Abetis is prescribed for the management of high blood pressure (hypertension). It can be used as a standalone treatment or combined with other antihypertensive medications.
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Olmesartan medoxomil is an angiotensin II receptor blocker (ARB). Angiotensin II, a potent vasoconstrictor, is formed from angiotensin I via the enzyme ACE (angiotensin-converting enzyme). It plays a critical role in regulating blood pressure by constricting blood vessels, promoting aldosterone secretion, increasing sodium reabsorption in the kidneys, and stimulating the heart.
Olmesartan selectively blocks angiotensin II from binding to AT₁ receptors on vascular smooth muscles, thereby preventing vasoconstriction. While AT₂ receptors exist in various tissues, they are not directly involved in blood pressure regulation. Olmesartan has a very high affinity for AT₁ receptors—over 12,500 times greater than for AT₂ receptors.
Unlike ACE inhibitors, olmesartan does not inhibit kininase II, so it does not interfere with bradykinin responses. Though blocking angiotensin II receptors may increase renin activity and circulating angiotensin II levels, these do not negate its antihypertensive action.
Common Side Effect: Dizziness (3% in Abetis vs. 1% in placebo).
Other Reported Reactions: Back pain, bronchitis, increased creatine phosphokinase, diarrhea, headache, hematuria, hyperglycemia, elevated triglycerides, flu-like symptoms, pharyngitis, rhinitis, and sinusitis. The incidence of cough was similar in both treatment (0.9%) and placebo (0.7%) groups.
Initial Dose: 20 mg once daily for patients not volume-depleted.
Titration: If further blood pressure reduction is needed after 2 weeks, the dose may be increased to 40 mg once daily. Doses beyond 40 mg do not enhance efficacy.
Dosing Frequency: Twice-daily dosing offers no added benefit over once-daily administration.
No initial dose adjustment is required for elderly patients or those with moderate-to-severe renal (CrCl <40 mL/min) or hepatic impairment. However, patients with reduced intravascular volume (e.g., those on diuretics) should start treatment under medical supervision, possibly at a lower dose. The medication can be taken with or without food.
Pediatric Use: Safety and effectiveness in children have not been established.
No significant interactions were observed when used with digoxin, warfarin, or antacids.
Olmesartan is not processed by the cytochrome P450 enzyme system, so interactions with drugs affecting this system are unlikely.
Co-use with NSAIDs (including COX-2 inhibitors) in elderly, volume-depleted, or renally impaired patients may worsen renal function or lead to acute renal failure. These effects are typically reversible.
NSAIDs may reduce the antihypertensive efficacy of olmesartan. Renal function should be monitored during such combined therapy.
There are no documented cases of olmesartan overdose. Likely symptoms include hypotension and increased heart rate; bradycardia may occur due to vagal activation. If the overdose is recent, consider gastric lavage or induced vomiting. Significant hypotension should be treated with cardiovascular support, including monitoring vital signs, elevating limbs, and ensuring adequate fluid and urine output.
Discontinue Abetis as soon as pregnancy is detected. Use during the second and third trimesters can cause serious harm or death to the fetus. Though not confirmed in humans, olmesartan is excreted in the milk of lactating rats. Due to potential risks to nursing infants, consider whether to stop breastfeeding or discontinue the drug, based on its necessity for the mother.
Olmesartan may impact kidney function, especially in patients dependent on the renin-angiotensin-aldosterone system (such as those with severe heart failure). It may lead to reduced urine output, azotemia, and rarely, acute kidney failure or death. These outcomes are more likely in susceptible individuals and should be monitored closely.
Store below 30°C in a cool, dry place, protected from light and moisture. Keep out of the reach of children.
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