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Olmesartan Medoxomil

Pronunciation

Class: Angiotensin II Receptor Antagonists
VA Class: CV805
Chemical Name: Cyclic 2,3 carbonate 2,3 - dihydroxy - 2 - butenyl - 4 - (1 - hydroxy - 1 - methylethyl) - 1 - propyl - 1 - [p - (o - 1H - tetrazol - 5 - ylphenyl)benzyl]imidazole - 5 - carboxylate
Molecular Formula: C29H30N6O6
CAS Number: 144689-63-4
Brands: Azor (combination), Benicar, Benicar HCT, Tribenzor

Warning(s)

  • May cause fetal and neonatal morbidity and mortality if used during pregnancy.1 31 42 43 44 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

  • If pregnancy is detected, discontinue the drug as soon as possible.1 31 43 44

Introduction

Olmesartan is an angiotensin II type 1 (AT1) receptor antagonist.1 2 3 16 28 31 44 139

Uses for Olmesartan Medoxomil

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents);1 2 3 8 9 28 31 44 139 500 may be used in fixed combination with amlodipine and/or hydrochlorothiazide when such combined therapy is indicated.31 44 139

Angiotensin II receptor antagonists are recommended as one of several preferred agents for the initial management of hypertension; other options include ACE inhibitors, calcium-channel blockers, and thiazide diuretics.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.501 502 503 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).500 501 502 503 504 515

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Angiotensin II receptor antagonists or ACE inhibitors may be preferred in hypertensive patients with diabetes mellitus or chronic kidney disease; angiotensin II receptor antagonists also may be preferred, as an alternative to ACE inhibitors, in hypertensive patients with heart failure or ischemic heart disease and/or post-MI.500 501 502 504 520 523 524 527 534 535 536 543

Black hypertensive patients generally tend to respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to angiotensin II receptor antagonists.500 501 504 However, diminished response to an angiotensin II receptor antagonist is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic.500 504

The optimum BP threshold for initiating antihypertensive drug therapy is controversial.501 504 505 506 507 508 515 523 530 Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.501 503 507 515 526 530

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg;500 JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age.501 Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age,502 504 505 530 application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.501 502 505 506 508 511 515

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg;500 503 current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.501 502 503 504 520 530 535 536 541

Diabetic Nephropathy

A recommended agent in the management of patients with diabetes mellitus and persistent albuminuria who have modestly elevated (30–300 mg/24 hours) or higher (>300 mg/24 hours) levels of urinary albumin excretion; slows rate of progression of renal disease in such patients.520 535 536

Heart Failure

Angiotensin II receptor antagonists are considered a reasonable alternative for inhibition of the renin-angiotensin system in patients with heart failure and reduced left ventricular ejection fraction (LVEF) who are intolerant of ACE inhibitors; because of their established benefits, ACE inhibitors are preferred.524 528

Olmesartan Medoxomil Dosage and Administration

General

BP Monitoring and Treatment Goals

  • Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.500 501

  • When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.501

  • If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug.501 May maximize dosage of the first drug before adding a second drug, or add a second drug before maximizing dosage of the initial drug.501

  • Consider initiating antihypertensive therapy with a combination of drugs if patient's BP exceeds goal BP by >20/10 mm Hg.500 501 503 504

  • Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.500 501 (See Hypertension under Uses.)

Administration

Oral Administration

Administer olmesartan orally once daily without regard to meals.1 2

May administer as extemporaneously prepared oral suspension in pediatric patients unable to swallow tablets.1

Reconstitution

Preparation of extemporaneous suspension containing olmesartan medoxomil 2 mg/mL: Add 50 mL of purified water to an amber polyethylene terephthalate (PET) bottle containing twenty 20-mg tablets of olmesartan medoxomil; allow contents to stand for ≥5 minutes.1 Shake container for ≥1 minute and allow to stand for ≥1 minute; repeat this alternating shaking and standing step 4 additional times.1 Dilute concentrated suspension with 100 mL of syrup (Ora-Sweet) and 50 mL of suspending vehicle (Ora-Plus) and shake well for ≥1 minute to disperse ingredients.1 Shake suspension well before dispensing each dose.1

