Maximum Dose of Olmesartan
The maximum recommended dose of olmesartan medoxomil for adults with hypertension is 40 mg once daily. 1
FDA-Approved Dosing
- Starting dose: 20 mg once daily for patients who are not volume-contracted 1
- Maximum dose: 40 mg once daily 1
- Doses above 40 mg do not appear to have greater effect, making higher doses unnecessary 1
- Twice-daily dosing offers no advantage over the same total dose given once daily 1
Dose Titration Strategy
- For patients requiring further blood pressure reduction after 2 weeks of therapy, the dose may be increased from 20 mg to 40 mg once daily 1
- If blood pressure remains uncontrolled on the maximum 40 mg dose, add a second antihypertensive agent from a different class (preferably a thiazide diuretic or calcium channel blocker) rather than exceeding 40 mg 2, 3
Special Populations Requiring Lower Doses
- Volume-depleted patients (e.g., those treated with diuretics, particularly with impaired renal function): Consider a lower starting dose and initiate under close medical supervision 1
- Severe renal insufficiency (creatinine clearance <20 mL/min): Maximum daily dose should not exceed 20 mg 4
- Moderate hepatic insufficiency (Child-Pugh score 7-9): Maximum daily dose should not exceed 20 mg 4
Clinical Evidence Supporting Maximum Dose
- Multiple clinical trials have confirmed that olmesartan medoxomil 10-40 mg once daily provides dose-dependent antihypertensive efficacy 4, 5
- The 40 mg dose provides sustained blood pressure control throughout the 24-hour dosing interval 5
- In patients who failed to respond adequately to 20 mg daily, uptitration to 40 mg daily resulted in a sitting DBP response in 62% and normalization in 47% of patients 6
Common Pitfall to Avoid
Do not remain at suboptimal doses when blood pressure is uncontrolled—uptitration to the maximum 40 mg dose should be attempted before adding combination therapy, unless contraindicated 3