From the Guidelines
The recommended starting dose of olmesartan for adults with hypertension is 20 mg once daily. For patients who may need additional blood pressure reduction, the dose can be increased to 40 mg once daily after about 2 weeks of therapy. Olmesartan can be taken with or without food at the same time each day to maintain consistent blood pressure control. For elderly patients (65 years and older), those with hepatic impairment, or patients with reduced kidney function, no initial dosage adjustment is typically necessary, but closer monitoring may be warranted. Patients with volume or salt depletion (such as those on high-dose diuretics) should start with a lower dose of 10 mg once daily due to the risk of hypotension. Olmesartan works by blocking angiotensin II receptors, preventing the hormone's blood vessel constricting effects and thereby lowering blood pressure. Full antihypertensive effects are usually achieved within 2 weeks of starting treatment. According to 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, the usual dose range for olmesartan is 20-40 mg once daily. Some key points to consider when prescribing olmesartan include:
- Monitoring for potential side effects such as dizziness, headache, and diarrhea
- Avoiding use in pregnancy due to potential fetal harm
- Being cautious when using olmesartan in combination with other antihypertensive agents, as this may increase the risk of hypotension. The most recent guidelines from 2022 do not provide a different recommendation for the starting dose of olmesartan 1. It's also worth noting that the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure recommend a target dose of 40 mg once daily for olmesartan 1. However, the starting dose remains the same. In terms of quality of life, olmesartan has been shown to be effective in reducing blood pressure and improving cardiovascular outcomes, which can lead to improved overall health and well-being. Morbidity and mortality benefits of olmesartan are also well-established, with studies demonstrating reduced risk of cardiovascular events and stroke. Overall, the recommended starting dose of 20 mg once daily is a safe and effective starting point for most patients, with the option to titrate up to 40 mg once daily as needed.
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. The recommended starting dose for olmesartan is 20 mg once daily for adult patients who are not volume-contracted, as monotherapy.
- For patients with possible depletion of intravascular volume, a lower starting dose should be considered. 2
From the Research
Recommended Starting Dose for Olmesartan
The recommended starting dose for olmesartan can be found in several studies:
- The study 3 states that the recommended once-daily starting dose of olmesartan medoxomil is 20 mg.
- The study 4 also mentions that the recommended starting dose is 20 mg, and patients received olmesartan 20 mg for 8 weeks.
- The study 5 mentions that the 20 mg/day dosage is the recommended starting dose, and it is significantly more effective in lowering mean BP than the 5 mg/day dosage.
- The study 6 confirms that a daily oral dose of 20 mg olmesartan is considered to be the optimal dose.
Key Points
- The recommended starting dose of olmesartan medoxomil is 20 mg once daily.
- This dose has been shown to be effective in reducing blood pressure in patients with mild-to-moderate hypertension.
- The dose can be titrated up to 40 mg/day if necessary, with significant additional mean BP reductions from baseline.
- Olmesartan medoxomil has been shown to be safe and well tolerated with an adverse event profile similar to the placebo 4, 6.