripheral artery vasodilator that reduces peripheral vascular resistance and blood pressure by acting directly on vascular smooth muscle.
Angiotensin II is a strong vasoconstrictor, the major vasoactive hormone of the Renin-angiotensin system, and a key component in the pathogenesis of hypertension. It is produced from angiotensin I in a process catalyzed by angiotensin-converting enzyme (ACE).
Dosage & Administration
Dosage must be individualized. The usual recommended starting dose of Olmesartan is 20 mg once daily when used as monotherapy in patients who are not volume-contracted. For patients requiring further reduction in blood pressure after 2 weeks of therapy, the dose of Olmesartan may be increased to 40 mg. Doses above 40 mg do not appear to have a greater effect. Twice-daily dosing offers no advantage over the same total dose given once daily.
No initial dosage adjustment is recommended for elderly patients, for patients with moderate to marked renal impairment (creatinine clearance <40 ml/min) or with moderate to marked hepatic dysfunction. For patients with possible depletion of intravascular volume (e.g. patients treated with diuretics, particularly those with impaired renal function), Olmesartan should be initiated under close medical supervision and consideration should be given to use of a lower starting dose. Olmesartan may be administered with or without food.
Interactions
NSAIDs such as selective COX-2 inhibitors may reduce the antihypertensive impact of angiotensin II receptor antagonists like Olmesartan Medoxomil. In patients receiving combination treatment or other drugs that impact the RAS, blood pressure, renal function, and electrolytes should be carefully monitored.
Contraindications
Cannot be co-administered with Aliskiren in patients with diabetes.
Side Effects
Peripheral edema, headache, flushing, and dizziness are the most frequent adverse effects. It can also induce sprue-like enteropathy, which is a type of intestinal disease.
Pregnancy & Lactation
D is the pregnancy category. The combination of amlodipine and olmesartan medoxomil should not be taken in the second or third trimester since it might cause fetal mortality. This combination should be stopped as soon as possible if pregnancy is found. Olmesartan and Amlodipine are not known to be excreted in human milk. Because of the risk of harm to the nursing child, a choice should be taken on whether to stop breastfeeding or stop taking the medicine, taking into account the drug's value to the mother.
Precautions & warnings
Because of the potential of hypotension in volume- or salt-depleted individuals, the combination of Amlodipine and Olmesartan Medoxomil should be taken with care.
Patients with severe aortic stenosis benefit from vasodilation.
Angina or acute Ml with a higher frequency, length, or severity in individuals with significant obstructive coronary artery disease.
Storage Conditions
Do not store above 30°C. Keep away from light and out of the reach of children.
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