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OLMETEC PLUS is a brand name for Hydrochlorothiazide, supplied as a tablet. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: OLMETEC PLUS® (Olmesartan Medoxomil and Hydrochlorothiazide) is indicated for the treatment of mild to moderate essential hypertension in patients for whom combination therapy is appropriate. OLMETEC PLUS® is not indicated for initial therapy (see DOSAGE AND ADMINISTRATION). 1.1 Pediatrics Pediatrics (<18 years of…
Verbatim from this product's HC label. Tap a section to expand.
1 Dosing Considerations OLMETEC PLUS (olmesartan medoxomil and hydrochlorothiazide) is not for initial therapy. The dosage must be individualized. To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy.
The dose of OLMETEC PLUS should be determined by the titration of the individual components. 2 Recommended Dose and Dosage Adjustment Replacement Therapy Once the patient has been stabilized on the individual components as described below, OLMETEC PLUS may be substituted if the doses on which the patient was stabilized are the same as those in the fixed combination.
5 mg and 40 mg/25 mg. A patient whose blood pressure is inadequately controlled by olmesartan medoxomil or hydrochlorothiazide alone may be switched to once daily OLMETEC PLUS. Dosage should be individualized. Depending on the blood pressure response, the dose may be titrated at intervals of 2-4 weeks.
5 mg to 40 mg/25 mg (see ACTION AND CLINICAL PHARMACOLOGY). The dose of OLMETEC PLUS is one tablet once daily. More than one tablet daily is not recommended.
Elderly:
No adjustment of dose is generally required in elderly patients (see below for dose recommendation in patients with renal impairment). If up-titration to the maximum dose of 40 mg/25 mg daily is required, blood pressure should be closely monitored (see ACTION AND CLINICAL PHARMACOLOGY, Special Populations).
Hepatic Impairment:
No adjustment of dosage is required for patients with mild hepatic impairment. 5 mg olmesartan medoxomil-hydrochlorothiazide daily should not be exceeded. Care should be exercised in patients with liver disease, especially in those patients with biliary obstructive disorders, as the majority of olmesartan is eliminated in the bile.
No information is available in patients with severe liver disease; therefore, use of OLMETEC in this group of patients is not recommended (see ACTION AND CLINICAL PHARMACOLOGY, Pharmacokinetics). 5 mg once daily. The use of olmesartan medoxomil in patients with severe renal impairment is not recommended, since there is only limited experience in this patient group.
1 Adverse Reaction Overview Olmesartan medoxomil-hydrochlorothiazide Olmesartan medoxomil-hydrochlorothiazide has been evaluated for safety in 1243 patients treated for essential hypertension. Treatment with olmesartan medoxomil-hydrochlorothiazide was well tolerated, with an incidence of adverse events similar to placebo.
Events generally were mild, transient and had no relationship to the dose of olmesartan medoxomil- hydrochlorothiazide. In the clinical trials, the overall frequency of adverse events was not dose-related. Analysis of gender, age and race groups demonstrated no differences between olmesartan medoxomil- hydrochlorothiazide and placebo-treated patients.
0% (7/342) of patients treated with placebo. The following potentially serious adverse reactions have been reported with OLMETEC/ OLMETEC PLUS in controlled trials: syncope, hypotension. 2 Clinical Trial Adverse Reactions Because clinical trials are conducted under very specific conditions, the adverse reaction rates observed in the clinical trials may not reflect the rates observed in practice and should not be compared to the rates in the clinical trials of another drug.
Adverse reaction information from clinical trials is useful for identifying drug-related adverse events and for approximating rates. In a placebo-controlled clinical trial, the following adverse events were reported with olmesartan medoxomil-hydrochlorothiazide in >1% of patients (Table 1).
2%) a Adverse events reported in >1% of patients in the Total Olmesartan Medoxomil + HCTZ treatment group. 0%, whether or not attributed to treatment, in the more than 1200 hypertensive patients treated with olmesartan medoxomil-hydrochlorothiazide in controlled or open-label trials are listed below.