Dosage

Olmesartan is available as olmesartan medoxomil; dosage expressed in terms of the salt.1 31 44

Pediatric Patients

Hypertension
Oral

Pediatric patients 6–16 years of age who weigh 20 to <35 kg: Initially, 10 mg once daily; may increase to maximum of 20 mg once daily after 2 weeks.1 137

Pediatric patients 6–16 years of age who weigh ≥35 kg: Initially, 20 mg once daily; may increase to maximum of 40 mg once daily after 2 weeks.1 137

Adults

Hypertension
Olmesartan Therapy
Oral

Initially, 20 mg once daily as monotherapy in adults without intravascular volume depletion.1

Usual dosage: 20–40 mg once daily; no additional therapeutic benefit with higher dosages or with twice-daily dosing.1 28 500

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.501

Olmesartan/Amlodipine Fixed-combination Therapy
Oral

Manufacturer states fixed-combination preparation should not be used for initial antihypertensive therapy.44

If BP is not adequately controlled by monotherapy with olmesartan (or another angiotensin II receptor antagonist) or amlodipine (or another dihydropyridine-derivative calcium-channel blocker), can switch to the fixed-combination preparation containing olmesartan medoxomil 20 mg and amlodipine 5 or 10 mg or, alternatively, olmesartan medoxomil 40 mg and amlodipine 5 or 10 mg.44

Can use the fixed combination as a substitute for the individually titrated drugs.44 Can switch to the fixed-combination preparation containing the corresponding individual doses of olmesartan and amlodipine; alternatively, can increase the dosage of one or both components for additional antihypertensive effects.44

Adjust dosage of olmesartan/amlodipine fixed combination, up to a maximum dosage of olmesartan medoxomil 40 mg and amlodipine 10 mg daily, according to patient’s response after ≥2 weeks at the current dosage.44

Olmesartan/Hydrochlorothiazide Fixed-combination Therapy
Oral

Manufacturer states fixed-combination preparation should not be used for initial antihypertensive therapy.31

If BP is not adequately controlled by monotherapy with olmesartan or hydrochlorothiazide, can switch to fixed-combination olmesartan/hydrochlorothiazide tablets.31 In patients already receiving olmesartan, initiate hydrochlorothiazide at dosage of 12.5 mg once daily; in those receiving hydrochlorothiazide, consider reducing hydrochlorothiazide dosage to 12.5 mg and initiate olmesartan medoxomil at dosage of 20 mg once daily.31 Increase dosages to olmesartan medoxomil 40 mg and hydrochlorothiazide 25 mg once daily, if needed, to control BP.31

If BP is controlled with olmesartan and hydrochlorothiazide (administered separately), can switch to the fixed-combination preparation containing the corresponding individual doses for convenience.31

Adjust dosage of olmesartan/hydrochlorothiazide fixed combination according to patient’s response after 2–4 weeks at the current dosage.31

Olmesartan/Amlodipine/Hydrochlorothiazide Fixed-combination Therapy
Oral

Manufacturer states fixed-combination preparation should not be used for initial antihypertensive therapy.139

Can switch to fixed-combination olmesartan/amlodipine/hydrochlorothiazide tablets if BP is not adequately controlled with maximally tolerated, labeled, or usual dosages of any 2 of the following drug classes: angiotensin II receptor antagonists, calcium-channel blockers, or diuretics.139

In patients who experience dose-limiting adverse effects to olmesartan, amlodipine, or hydrochlorothiazide while receiving any dual combination of these drugs, may switch to the triple fixed-combination preparation containing a lower dose of that component.139

Can use the fixed combination as a substitute for the individually titrated drugs.139

May increase dosage of the fixed combination after 2 weeks if additional BP control is needed (up to maximum of olmesartan medoxomil 40 mg, amlodipine 10 mg, and hydrochlorothiazide 25 mg daily).139

