Angiotensin II receptor blocker (ARB, sartan)
Updated · Methodology
First line
First-line for hypertension under 2024. Antihypertensive effect is comparable to other ARBs and ACE inhibitors. Standard dose 20 mg once daily; up-titrate to 40 mg if needed. Particularly suitable when hypertension coexists with diabetes, proteinuria, CKD, or metabolic syndrome.
Sources
ICD-10: I10 · ICD-11: BA00
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Olmesartan medoxomil is an ARB with a prolonged antihypertensive effect. It is prescribed for hypertension ( 2023, SEH-LELHA). In anti-aging regimens, olmesartan is promoted to healthy normotensives as a vessel protector and a means to slow vascular aging. In people with normal blood pressure, no clinical studies of prophylactic use exist. Olmesartan has a specific risk of severe sprue-like enteropathy (chronic diarrhea, weight loss, and intestinal villous atrophy; described by Marthey 2014, Drug Safety Communication 2013). Other risks: hyperkalemia, dizziness, teratogenicity. If olmesartan was prescribed to a healthy person, consider seeking a second opinion.
Olmesartan medoxomil is a prodrug converted in the intestine to active olmesartan. Selectively and competitively blocks AT1 angiotensin II receptors in the vascular wall, adrenal cortex, and heart. Reduces vasoconstriction, aldosterone secretion, and sodium reabsorption, lowering BP. Unlike ACE inhibitors, it does not affect bradykinin breakdown – the characteristic dry cough is absent.
Absolute contraindication. In T2 and T3, ARBs cause oligohydramnios, lung and kidney hypoplasia, limb contractures, and fetal demise. In women on a sartan planning pregnancy, switch in advance to labetalol or methyldopa.
No data on milk excretion. Enalapril or captopril with better lactation data are preferred during breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«Dual Blockade of the Renin-Angiotensin System (RAS): Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension…»FDA, section 7 · Open on DailyMed
«Suplementos de potasio y diuréticos ahorradores de potasio: En base a la experiencia con otros medicamentos que afectan al sistema renina-angiotensina, el uso concomitante de diuréticos ahorradores…»AEMPS, section 4.5 · Open on CIMA
«Bloqueo dual del sistema renina-angiotensina-aldosterona (SRAA): No se deben utilizar de forma concomitante los inhibidores de la enzima convertidora de angiotensina y los antagonistas de los…»AEMPS, section 4.4 · Open on CIMA
«Litio : Se ha descrito aumento reversible de la concentración sérica de litio y casos de toxicidad durante la administración concomitante de litio con inhibidores de la enzima conversora de…»AEMPS, section 4.5 · Open on CIMA
«Suplementos de potasio y diuréticos ahorradores de potasio: En base a la experiencia con otros medicamentos que afectan al sistema renina-angiotensina, el uso concomitante de diuréticos ahorradores…»AEMPS, section 4.5 · Open on CIMA
«Medicamentos antiinflamatorios no esteroideos (AINE) : Los AINE (incluyendo el ácido acetilsalicílico a dosis > 3 g/AEMPS, section 4.5 · Open on CIMA
«Medicamentos antiinflamatorios no esteroideos (AINE) : Los AINE (incluyendo el ácido acetilsalicílico a dosis > 3 g/AEMPS, section 4.5 · Open on CIMA
«Lithium: Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists, including olmesartan…»FDA, section 7 · Open on DailyMed
«Agents Increasing Serum Potassium: In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including…»FDA, section 7 · Open on DailyMed
«Agents Increasing Serum Potassium: Concomitant use of olmesartan with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)…»FDA, section 7 · Open on DailyMed
«Agents Increasing Serum Potassium: Concomitant use of olmesartan with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)…»FDA, section 7 · Open on DailyMed
«Agents Increasing Serum Potassium: Concomitant use of olmesartan with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)…»FDA, section 7 · Open on DailyMed
«Agents Increasing Serum Potassium: Concomitant use of olmesartan with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)…»FDA, section 7 · Open on DailyMed
«Después del tratamiento con un antiácido (hidróxido de magnesio y aluminio) se observó una leve reducción de la biodisponibilidad de olmesartán. La administración conjunta de warfarina y de digoxina…»AEMPS, section 4.5 · Open on CIMA
«Después del tratamiento con un antiácido (hidróxido de magnesio y aluminio) se observó una leve reducción de la biodisponibilidad de olmesartán. La administración conjunta de warfarina y de digoxina…»AEMPS, section 4.5 · Open on CIMA
«Los medicamentos investigados en estudios clínicos específicos en voluntarios sanos incluyen warfarina, digoxina, un antiácido (hidróxido de aluminio y magnesio), hidroclorotiazida y pravastatina. No…»AEMPS, section 4.5 · Open on CIMA
«Después del tratamiento con un antiácido (hidróxido de magnesio y aluminio) se observó una leve reducción de la biodisponibilidad de olmesartán. La administración conjunta de warfarina y de digoxina…»AEMPS, section 4.5 · Open on CIMA
«Los medicamentos investigados en estudios clínicos específicos en voluntarios sanos incluyen warfarina, digoxina, un antiácido (hidróxido de aluminio y magnesio), hidroclorotiazida y pravastatina. No…»AEMPS, section 4.5 · Open on CIMA
«Después del tratamiento con un antiácido (hidróxido de magnesio y aluminio) se observó una leve reducción de la biodisponibilidad de olmesartán. La administración conjunta de warfarina y de digoxina…»AEMPS, section 4.5 · Open on CIMA
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Olmesartan medoxomil is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Olmesartan medoxomil (≥ 1 in 100): Dizziness, Headache, Hyperkalemia, Elevated creatinine, Fatigue. See the Safety section for uncommon and serious reactions.
Absolute contraindication. In T2 and T3, ARBs cause oligohydramnios, lung and kidney hypoplasia, limb contractures, and fetal demise. In women on a sartan planning pregnancy, switch in advance to labetalol or methyldopa.
No data on milk excretion. Enalapril or captopril with better lactation data are preferred during breastfeeding.
Olmesartan medoxomil is contraindicated in: Olmesartan hypersensitivity; Pregnancy (all trimesters); Severe hepatic or biliary impairment with cholestasis; Combination with aliskiren in diabetes or CKD with eGFR under 60. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Olmesartan + Hydrochlorothiazide, Perindopril + Indapamide, Ramipril, Sacubitril + Valsartan, Telmisartan, Amlodipine + Olmesartan + Hydrochlorothiazide, Beetroot juice / dietary nitrate (Beta vulgaris), Enalapril + Hydrochlorothiazide