Olmesartan/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Benicar HCT

• ARB/HCTZ Combos

Oral antihypertensive combination product containing an angiotensin II receptor antagonist and thiazide diuretic
Used for the management of hypertension in adults
Additive blood pressure reduction

Indicated for the treatment of hypertension in patients who do not respond to monotherapy.

Hypersensitivity to olmesartan, hydrochlorothiazide or sulfonamides

Acute transient myopia and acute angle-closure glaucoma in patients with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

Pregnancy (2nd/3rd trimesters)

Anuria

Coadministration with aliskiren in patients with diabetes mellitus

Adverse reactions with combination products and individual agents

Olmesartan

• Dizziness (3%)
• Headache (1%)
• Fatigue
• Diarrhea (1%)
• Hyperglycemia (1%)
• Hypertriglyceridemia (1%)
• Back pain (1%)
• Bronchitis (1%)
• Flu-like symptoms (1%)
• Pharyngitis (1%)
• Rhinitis (1%)
• Sinusitis (1%)
• URI (1%)
• Chest pain
• Peripheral edema
• Rash
• Hyperuricemia
• Dizziness
• Hyperlipidemia
• Diarrhea
• Hyperuricemia
• Hematuria
• Hyperglycemia
• Upper respiratory infections
• Increased transaminases
• Gastroenteritis
• Dyspepsia
• Arthralgia
• Arthritis
• Myalgia
• Back pain
• Increased CPK

Hydrochlorothiazide

• Anorexia
• Epigastric distress
• Hypotension
• Orthostatic hypotension
• Photosensitivity
• Anaphylaxis
• Anemia
• Confusion
• Erythema multiforme
• Stevens-Johnson syndrome
• Exfoliative dermatitis including toxic epidermal necrolysis
• Dizziness
• Hypokalemia and/or hypomagnesemia
• Hyperuricemia
• Headache
• Non-melanoma skin cancer

Hypersensitivity reactions to hydrochlorothiazide may occur in patients with or without a history of allergy or bronchial asthma, but are more likely in patients with such a history

Hyperkalemia, particularly when coadministered with potassium-sparing diuretics, potassium supplements, or salt substitutes; concurrent therapy with hydrochlorothiazide may reduce the frequency of this effect

Dual blockade of the renin-angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy; closely monitor blood pressure

Hydrochlorothiazide can cause hypokalemia and hyponatremia; hypomagnesemia can result in hypokalemia which appears difficult to treat despite potassium repletion

Drugs that inhibit the renin-angiotensin system can cause hyperkalemia; monitor serum electrolytes periodically

Electrolyte disturbances may occur

Photosensitivity may occur; instruct patients to protect skin from sun and undergo regular skin cancer screening

Hyperuricemia may occur or gout may be precipitated in certain patients receiving thiazide therapy

Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides

Thiazides decrease urinary calcium excretion and may cause elevations of serum calcium; monitor calcium levels.

Thiazide diuretics reported to cause exacerbation or activation of systemic lupus erythematosus

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimesters)

Lactation: discontinue drug or do not nurse