Special Populations

The following information addresses dosage of olmesartan in special populations. Dosages of drugs administered in fixed combination with olmesartan also may require adjustment in certain patient populations; the need for such dosage adjustments must be considered in the context of cautions, precautions, and contraindications specific to that population and drug.31 44

Hepatic Impairment

No adjustment of initial olmesartan dosage necessary in patients with moderate to severe hepatic impairment.1 31

Amount of amlodipine in olmesartan/amlodipine fixed combinations exceeds the recommended initial dosage of amlodipine (2.5 mg daily) in patients with hepatic impairment.44 139

Renal Impairment

Manufacturer states that no adjustment of initial olmesartan dosage is necessary in patients with moderate to severe renal impairment (Clcr <40 mL/minute).1 31 44 However, some clinicians recommend lower initial dosage in patients with Clcr <20 mL/minute, with maximum dosage of 20 mg once daily in such patients.10

Dosage of olmesartan in patients with end-stage renal disease not determined.29

Fixed combinations containing hydrochlorothiazide are not recommended in patients with severe renal impairment (Clcr ≤30 mL/minute).31 139 Loop diuretics are preferred to thiazides in these patients.31 139

Geriatric Patients

No adjustment of initial olmesartan dosage is necessary.1 31

Amount of amlodipine in olmesartan/amlodipine fixed combinations exceeds the recommended initial dosage of amlodipine (2.5 mg daily) in patients ≥75 years of age.44 139

Volume- and/or Salt-depleted Patients

Correct volume and/or salt depletion prior to initiation of olmesartan therapy or initiate therapy under close medical supervision using lower initial dosage.1 31 44

Cautions for Olmesartan Medoxomil

Contraindications

  • Known hypersensitivity to olmesartan or any ingredient in the formulation.31

  • When olmesartan is used in fixed combination with hydrochlorothiazide and/or amlodipine, consider contraindications associated with the concomitant agent(s).31 139

  • Concomitant use of aliskiren and olmesartan in patients with diabetes mellitus.1 139

Warnings/Precautions

Warnings

Cardiovascular Effects

Possible symptomatic hypotension with olmesartan, particularly in volume- and/or salt-depleted patients (e.g., those treated with diuretics).1 31 44 (See Volume- and/or Salt-Depleted Patients under Dosage and Administration.)

Transient hypotension is not a contraindication to additional doses; may reinstate olmesartan therapy cautiously after BP is stabilized (e.g., with volume expansion).1 31 44

Findings from several studies have prompted concerns of an increased risk of cardiovascular death (e.g., fatal MI, sudden cardiac death) in patients with diabetes mellitus receiving high-dose olmesartan.124 132 140 Following review of all the available data, FDA has concluded that the collective evidence to date does not clearly demonstrate such an association and that the benefits of olmesartan in hypertensive patients continue to outweigh potential risks.124 138 140 141 142 143

Fetal/Neonatal Morbidity and Mortality

Possible fetal and neonatal morbidity and mortality when drugs that act on the renin-angiotensin system (e.g., angiotensin II receptor antagonists, ACE inhibitors, aliskiren) are used during the second and third trimesters of pregnancy.1 4 31 43 44 (See Boxed Warning.) Most epidemiologic studies assessing fetal abnormalities following exposure to antihypertensive agents during the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents.1

Discontinue olmesartan as soon as possible when pregnancy is detected, unless continued use is considered lifesaving.1 31 42 43 44 Nearly all women can be transferred successfully to alternative therapy for the remainder of their pregnancy.13

Malignancies

In July 2010, FDA initiated a safety review of angiotensin II receptor antagonists after a published meta-analysis found a modest but statistically significant increase in risk of new cancer occurrence in patients receiving an angiotensin II receptor antagonist compared with control.120 121 123 126 However, subsequent studies, including a larger meta-analysis conducted by FDA, have not shown such risk.126 127 128 129 Based on currently available data, FDA has concluded that angiotensin II receptor antagonists do not increase the risk of cancer.126

Sprue-like Enteropathy

Risk of sprue-like enteropathy, an intestinal condition characterized by severe chronic diarrhea with substantial weight loss; intestinal biopsy may reveal villous atrophy.1 133 134 135 139 Can occur months to years after initiating olmesartan.1 133 134 139 Clinical improvement is expected after the drug is discontinued.133 134 135

