Drugs that act on renin-angiotensin system can cause fetal injury and death when used in 2nd and 3rd trimesters of pregnancy. Olmesartan medoxomil should be discontinued as soon as possible once pregnancy is detected. Symptomatic hypotension may occur in patients who are volume- and/or salt-depleted. May be associated with oliguria, progressive azotaemia, and acute renal failure (rare). Patients with bilateral or unilateral renal artery stenosis may have increased risk of severe hypotension and renal insufficiency. Caution in renal impairment; monitor serum creatinine and potassium levels periodically. Avoid use in severe renal impairment (CrCl< 20 mL/min) and severe hepatic impairment. Caution in patients with aortic or mitral valve stenosis, obstructive hypertrophic cardiomyopathy. Patients with primary aldosteronism may not respond to angiotensin receptor antagonist. Not recommended in lactation.
Adult: Initial: 10-20 mg once daily. Antihypertensive effect is substantially present within 2 wk of therapy initiation. Dose may be increased up to 40 mg once daily if needed. May consider a lower starting dose in patients with possible depletion of intravascular volume (e.g. patients receiving concomitant diuretics, especially those with renal impairment).
Child: 6 to 16 yr: 20-35 kg: 10 mg once daily, may increase to maximum of 20 mg once daily. >35 kg: 20 mg once daily, may increase to maximum of 40 mg once daily.
Elderly: May consider lower starting dose of 5-10 mg daily.