Olmesar A

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What Is Olmesar A?

Olmesar A is an oral fixed-dose combination tablet supplying olmesartan 20 mg (olmesartan medoxomil) and amlodipine 5 mg (amlodipine besilate) in a single pill. Made by Cipla, supplied in 30-180 tablets.

Olmesartan is an angiotensin-II receptor blocker (ARB) introduced by Daiichi-Sankyo in 2002 as Benicar/Olmetec; 13-hour half-life; among the more potent ARBs per milligram. Amlodipine is a long-acting dihydropyridine calcium-channel blocker introduced by Pfizer in 1990 as Norvasc; 30-50 hour half-life giving exceptionally smooth 24-hour BP coverage.

Why Combine an ARB With a Calcium-Channel Blocker?

ARB + dihydropyridine CCB is a guideline-recommended two-drug combination for hypertension. The rationale:

• Complementary mechanisms. Olmesartan blocks the angiotensin-II-driven vasoconstriction and aldosterone arm; amlodipine blocks the calcium-driven vascular-smooth-muscle contraction arm. Together they produce additive blood-pressure reduction of 10-15 mmHg systolic beyond either monotherapy.
• Metabolic neutrality. Unlike thiazide-based combinations, ARB+CCB does not worsen glucose tolerance, lipid profile, or serum urate. This makes the combination particularly suitable for patients with metabolic syndrome, diabetes, or gout.
• Counter-regulation of amlodipine ankle oedema. Amlodipine preferentially dilates pre-capillary arterioles, raising capillary hydrostatic pressure and driving fluid into tissue spaces — clinically visible as ankle oedema in 10-20% of patients. ARBs balance this by dilating the post-capillary venous bed, lowering capillary hydrostatic pressure. Adding an ARB to amlodipine roughly halves the ankle-oedema rate. This is the single strongest clinical argument for ARB+CCB over either agent alone.
• RAAS counter-regulation. Amlodipine-induced vasodilation reflexively activates the renin-angiotensin system; the ARB blocks that compensatory response, unlocking amlodipine’s full BP effect without the sympathetic tachycardia seen on some short-acting CCBs.

Evidence base:

• ACCOMPLISH trial (2008) — benazepril+amlodipine reduced CV events by 20% vs benazepril+HCTZ in high-risk hypertensive patients. Extrapolated widely to ARB+amlodipine combinations.
• ASCOT-BPLA (2005) — amlodipine-based regimen (often with perindopril added) beat atenolol-based regimen on CV and stroke outcomes.
• COACH trial (2010) — fixed-dose olmesartan/amlodipine combinations achieved BP targets in 60-70% of patients vs 35-50% on monotherapy.
• Meta-analyses consistently show ARB+CCB produces lower CV events per mmHg of BP reduction than ARB+thiazide.

Dosage & Titration

Standarddos: one 20/5 mg tablet once daily. Time of day does not matter clinically; take at the same time each day.

When to start Olmesar A:

• BP not controlled on olmesartan eller amlodipine monotherapy at target dose for 4-6 weeks
• Stage 2 hypertension (≥160/100) as an initial two-drug combination per AHA/ACC preference
• Stepping up when amlodipine monotherapy has caused intolerable ankle oedema — adding the ARB often halves oedema while improving BP
• Patients with metabolic syndrome, diabetes, or gout where ARB+CCB is metabolically preferred over ARB+thiazide

Titrering: most manufacturers supply 20/5, 40/5, 20/10, and 40/10 mg strengths. Start at 20/5; increase to 40/5 if BP responds well but target not reached; increase to 40/10 for maximum single-pill effect. Beyond 40/10, add a third class — typically a thiazide (Olmesar A + HCTZ = ARB+CCB+thiazide triple).

Monitoring schedule:

• Baseline: urea, electrolytes, creatinine, eGFR. Home BP baseline.
• 1-2 weeks: repeat U&E. Expect small creatinine rise (up to 30% is acceptable). Potassium rise is usually minimal.
• 4-6 weeks: BP review; check for ankle oedema and gingival hyperplasia.
• Ongoing: annual U&E. Home BP twice weekly.
• Stop and investigate: creatinine rise >30%, potassium >5.5, symptomatic hypotension, severe ankle oedema not responding to dose reduction, chronic unexplained diarrhoea or weight loss (olmesartan-specific sprue-like enteropathy warning).