Not associated with other angiotensin II receptor antagonists to date; not considered to be a class effect of the drugs.133

If symptoms of sprue-like enteropathy develop, exclude other etiologies (e.g., celiac disease); if no other causative factor can be identified, consider drug discontinuance.1 133 139

Sensitivity Reactions

Anaphylactoid reactions and/or angioedema possible with angiotensin II receptor antagonists;1 2 7 14 extreme caution in patients with a history of angioedema associated with or unrelated to ACE inhibitor or angiotensin II receptor antagonist therapy.7 15 45

General Precautions

Use of Fixed Combinations

When olmesartan is used in fixed combination with amlodipine and/or hydrochlorothiazide, consider cautions, precautions, contraindications, and interactions associated with the concomitant agent(s).31 44 139 Consider cautionary information applicable to specific populations (e.g., pregnant or nursing women, individuals with hepatic or renal impairment, geriatric patients) for each drug in the fixed combination.31 44 139

Renal Effects

Possible oliguria, progressive azotemia and, rarely, acute renal failure and/or death in patients with severe heart failure.1 31 44

Increases in BUN and Scr possible in patients with unilateral or bilateral renal artery stenosis.1 31 44

Specific Populations

Pregnancy

Category D.1 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Lactation

Olmesartan is distributed into milk in rats; not known whether olmesartan is distributed into human milk.1 31 44 Discontinue nursing or the drug.1 31 44

Pediatric Use

Safety and efficacy of olmesartan in fixed combination with amlodipine and/or hydrochlorothiazide not established.31 44 139

Safety and efficacy of olmesartan established in pediatric patients 6–16 years of age with hypertension.1 136 Although evaluated in pediatric patients 1–5 years of age, statistically significant reductions in BP were not observed.1

Not evaluated in infants <1 year of age; because of the possibility of abnormal kidney development, do not use in this age group.1 If oliguria or hypotension occurs in a neonate with a history of in utero exposure to olmesartan, support BP and renal function; exchange transfusions or dialysis may be required.1 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Adverse effects in pediatric patients appear to be similar to those observed in adults.1

Geriatric Use

No overall differences in safety or efficacy of olmesartan alone or in fixed combination with amlodipine and/or hydrochlorothiazide relative to younger adults, but increased sensitivity cannot be ruled out.1 44 139 In general, select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.31

Hepatic Impairment

Systemic exposure to olmesartan may be increased.1 31 44 (See Absorption: Special Populations, under Pharmacokinetics.)

Renal Impairment

Systemic exposure to olmesartan may be increased.1 31 44 (See Absorption: Special Populations, under Pharmacokinetics and also see Renal Impairment under Dosage and Administration.)

Use of olmesartan in fixed combination with hydrochlorothiazide is not recommended in patients with Clcr ≤30 mL/minute.31 139

Deterioration of renal function may occur.1 31 44 (See Renal Effects under Cautions.)

Black Patients

BP reduction with olmesartan may be smaller in black patients compared with nonblack patients.1 5 31 500 (See Hypertension under Uses.)

Common Adverse Effects

Olmesartan: Dizziness,1 2 3 back pain,1 bronchitis,1 2 12 diarrhea,1 headache,1 2 3 12 hematuria,1 hyperglycemia,1 hypertriglyceridemia,1 influenza-like symptoms,1 2 12 pharyngitis,1 rhinitis,1 sinusitis,1 upper respiratory tract infection.2 3 12

Interactions for Olmesartan Medoxomil

The following information addresses potential interactions with olmesartan. When olmesartan is used in fixed combination with hydrochlorothiazide or amlodipine, consider interactions associated with the concomitant agent.31 44

Olmesartan is not metabolized by and does not inhibit or induce CYP isoenzymes.1 2

