Can the dosage of olmesartan be increased to 80 mg per day for hypertension management?

From the Guidelines

I do not recommend increasing olmesartan to 80 mg per day without consulting your healthcare provider, as the maximum FDA-approved daily dose for olmesartan (Benicar) is 40 mg once daily, and taking higher doses than recommended could increase the risk of side effects without providing additional blood pressure-lowering benefits. According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1, combining drugs from different drug classes can have additive or synergistic effects and lead to greater BP reduction than increasing the dose of one drug.

If your current olmesartan dose isn't adequately controlling your blood pressure, your doctor might consider adding a second medication from a different class (like a calcium channel blocker or diuretic) rather than exceeding the maximum recommended dose. This approach often works better because blood pressure medications from different classes work through complementary mechanisms, providing more effective control with fewer side effects than simply increasing one medication beyond its recommended maximum.

Some key points to consider:

• The 2024 ESC guidelines recommend upfront low-dose combination therapy in persons with hypertension, with the potential advantages of fewer side effects and swifter BP control being important for long-term adherence 1.
• The major four drug classes (ACE inhibitors, ARBs, dihydropyridine CCBs, and thiazide or thiazide-like diuretics) are recommended as first-line BP-lowering medications, either alone or in combination 1.
• The maximum daily dose of olmesartan is 40 mg once daily, and there is no evidence to support the use of higher doses for hypertension management 1.

Please schedule an appointment with your healthcare provider to discuss your blood pressure management if you feel your current regimen isn't working effectively.

From the FDA Drug Label

The usual recommended starting dose of olmesartan medoxomil tablets 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 medoxomil tablets may be increased to 40 mg Doses above 40 mg do not appear to have greater effect.

The dosage of olmesartan can be increased, but doses above 40 mg do not appear to have a greater effect. Therefore, increasing the dosage to 80 mg per day is not recommended as it is not likely to provide additional benefits for hypertension management 2.

From the Research

Dosage of Olmesartan for Hypertension Management

• The dosage of olmesartan can be increased for hypertension management, with studies showing that higher doses can lead to greater reductions in blood pressure 3, 4.
• An integrated analysis of seven randomized, placebo-controlled, dose-ranging trials found that olmesartan medoxomil doses of 20 mg/day and 40 mg/day were significantly more effective in lowering mean blood pressure than the 5 mg/day dosage 3.
• The study also found that uptitration of olmesartan medoxomil from 20 to 40 mg/day resulted in substantial additional mean blood pressure reductions from baseline 3.
• Another study found that olmesartan medoxomil dose titration to 40 mg/day was effective in reducing blood pressure in patients who did not achieve adequate control with low-dose monotherapy 4.
• However, the maximum approved dose of olmesartan medoxomil is 40 mg/day, and there is limited evidence to support the use of doses above 40 mg/day 3, 4.
• One study did investigate the use of olmesartan medoxomil up to 80 mg/day, but this was in the context of a dose-ranging study and not a specific investigation of the 80 mg/day dose 3.

Safety and Efficacy of High-Dose Olmesartan

• The safety and efficacy of olmesartan medoxomil at high doses have been evaluated in several studies, with results suggesting that the drug is well-tolerated and effective in reducing blood pressure 4, 5.
• A study in elderly patients with essential hypertension or isolated systolic hypertension found that olmesartan medoxomil was effective and well-tolerated at doses of 20-40 mg/day, with or without hydrochlorothiazide 5.
• Another study found that replacing candesartan with olmesartan medoxomil at a dose of 20 mg/day decreased left ventricular mass index in association with a sustained decrease in plasma angiotensin II over a 12-month period 6.