Biverkningar

Common (>1%):

• Ankle oedema — amlodipine-related; typically milder on Olmesar A than on amlodipine monotherapy (roughly halved by the ARB component)
• Mild dizziness, flushing, headache (usually first 1-2 weeks; settles as vasodilator tolerance develops)
• Palpitations (amlodipine-related; reflex tachycardia is mild with long-acting amlodipine)
• Expected small creatinine rise (up to 30%)
• Mild hyperkalaemia
• Fatigue, nausea, upper respiratory symptoms

Uncommon but clinically important:

• Gingival hyperplasia — amlodipine-related; 1-3% of long-term users. Attention to oral hygiene reduces risk. Switch to a non-DHP or ARB-only regimen if severe.
• Angioedema — lower rate than ACE inhibitors but possible. Stop immediately.
• Severe hyperkalaemia — particularly with potassium supplements, K+-sparing diuretics, NSAIDs, or CKD
• Acute kidney injury in bilateral renal artery stenosis — same mechanism as monotherapy ARBs
• Olmesartan-specific sprue-like enteropathy (FDA 2013 warning) — chronic diarrhoea, weight loss, villous atrophy mimicking coeliac disease. Rare but recognised; resolves after stopping olmesartan.
• Worsening or precipitation of HF in severely reduced EF — amlodipine is neutral in HF-REF (PRAISE trial) but not protective; better HF-REF choices exist.
• First-dose hypotension in volume-depleted patients or those on high-dose diuretics

Kontraindikationer

• Pregnancy — ABSOLUTE contraindication at all trimesters. Olmesartan is teratogenic (fetal renal agenesis, oligohydramnios, pulmonary hypoplasia). Switch to labetalol, methyldopa, or nifedipine pre-conception.
• Severe symptomatic hypotension (systolic BP <90)
• Severe aortic stenosis — amlodipine-induced vasodilation can precipitate syncope in fixed outflow obstruction
• Obstructive hypertrophic cardiomyopathy — similar dynamic obstruction concern
• Cardiogenic shock or acute MI within 1 week
• Bilateral renal artery stenosis
• History of angioedema to ARB or ACE inhibitor (within 4 weeks)
• Hyperkalaemia >5.5 mmol/L at baseline
• Svår leversvikt (Child-Pugh C)
• Concurrent sacubitril/valsartan (Entresto), aliskiren in diabetes or CKD, ACE-hämmare (ONTARGET harm)

Läkemedelsinteraktioner

• Simvastatin — amlodipine raises simvastatin exposure and increases rhabdomyolysis risk. Simvastatin dose must not exceed 20 mg daily when taken with amlodipine. Use an alternative statin (rosuvastatin, atorvastatin up to 40 mg) if higher statin doses are needed.
• Starka CYP3A4-hämmare (clarithromycin, itraconazole, ketoconazole, ritonavir, cobicistat, diltiazem, verapamil) — raise amlodipine levels. Avoid chronic co-administration where possible; monitor BP closely and reduce amlodipine dose if hypotension or oedema worsen.
• Strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John’s wort) — lower amlodipine levels and BP effect.
• Grapefruktjuice — mild amlodipine level elevation; large habitual intake (>1 L/day) may raise BP effect; occasional consumption is fine.
• NSAID — reduce antihypertensive effect of both components; raise AKI risk with the ARB.
• Potassium supplements, K+-sparing diuretics (spironolactone, eplerenone, amiloride) — additive hyperkalaemia; monitor closely.
• Lithium — ARBs reduce lithium clearance; monitor levels if combination unavoidable.
• Tacrolimus, ciclosporin — amlodipine raises their levels; monitor trough levels.
• Other ACE inhibitors, other ARBs, aliskiren — do not combine.
• Sildenafil, tadalafil, alpha-blockers — additive hypotension. Separate dosing; start at lower PDE5-inhibitor dose (sildenafil 25 mg; tadalafil 5 mg).