Gastrointestinal disorders: abdominal pain, dyspepsia, diarrhea. General disorders and administration site conditions: chest pain, edema peripheral. Infections and infestations: gastroenteritis. Investigations: alanine aminotransferase increased, aspartate aminotransferase increased, creatine phosphokinase increased, gamma-glutamyltransferase increased.
Please see the Serious Warnings and Precautions Box at the beginning of Part I:
Health Professional Information.
Carcinogenesis and Mutagenesis Non-melanoma skin cancer:
An increased risk of non-melanoma skin cancer (NMSC) [basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin] after hydrochlorothiazide therapy was reported in some epidemiological studies. The risk may be higher with increasing cumulative use (see ADVERSE REACTIONS, Post Market Adverse Drug Reactions).
The photosensitizing action of hydrochlorothiazide may be a possible mechanism for NMSC (see NON-CLINICAL TOXICOLOGY, Carcinogenicity – Hydrochlorothiazide). Patients taking hydrochlorothiazide should be informed of the potential risk of NMSC.
They should be advised to regularly check their skin for new lesions as well as changes to existing ones, and to promptly report any suspicious skin lesions. g. a broad spectrum sunscreen with a SPF of 30 or higher, clothing, and a hat) when exposed to sunlight or UV light to minimize the risk of skin cancer.
) (see ADVERSE REACTIONS, Post Market Adverse Drug Reactions). , those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of treatment with OLMETEC PLUS. Treatment should start under close medical supervision.
Similar considerations apply to patients with ischemic heart or cerebrovascular disease, in whom an excessive fall in blood pressure could result in myocardial infarction or cerebrovascular accident. If hypotension does occur, the patient should be placed in the supine position and, if necessary, given an intravenous infusion of normal saline (see DOSAGE AND ADMINISTRATION).
When electrolyte and fluid imbalances have been corrected, therapy usually can be continued without difficulty. A transient hypotensive response is not a contraindication to further treatment. - Valvular Stenosis: there is concern on theoretical grounds that patients with aortic stenosis might be at a particular risk of decreased coronary perfusion, because they do not develop as much afterload reduction.
OLMETEC PLUS® (Olmesartan medoxomil and hydrochlorothiazide) is contraindicated in patients who are hypersensitive to this drug or to any ingredient in the formulation, including any non- medicinal ingredient, or component of the container.
For a complete listing, see Dosage Forms, Strengths, Composition and Packaging. 73m2) is contraindicated (see WARNINGS and PRECAUTIONS, Dual Blockade of the Renin-Angiotensin System (RAS) and Renal, and DRUG INTERACTIONS, Dual Blockade of the Renin-Angiotensin-System (RAS) with ARBs, ACE inhibitors or aliskiren-containing drugs) Pregnant women (see WARNINGS AND PRECAUTIONS, Special Populations, Pregnant Women) Breast-feeding women (see WARNINGS AND PRECAUTIONS, Special Populations, Breast- feeding)
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Hydrochlorothiazide in Canada.
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Brand names are compiled from public regulatory records for active-ingredient mapping only. Drugvu is not affiliated with any manufacturer. This is not medical advice.
In patients with more Page 6 of 39 OLMETEC PLUS® (olmesartan medoxomil and hydrochlorothiazide) severe renal impairment, loop diuretics are preferred to thiazides, so OLMETEC PLUS is not recommended. , patients treated with diuretics, particularly those with impaired renal function), OLMETEC PLUS should be initiated under close medical supervision and consideration should be given to use of a lower starting dose (see WARNINGS AND PRECAUTIONS, Renal).
The side effects (see WARNINGS AND PRECAUTIONS) of olmesartan medoxomil are generally rare and independent of dose; those of hydrochlorothiazide are most typically dose- dependent (primarily hypokalemia). , pancreatitis) do occur with hydrochlorothiazide.
Therapy with any combination of olmesartan medoxomil and hydrochlorothiazide will be associated with both sets of dose-independent side effects. To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy.
Olmesartan Medoxomil Monotherapy The usual recommended starting dose of olmesartan medoxomil monotherapy is 20 mg once daily in patients who are not volume-contracted. For patients requiring further reduction in blood pressure after 2 weeks of therapy, the dose may be increased to 40 mg.
