Olmesartan Medoxomil And Hydrochlorothiazide

Contraindicated in patients with diabetes. Avoid in patients with renal impairment (GFR <60 ml/min) due to increased risk of hypotension, hyperkalemia, and acute renal failure.

Dual blockade with ACE inhibitors is associated with increased risks of hypotension, hyperkalemia, and changes in renal function. Most patients do not obtain additional benefit compared to monotherapy.

Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration. Monitor serum lithium levels during concomitant use.

Dual blockade of the renin-angiotensin system is associated with increased risks of hypotension, hyperkalemia, and acute renal failure. Avoid combined use.

NSAIDs may reduce diuretic, natriuretic, and antihypertensive effects; increased risk of renal toxicity and acute renal failure, particularly in elderly, volume-depleted, or renal-compromised patients.

Reduced diuretic, natriuretic and antihypertensive effects; increased risk of renal toxicity and acute renal failure, especially in elderly or volume-depleted patients.

Coadministration may result in hyperkalemia. Monitor serum potassium in patients receiving concomitant potassium-raising agents.

Reduces absorption of thiazides.

7 DRUG INTERACTIONS Lithium: Risk of lithium toxicity ( 7.2 ) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic and antihypotensive effects; increased risk of renal toxicity ( 7.3 ) Dual inhibition of the renin-angiotensin system: Increased risk of renal impairment, hypotension, and hyperkalemia ( 7.4 ) Colesevelam hydrochloride: Consider administering olmesartan at least 4 hours before colesevelam hydrochloride dose ( 7.5 ) Antidiabetic drugs: Dosage adjustment may be required ( 7.6 ) Cholestyramine and colestipol: Reduced absorption of thiazides ( 7.6 ) 7.1 Agents Increasing Serum Potassium Coadministration of olmesartan medoxomil and hydrochlorothiazide with other drugs that raise serum potassium levels may result in hyperkalemia. 7.5 Colesevelam Hydrochloride Concurrent administration of bile acid sequestering agent colesevelam hydrochloride reduces the systemic exposure and peak plasma concentration of olmesartan. Administration of olmesartan at least 4 hours prior to colesevelam hydrochloride decreased the drug interaction effect.

May reduce absorption of olmesartan. Administer olmesartan at least 4 hours before colesevelam hydrochloride dose.

Reduces absorption of thiazides.

7 DRUG INTERACTIONS • Lithium: Risk of lithium toxicity ( 7.2 ) • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic and antihypotensive effects; increased risk of renal toxicity ( 7.3 ) • Dual inhibition of the renin-angiotensin system: Increased risk of renal impairment, hypotension, and hyperkalemia ( 7.4 ) • Colesevelam hydrochloride: Consider administering olmesartan at least 4 hours before colesevelam hydrochloride dose ( 7.5 ) • Antidiabetic drugs: Dosage adjustment may be required ( 7.6 ) • Cholestyramine and colestipol: Reduced absorption of thiazides ( 7.6 ) 7.1 Agents Increasing Serum Potassium Coadministration of olmesartan medoxomil and hydrochlorothiazide tablets with other drugs that raise serum potassium levels may result in hyperkalemia. 7.2 Lithium Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists or hydrochlorothiazide. Hydrochlorothiazide In some patients the administration of a NSAID can reduce the diuretic, natriuretic, and antihypertensive effects of thiazide diuretics.

7 DRUG INTERACTIONS Lithium: Risk of lithium toxicity ( 7.2 ) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic and antihypotensive effects; increased risk of renal toxicity ( 7.3 ) Dual inhibition of the renin-angiotensin system: Increased risk of renal impairment, hypotension, and hyperkalemia ( 7.4 ) Colesevelam hydrochloride: Consider administering olmesartan at least 4 hours before colesevelam hydrochloride dose ( 7.5 ) Antidiabetic drugs: Dosage adjustment may be required ( 7.6 ) Cholestyramine and colestipol: Reduced absorption of thiazides ( 7.6 ) 7.1 Agents Increasing Serum Potassium Coadministration of olmesartan medoxomil and hydrochlorothiazide with other drugs that raise serum potassium levels may result in hyperkalemia. 7.3 Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) Olmesartan medoxomil In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists (including olmesartan medoxomil) may result in deterioration of renal function, including possible acute renal failure. Monitor renal function periodically in patients receiving olmesartan medoxomil and NSAID therapy.

Coadministration may result in hyperkalemia. Monitor serum potassium levels.