Olmesartan

BENICAR

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Pronunciation: awl-mi-SAR-tan

Olmesartan ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Olmesartan ballicule

Olmesartan BENICAR mascot mnemonic cartoon — Visual mnemonic: Olmesartan mascot
**“Be nicer, Omelette Sa(r)tan!”**

What it isAngiotensin II receptor blocker; hypertension.

Why this oneStrong pressure lowering is its appeal, but unlike several ARBs it lacks a separate heart-failure or kidney-disease indication.

What limits itSprue-like enteropathy with chronic diarrhea and weight loss is the distinctive risk, sometimes appearing years in. Hyperkalemia as for the class.

Pearls

Enteropathy reverses on stopping; check med list before celiac workup.

Olmesartan molecular structure (skeletal formula) — Molecular structure: Olmesartan

Olmesartan prescription history

Animated chart of estimated U.S. prescriptions per year, RAAS inhibitors (1981–2026). Olmesartan enters in 2002 (estimated).

FDA-approved for

hypertension (2002)

Principal riskHyperkalemia; sprue-like enteropathy

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, fetal toxicity and increased lithium exposure.

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity — discontinue as soon as pregnancy is detected; drugs acting on the renin-angiotensin system can cause fetal injury and death

FDA dosing	Population	Start	Target	Max
Hypertension	Adults	20 mg QD	20-40 mg QD	40 mg QD
Hypertension	Children ≥6 yr, 20 to <35 kg	10 mg QD	10-20 mg QD	20 mg QD
Hypertension	Children ≥6 yr, ≥35 kg	20 mg QD	20-40 mg QD	40 mg QD

Titration May increase after 2 weeks if further BP reduction needed

Renal Undefined

Hepatic Undefined

Doses above 40 mg have no greater effect; twice-daily offers no advantage over same total daily dose

Instructions

When pregnancy is detected, discontinue as soon as possible
Consider lower starting dose in volume/salt-depleted patients

Available strengths

tab 5, 20, 40 mg

Contraindications

Do not co-administer aliskiren in patients with diabetes

Cautions

Fetal toxicity
Hypotension in volume- or salt-depleted patients
Worsening renal function in renal impairment
Sprue-like enteropathy
Not recommended in children <1 year

Adverse reactions

Dizziness (3%)

Pregnancy Can cause fetal harm; discontinue as soon as pregnancy is detected

Lactation No human data; decide whether to discontinue nursing or the drug

Cost

Olmesartan (BENICAR)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
5 mg	tab	30 qd	$1.72	offered
20 mg	tab	30 qd	$2.41	offered
40 mg	tab	30 qd	$3.33	offered

Generic entry2016

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Memory aids: interaction avatars

Box: minimal PK interactions

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Self-check

Olmesartan: What distinctive GI syndrome can appear years into treatment?
Sprue-like enteropathy.
Olmesartan: Which electrolyte can rise?
Potassium.