What are the doses of Olmesartan (Angiotensin II receptor antagonist)?

From the Guidelines

Olmesartan is typically started at 20 mg once daily for adults with hypertension, with the dose adjustable up to 40 mg once daily based on blood pressure response. For patients who require additional blood pressure reduction, the maximum recommended dose is 40 mg daily. This dosing recommendation is supported by the most recent guidelines, including the 2018 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Considerations

• Elderly patients generally don't need dose adjustments, but those with moderate to severe renal impairment (creatinine clearance <40 mL/min) should start at a lower dose of 10 mg daily.
• Olmesartan can be taken with or without food and at any time of day, though taking it at the same time daily helps maintain consistent blood pressure control.
• The full antihypertensive effect usually develops within 2 weeks of starting treatment.
• Olmesartan works by blocking angiotensin II receptors, preventing the hormone from binding and causing blood vessel constriction, which helps lower blood pressure.
• Side effects may include dizziness, headache, and rarely, severe intestinal problems, so patients should report persistent diarrhea or significant weight loss to their healthcare provider.

Dosing in Different Contexts

• The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure also support the use of Olmesartan up to 40 mg once daily 1.
• The 2022 AHA/ACC/HFSA guideline for the management of heart failure does not specifically address Olmesartan dosing for hypertension but emphasizes the importance of evidence-based medication use in heart failure management 1.
• It's crucial to follow the most recent and highest quality guidelines for dosing Olmesartan, considering the patient's specific condition, such as hypertension or heart failure, and adjusting the dose based on clinical response and tolerance.

From the FDA Drug Label

1. 1 Adult Hypertension Dosage must be individualized. 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.
2. 2 Pediatric Hypertension (6 Years of Age and Older) Dosage must be individualized. For children who can swallow tablets, the usual recommended starting dose of olmesartan medoxomil tablets is 10 mg once daily for patients who weigh 20 to <35 kg (44 to 77 lb), or 20 mg once daily for patients who weigh ≥35 kg For patients requiring further reduction in blood pressure after 2 weeks of therapy, the dose of olmesartan medoxomil tablets may be increased to a maximum of 20 mg once daily for patients who weigh <35 kg or 40 mg once daily for patients who weigh ≥35 kg.

The doses of Olmesartan are:

• Adults:
  • Starting dose: 20 mg once daily
  • Maximum dose: 40 mg once daily
• Pediatric (6 years and older):
  • Starting dose:
    • 10 mg once daily for patients who weigh 20 to <35 kg
    • 20 mg once daily for patients who weigh ≥35 kg
  • Maximum dose:
    • 20 mg once daily for patients who weigh <35 kg
    • 40 mg once daily for patients who weigh ≥35 kg 2

From the Research

Doses of Olmesartan

• The recommended dose of olmesartan medoxomil for the treatment of adult patients with hypertension is 10-40 mg once daily 3.
• A dose of 20 mg/day is considered optimal, with a responder rate of 70% 4.
• The dose-response curve for olmesartan medoxomil shows that optimal BP-lowering efficacy is observed at higher dosages, with significant improvements in BP control and BP goal attainment achieved with uptitration from 20 to 40 mg/day 5.
• Combination therapy with olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mg is also approved for the treatment of hypertension 6.

Key Findings

• Olmesartan medoxomil has been shown to be effective in lowering blood pressure in patients with hypertension, with a dose-dependent response 4, 5.
• The efficacy of olmesartan medoxomil is sustained throughout the 24-hour dosage interval, including during the last 4 hours of this period 3.
• Combination therapy with olmesartan medoxomil and other antihypertensive agents, such as calcium channel blockers or diuretics, may be effective in achieving target blood pressure levels 7.