Specific Drugs

Drug

Interaction

Comments

ACE inhibitors

Increased risk of renal impairment, hyperkalemia, and hypotension1

Closely monitor BP, renal function, and serum electrolytes1

Aliskiren

Increased risk of renal impairment, hyperkalemia, and hypotension1

Closely monitor BP, renal function, and serum electrolytes1

Concomitant use contraindicated in patients with diabetes mellitus1

Avoid concomitant use in patients with GFR <60 mL/minute1

Antacids

Pharmacokinetic interactions unlikely1 2 28

Colesevelam

Decreased AUC and peak plasma concentrations of olmesartan1

Consider administering olmesartan at least 4 hours before colesevelam1

Digoxin

Pharmacokinetic interactions unlikely1 2 28

Hydrochlorothiazide

Pharmacokinetic interactions unlikely1 2 28

Additive hypotensive effects1 31

NSAIAs, including selective cyclooxygenase-2 (COX-2) inhibitors

Possible deterioration of renal function, including possible acute renal failure, in geriatric, volume-depleted, or renally impaired patients1

Possible decreased hypotensive effect1

Monitor renal function periodically1

Warfarin

Pharmacokinetic interaction unlikely1 2 28

Olmesartan Medoxomil Pharmacokinetics

Absorption

Bioavailability

Olmesartan medoxomil (prodrug) is rapidly and completely hydrolyzed to olmesartan during absorption in the GI tract.1 31 44

Absolute bioavailability of olmesartan is about 26%.1 31 44 Bioavailability of the extemporaneously prepared suspension (see Reconstitution under Dosage and Administration) is similar to that of olmesartan tablets.1

Peak plasma olmesartan concentration generally reached 1–2 hours following oral administration.1 31 44

Onset

Antihypertensive effect of olmesartan is evident within 2 weeks, with maximum BP reduction after 4–6 weeks.1 3

Food

Food does not affect bioavailability of olmesartan.1 31 44

Special Populations

In patients with moderate hepatic impairment, peak plasma concentration of olmesartan is increased; AUC increased by about 60%.1 31 44

In patients with severe renal impairment (Clcr <20 mL/minute), plasma concentrations and AUC of olmesartan are increased.1 31 44 After repeated dosing, AUC values are approximately triple those in patients with normal renal function.1 31 44

In women, peak plasma concentration and AUC of olmesartan are about 10–15% higher than values in men.1 31 44

Distribution

Extent

Olmesartan crosses the placenta and is distributed in the fetus in animals.1 31 44

Olmesartan crosses the blood-brain barrier poorly, if at all, in animals.1 31 44

Olmesartan is distributed into milk in rats; not known whether olmesartan is distributed into human milk.1 31 44

Plasma Protein Binding

Olmesartan: 99%.1 31 44

Elimination

Metabolism

Olmesartan medoxomil undergoes rapid and complete ester hydrolysis to olmesartan.1 2 28 31 44 Virtually no further metabolism of olmesartan occurs; not metabolized by CYP isoenzymes.1 2 28 31 44

Elimination Route

Olmesartan is eliminated mainly in urine (35–50%) and feces (via bile).1 2 31 44

Half-life

Biphasic; terminal half-life of olmesartan is approximately 13 hours.1 31 44

Special Populations

Clearance (adjusted for body weight) in pediatric patients 1–16 years of age is similar to that in adults.1

In geriatric patients, renal clearance of olmesartan is decreased by approximately 30%.1 31 44

Stability

Storage

Oral

Extemporaneous Suspension

2-mg/mL preparation of olmesartan medoxomil in a mixture of syrup (Ora-Sweet) and suspending vehicle (Ora-Plus) (see Reconstitution under Dosage and Administration): Up to 4 weeks at 2–8°C.1

Tablets

Olmesartan or olmesartan/hydrochlorothiazide fixed combination: 20–25°C.1 31

Olmesartan/amlodipine or olmesartan/amlodipine/hydrochlorothiazide fixed combination: 25ºC (may be exposed to 15–30ºC).44 139

Actions

  • Olmesartan medoxomil (prodrug) has little pharmacologic activity until hydrolyzed to olmesartan during absorption.1 2 31 44

