Names and pronunciation
(ol-meh-sar′tan) Benicar, Olmetec
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Drug reference
(ol-meh-sar′tan) Benicar, Olmetec
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Func. class.: Antihypertensive
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Chem. class.: Angiotensin II receptor (type AT1) antagonist
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Do not confuse: Benicar/Mevacor
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ACTION: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
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USES: Hypertension, alone or in com- bination with other antihypertensives
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CONTRAINDICATIONS: Hyper- sensitivity
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Black Box Warning: Pregnancy second/ third trimester Precautions: Breastfeeding, children, geriatric patients, hepatic disease, HF, renal artery stenosis, African descent, hyperkalemia Black Box Warning: Pregnancy/breast- feeding: product can cause fetal death when given during pregnancy; assess for pregnancy before starting therapy; do not breastfeed Black Box Warning: To notify prescriber immediately if pregnant; not to use dur- ing breastfeeding
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SIDE EFFECTS CNS: Dizziness, fatigue, headache, insomnia, syncope CV: Chest pain, peripheral edema, tachy- cardia, hypotension EENT: Sinusitis, rhinitis, pharyngitis GI: Diarrhea, abdominal pain META: Hyperkalemia MS: Arthralgia, pain, rhabdomyolysis RESP: Upper respiratory infection, bronchitis SYST: Angioedema
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INTERACTIONS Increase: antihypertensive effects— other antihypertensives, diuretics Increase: hyperkalemia—potassium sup- plements, potassium-sparing diuretics, ACE inhibitors Increase: effect of lithium, antioxidants Decrease: antihypertensive effect— NSAIDs, colesevelam, COX-2 inhibitors Drug/Herb Increase: antihypertensive effect— hawthorn, garlic Decrease: antihypertensive effect— ephedra, black licorice
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DOSAGE AND ROUTES • Adult: PO single agent 20 mg/day initially in patients who are not vol- ume depleted; may be increased to 40 mg/day if needed after 2 wk; in vol- ume depletion: start with lower dose • Child ≥6 yr/adolescent ≤16 yr weigh- ing ≥35 kg: PO 20 mg/day; may increase to max 40 mg/day after 2 wk • Child ≥6 yr/adolescent ≤16 yr weigh- ing 20-<35 kg: PO 10 mg daily; may in- crease to max 20 mg/day after 2 wk
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Available forms: Tabs 5, 20, 40 mg
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Administer: • Without regard to meals • Compounded suspension may be made in the pharmacy; refrigerate up to 1 mo, shake well before use
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Assess: • Volume depletion: correct volume de- pletion before starting therapy • Hypertension: B/P, pulse; note rate, rhythm, quality; electrolytes: sodium, po- tassium, chloride; baselines for renal, hepatic studies before therapy begins; may use antihypertensives to control B/P if needed • Hypotension: place supine; may occur with hyponatremia or in those with vol- ume depletion; more common in those taking a diuretic also • Heart failure: monitor for edema, jug- ular vein distention, dyspnea; monitor weight daily • ACE inhibitors should be avoided in black patients
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Evaluate: • Therapeutic response: decreased B/P
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To comply with dosage schedule, not to double or skip dose, to take missed dose when remembered if not close to next dose • To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain, severe chronic di- arrhea, severe weight loss • That excessive perspiration, dehy- dration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur; to maintain adequate hy- dration • That product may cause dizziness, fainting, light-headedness; to avoid haz- ardous activities • To rise slowly to sitting or standing po- O sition to minimize orthostatic hypotension • To notify provider immediately of swelling of the face, lips, tongue, trouble breathing • That follow-up exams will be needed • To avoid all OTC medications unless approved by prescriber • That blood glucose may increase and antidiabetic product may need dosage change • To inform all health care providers of medication use • To use proper technique for obtaining B/P, and discuss acceptable parameters
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PHARMACOKINETICS Peak 1-2 hr; excreted in urine, (50% unchanged) feces; half-life 13 hr; protein binding 99%
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• Adult: PO single agent 20 mg/day initially in patients who are not vol- ume depleted; may be increased to 40 mg/day if needed after 2 wk; in vol- ume depletion: start with lower dose
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• Child ≥6 yr/adolescent ≤16 yr weigh- ing ≥35 kg: PO 20 mg/day; may increase to max 40 mg/day after 2 wk
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• Child ≥6 yr/adolescent ≤16 yr weigh- ing 20-<35 kg: PO 10 mg daily; may in- crease to max 20 mg/day after 2 wk
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