Can Olmesartan (Benicar) cause autoimmune-like conditions?

From the Guidelines

Olmesartan (Benicar) can cause autoimmune-like conditions, specifically olmesartan-associated enteropathy, which mimics celiac disease and typically resolves with drug cessation. This condition is characterized by symptoms such as chronic diarrhea, weight loss, and intestinal villous atrophy, and usually develops after months or years of olmesartan use 1. The exact pathophysiology of olmesartan-associated enteropathy is not fully understood, but it is thought to be related to the medication's effects on intestinal immune function and barrier integrity.

Key features of olmesartan-associated enteropathy include:

• Severe illness that responds rapidly to drug cessation
• Similar symptoms and pathology to celiac disease, but does not respond to a gluten-free diet
• Can be confused with other causes of villous atrophy, such as mycophenolate, methotrexate, and azathioprine-induced enteropathy
• May coexist with other autoimmune diseases and anti-enterocyte and/or anti-goblet cell antibodies

It is essential to note that not all patients taking olmesartan will develop these issues, and other angiotensin receptor blocker drugs in the same class do not appear to cause similar problems with the same frequency 1. If you are taking olmesartan and experiencing unexplained gastrointestinal symptoms, weight loss, or other concerning symptoms, you should consult your healthcare provider promptly, as they may recommend discontinuing olmesartan and switching to another antihypertensive medication.

From the FDA Drug Label

1. 5 Sprue-like Enteropathy Severe, chronic diarrhea with substantial weight loss has been reported in patients taking olmesartan months to years after drug initiation. Intestinal biopsies of patients often demonstrated villous atrophy.
2. 2 Post-Marketing Experience The following adverse reactions have been reported in post-marketing experience. ... Gastrointestinal: Vomiting, sprue-like enteropathy [see WARNINGS AND PRECAUTIONS (5. 5)]

The FDA drug label reports sprue-like enteropathy, a condition that can be considered autoimmune-like, associated with the use of olmesartan. This condition is characterized by severe, chronic diarrhea and substantial weight loss, with intestinal biopsies often demonstrating villous atrophy. Key points to consider:

• Sprue-like enteropathy has been reported in patients taking olmesartan months to years after drug initiation.
• The condition is associated with substantial weight loss and severe, chronic diarrhea.
• Intestinal biopsies of patients often demonstrated villous atrophy. 2 2

From the Research

Olmesartan and Autoimmune-like Conditions

• Olmesartan, also known as Benicar, has been associated with sprue-like enteropathy, a condition that mimics autoimmune enteropathy 3, 4.
• Studies have shown that olmesartan can induce intestinal damage reminiscent of autoimmune enteropathy, with symptoms such as diarrhea, weight loss, and villous atrophy 4, 5.
• The exact pathophysiology of olmesartan-induced enteropathy is not fully understood, but it is thought to interfere with gut immune homeostasis 4.
• Discontinuation of olmesartan has been shown to lead to significant improvement or complete remission of symptoms in most cases 3, 5, 6, 7.
• Immunosuppressive drugs may be necessary to achieve remission in some cases, but discontinuation of olmesartan is often sufficient 4.

Clinical Presentation and Diagnosis

• Patients with olmesartan-induced enteropathy may present with symptoms such as diarrhea, weight loss, and abdominal pain 3, 5, 6.
• The condition can mimic other autoimmune disorders, such as celiac disease or lymphocytic colitis, making diagnosis challenging 5, 7.
• A high index of suspicion is necessary to diagnose olmesartan-induced enteropathy, and discontinuation of the drug should be considered in patients with unexplained gastrointestinal symptoms 6, 7.

Treatment and Management

• Discontinuation of olmesartan is the primary treatment for olmesartan-induced enteropathy 3, 5, 6, 7.
• Immunosuppressive drugs may be necessary to achieve remission in some cases, but their use should be carefully considered and monitored 4.
• Patients should be closely monitored for resolution of symptoms and improvement in laboratory tests after discontinuation of olmesartan 3, 7.