Doses above 40 mg do not appear to have greater effect. Twice-daily dosing offers no advantage over the same total dose given once daily. Elderly: No adjustment of dose is generally required in elderly patients (see below for dose recommendation in patients with renal impairment).
If up-titration to the maximum dose of 40 mg daily is required, blood pressure should be closely monitored (see ACTION AND CLINICAL PHARMACOLOGY, Special Populations). Hepatic Impairment: No adjustment of dosage is required for patients with mild hepatic impairment.
5 mg olmesartan medoxomil- hydrochlorothiazide daily should not be exceeded. Care should be exercised in patients with liver disease, especially in those patients with biliary obstructive disorders, as the majority of olmesartan is eliminated in the bile.
No information is available in patients with severe liver disease; therefore, use of OLMETEC in this group of patients is not recommended (see ACTION AND CLINICAL PHARMACOLOGY, Pharmacokinetics). Renal Impairment: Owing to the limited experience of higher dosages in this patient group, the maximum dose in patients with mild to moderate renal impairment is 20 mg olmesartan medoxomil once daily.
The use of olmesartan medoxomil in patients with severe renal impairment is not recommended, since there is only limited experience in this patient group. , patients treated with diuretics, particularly those with impaired renal function), OLMETEC PLUS® should be initiated under close medical […]
Musculoskeletal and connective tissue disorders: arthritis, arthralgia, back pain, myalgia. Nervous system disorders: vertigo. Renal and urinary disorders: hematuria. Respiratory, thoracic and mediastinal disorders: cough. Skin and subcutaneous tissue disorders: rash.
3 Less Common Clinical Trial Adverse Reactions (<1%) Facial edema was reported in 2/1243 patients receiving olmesartan medoxomil- hydrochlorothiazide. Angioedema has been reported with angiotensin II receptor antagonists. 4 Abnormal Laboratory Findings: Hematologic, Clinical Chemistry and Other Quantitative Data In controlled clinical trials, clinically important changes in standard laboratory parameters were rarely associated with administration of olmesartan medoxomil-hydrochlorothiazide.
Liver Functions Tests: elevations of liver enzymes and/or serum bilirubin were observed infrequently. 4%) […]
73m2). Therefore, the use of OLMETEC PLUS in combination with aliskiren-containing drugs is contraindicated in these patients (see CONTRAINDICATIONS). Further, co- administration of ARBs, including the “olmesartan medoxomil” component of OLMETEC PLUS, with other agents blocking the RAS, such as ACE inhibitors or aliskiren-containing drugs, is generally not recommended in other patients, since such treatment has been associated with an increased incidence of severe hypotension, renal failure and hyperkalemia.
Endocrine and Metabolism Periodic determinations of serum electrolytes to detect possible electrolyte imbalance should be performed at appropriate intervals. All patients receiving thiazide therapy should be observed for clinical signs of fluid or electrolyte imbalance: hyponatremia, hypochloremic alkalosis and hypokalemia.
Serum and urine electrolyte determinations are important when the patient is vomiting excessively or receiving parenteral fluids. Warning signs or symptoms of fluid and electrolyte imbalance, irrespective of cause, include dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, confusion, seizures, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia and gastrointestinal disturbances such as nausea and vomiting.
Hypokalemia may develop, especially with brisk diuresis, when severe cirrhosis is present, or after prolonged therapy. Page 10 of 39 OLMETEC PLUS® (olmesartan medoxomil and hydrochlorothiazide) OLMETEC PLUS contains olmesartan, a drug that inhibits the renin-angiotensin system (RAS).
Drugs that inhibit the RAS can cause hyperkalaemia. Monitor serum electrolytes periodically. Interference with adequate oral electrolyte intake will also contribute to hypokalemia. , increased ventricular irritability). Although any chloride deficit during thiazide therapy is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease), chloride replacement may be required in the treatment of metabolic alkalosis.
Dilutional hyponatremia may occur in edematous patients in hot weather. Appropriate therapy is water restriction rather than administration of salt, except in rare instances, when the hyponatremia is life […]
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