  • Olmesartan blocks the physiologic actions of angiotensin II, including vasoconstrictor and aldosterone-secreting effects.1 31 44

  • Olmesartan does not interfere with response to bradykinins and substance P.1 31 44

  • Olmesartan does not share the ACE inhibitor common adverse effect of dry cough.1

Advice to Patients

  • When olmesartan is used in fixed combination with hydrochlorothiazide and/or amlodipine, importance of advising patients of important precautionary information about the concomitant agent(s).31 44 139

  • Importance of advising women of childbearing age about the risks of use during pregnancy.1 31 42 43 44

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.1 31 44

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1 31 44

  • Importance of informing patients of other important precautionary information.1 31 44 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Olmesartan Medoxomil

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

5 mg

Benicar

Daiichi Sankyo

20 mg

Benicar

Daiichi Sankyo

40 mg

Benicar

Daiichi Sankyo

Olmesartan Medoxomil Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

20 mg with Amlodipine Besylate 5 mg (of amlodipine)

Azor

Daiichi Sankyo

20 mg with Amlodipine Besylate 5 mg (of amlodipine) and Hydrochlorothiazide 12.5 mg

Tribenzor

Daiichi Sankyo

20 mg with Amlodipine Besylate 10 mg (of amlodipine)

Azor

Daiichi Sankyo

40 mg with Amlodipine Besylate 5 mg (of amlodipine)

Azor

Daiichi Sankyo

40 mg with Amlodipine Besylate 5 mg (of amlodipine) and Hydrochlorothiazide 12.5 mg

Tribenzor

Daiichi Sankyo

40 mg with Amlodipine Besylate 5 mg (of amlodipine) and Hydrochlorothiazide 25 mg

Tribenzor

Daiichi Sankyo

40 mg with Amlodipine Besylate 10 mg (of amlodipine)

Azor

Daiichi Sankyo

40 mg with Amlodipine Besylate 10 mg (of amlodipine) and Hydrochlorothiazide 12.5 mg

Tribenzor

Daiichi Sankyo

40 mg with Amlodipine Besylate 10 mg (of amlodipine) and Hydrochlorothiazide 25 mg

Tribenzor

Daiichi Sankyo

Tablets, film-coated

20 mg with Hydrochlorothiazide 12.5 mg

Benicar HCT

Daiichi Sankyo

40 mg with Hydrochlorothiazide 12.5 mg

Benicar HCT

Daiichi Sankyo

40 mg with Hydrochlorothiazide 25 mg

Benicar HCT

Daiichi Sankyo

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 12/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Azor 10-20MG Tablets (SANKYO): 30/$117.76 or 90/$340.05

Azor 10-40MG Tablets (SANKYO): 90/$442.99 or 270/$1,299.02

Azor 5-20MG Tablets (SANKYO): 30/$121.06 or 90/$349.97

Azor 5-40MG Tablets (SANKYO): 30/$154.35 or 90/$450.93

Benicar 20MG Tablets (SANKYO): 30/$95.99 or 90/$276.96

Benicar 40MG Tablets (SANKYO): 30/$134.99 or 90/$387.95

Benicar 5MG Tablets (SANKYO): 30/$78.99 or 90/$225.97

Benicar HCT 20-12.5MG Tablets (SANKYO): 30/$96.99 or 90/$275.96

Benicar HCT 40-12.5MG Tablets (SANKYO): 30/$135.99 or 90/$391.96

Benicar HCT 40-25MG Tablets (SANKYO): 30/$135.99 or 90/$376.98

Tribenzor 20-5-12.5MG Tablets (SANKYO): 30/$119.99 or 90/$335.95

Tribenzor 40-10-25MG Tablets (SANKYO): 30/$152.14 or 90/$433.29

Tribenzor 40-5-12.5MG Tablets (SANKYO): 30/$152.14 or 60/$304.27

Tribenzor 40-5-25MG Tablets (SANKYO): 30/$154.49 or 90/$444.01

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions November 19, 2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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24. Parving HH, Lehnert H, Brochner-Mortensen J et al and the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001; 345:870-8. [IDIS 469608] [PubMed 11565519]

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