Olmesar A vs ARB+Thiazide Combinations

Both ARB+CCB and ARB+thiazide are guideline-recommended second-line combinations. Key differences:

Bottom line: for most younger patients with uncomplicated hypertension who need a two-drug combination, ARB+CCB (Olmesar A) has a slight edge in CV outcome evidence and metabolic profile. ARB+HCTZ remains first choice in volume-expanded states (salt-sensitive hypertension, obesity, Black patients — though amlodipine is also strongly effective in Black patients) and in resistant hypertension requiring triple therapy.

Förvaring

Store Olmesar A below 25°C in the original blister pack. Keep out of reach of children.

Vanliga frågor

Why combine olmesartan with amlodipine in one pill?

Two reasons. First, additive blood-pressure reduction: the two drugs act on complementary pathways (angiotensin receptor and L-type calcium channel), producing 10-15 mmHg more systolic BP drop than either agent alone. Second, and less obviously, adding the ARB to amlodipine roughly halves the ankle-oedema rate — the ARB’s venous dilation rebalances amlodipine’s arteriolar dilation, improving capillary hydrostatic pressure. ACCOMPLISH trial evidence shows lower cardiovascular events on ARB+amlodipine than on ARB+HCTZ in high-risk patients.

Will Olmesar A cause ankle swelling?

Possibly — but less often than amlodipine monotherapy. Amlodipine alone causes ankle oedema in 10-20% of patients. Adding olmesartan drops that rate to roughly 5-10%. Oedema is typically mild, non-progressive, and does not respond to diuretics (it is capillary-hydrostatic not volume-overload). If oedema is troublesome, options are: reduce amlodipine to 5 mg (20/5 tablet), switch to a non-DHP CCB (diltiazem), or switch to an ARB+thiazide combination.

When should I take Olmesar A?

Once daily at the same time each day. Time of day does not matter clinically for Olmesar A — both olmesartan (13-hour half-life) and amlodipine (30-50-hour half-life) give 24-hour BP coverage. Morning dosing is most convenient for most patients; evening dosing is occasionally used in patients who do not show normal nocturnal BP dipping.

I’m diabetic — is Olmesar A safe?

Yes — ARB+amlodipine is a preferred combination in diabetes because it is metabolically neutral (does not worsen glucose tolerance, lipids, or urate, unlike thiazides). Olmesartan has dedicated diabetic nephropathy evidence (ROADMAP). Monitor renal function and potassium as usual.

Can I take Olmesar A with a statin?

Mostly yes, with one caveat: simvastatin dose must not exceed 20 mg daily when taken with amlodipine (amlodipine raises simvastatin exposure and increases rhabdomyolysis risk). Rosuvastatin (Rosu-HDL), atorvastatin up to 40 mg, and pravastatin are unaffected by amlodipine and can be used at any dose.

Can I eat grapefruit while taking Olmesar A?

Occasional grapefruit is fine. Large habitual intake (more than about 1 litre of juice daily) can modestly raise amlodipine levels via CYP3A4 inhibition, potentially worsening BP drop or ankle oedema. Other dihydropyridines (felodipine especially) are much more grapefruit-sensitive; amlodipine’s interaction is relatively mild.

Can I take Olmesar A in pregnancy?

No — absolutely contraindicated. Olmesartan is teratogenic (fetal renal agenesis, oligohydramnios, pulmonary hypoplasia, skull defects). Amlodipine alone has been used in pregnancy (there is modest safety data) but the olmesartan component makes Olmesar A unsuitable. Switch to labetalol, methyldopa, or nifedipine (monotherapy) before conception.

Vad händer om jag missar en dos?

Take it as soon as you remember, unless your next dose is within a few hours — in that case skip the missed dose. Do not double up. Amlodipine’s long half-life makes BP control quite forgiving of a single missed dose; several consecutive missed days will allow BP to climb back.

I developed chronic diarrhoea on Olmesar A — what should I do?

Investigate for olmesartan-associated sprue-like enteropathy — a rare but recognised complication (FDA 2013 warning), presenting as chronic diarrhoea, weight loss, and villous atrophy mimicking coeliac disease. Resolves after stopping olmesartan. Switch to a different ARB (telmisartan, valsartan, losartan) or a different class entirely.

Where can I buy Olmesar A online?

You can buy Olmesar A (20/5 mg olmesartan + amlodipine, 30-180 tablets) from MedsBase with discreet packaging and worldwide shipping.

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