Olmesartan, Amlodipine, and Hydrochlorothiazide (Oral)

Overview

Each of these three medications plays a specific role in helping to lower high blood pressure in patients who have not had significant success with other medications. Amlodipine is a calcium channel blocker which improved blood circulation by widening the blood vessels to establish more room for flow. Hydrochlorothiazide is a diuretic which discourages your body from absorbing too much salt from ingested foods and beverages, because excessive salt can lead to harmful fluid retention. Olmesartan is an angiotensin II receptor antagonist, which means it blocks a substance in the body that causes blood vessels to narrow, and it provides a three-pronged attack against high blood pressure by preventing blood vessels from narrowing, improving circulation, and actually lowering blood pressure.

The reason this is important is that if high blood pressure is allowed to persist as a condition in a patient, the body's arteries and heart may begin to malfunction, and this will lead to a whole catalog of other problems. The blood vessels of the brain can become damaged, as well as those of the heart, kidneys and elsewhere, which can increase the risk of heart attack or stroke. When blood pressure has been lowered and managed well, the flow of blood to the heart and brain are increased, and a healthier medical condition prevails.

This combination medication comes in the form of a tablet and is marketed commercially in this country under the name of Tribenzor.

Condition treated

  • Hypertension

Type Of Medicine

  • Olmesartan angiotensin II receptor antagonist, Hydrochlorothiazide diuretic, Amlodipine calcium channel blocker

Side Effects

Along with the highly beneficial medical effects that this triple medication provides, there's a possibility that some unwanted side effects may occur in patients being treated with it. While most patients will experience relatively mild side effects or perhaps none at all, there is a slight chance that some fairly severe side effects can result from taking this medication. One possibility is a severe allergic reaction, and if this happens, you should seek immediate medical attention because the symptoms which normally appear can have the potential to become life-threatening.

Symptoms to look for in an allergic reaction are as follows:

  • Extreme itchiness at various sites around the body
  • A tightness in the chest, often experienced in conjunction with severe difficulty in breathing
  • Rashes and/or hives appearing on surfaces of the skin
  • Noticeable puffiness or swelling of the eyelids, on the tongue, lips or throat
  • Lightheadedness or dizziness, with the sensation that you are about to faint
  • Sudden onset of nausea.

Some of the lesser effects which patients have reported after using this combination medication are listed below, and if you should experience any of these to the degree where you feel discomfort, you should report the symptoms to your doctor at the earliest opportunity. Your doctor may decide to discontinue use of the medication if your symptoms are fairly severe, or he/she may decide to alter your dosage level to something which can be tolerated more readily by your body.

Here are some of the most commonly reported symptoms by patients using this combination medicine:

  • Fainting
  • Severe and sudden fatigue or weakness
  • Pain in the joints, especially in the big toe
  • Swelling of the feet, ankles, or hands
  • Symptoms which may indicate an unusually high level of potassium in the blood, such as an irregular heartbeat or muscle weakness
  • Indicators of kidney problems such as a change in the frequency of urination, the amount of urination, or the urgency of urination
  • Persistent and severe diarrhea
  • Eye pain
  • Blurry vision or other changes to vision
  • Chest pain
  • Shortness of breath
  • Profuse sweating
  • Symptoms of dehydration such as dry mouth, muscle cramps, confusion or disorientation, and extreme thirst.

Some people may experience a persistent dizziness or lightheadedness when they rise quickly from a sitting or lying position after having taken this combination medicine. In order to mitigate the effects of this symptom, you can make a point of rising slowly, or by dangling your feet over the side of the bed for a short period of time before rising.

Dosage

The dosage listed below is not to be considered the dosage you should be taking personally, but is instead merely a guideline or a standard dosage. Your own actual dosage level will be determined by your doctor after considering a number of factors related to your medical profile, including how well your body tolerates the medicine, your specific medical condition and what you're being treated for, the number of dosages you take daily, the length of time you have been taking this medicine, and the strength of the medicine itself.

If you should miss a regularly scheduled dosage of this medication, you can take it as soon as you remember it, unless it happens to be very close to the time of your next scheduled dosage. In that case, it's much better to skip the dosage you missed and simply wait for the time of your next regularly scheduled dosage. Do not take extra doses to get back on schedule, or because you feel that you need more medication at any given time.

  • An adult dosage for a patient being treated for hypertension would be 5 to 10 mg of amlodipine, 12.5 to 25 mg of hydrochlorothiazide, and 20 to 40 mg of olmesartan, taken orally once each day. After two weeks of this regimen, you should observe a significant change in your blood pressure, since that is the time frame where this combination medicine will achieve maximum impact. If you see no change in your blood pressure readings, you should consult with your doctor about alternative strategies, or about the possibility of increasing your dosage. The maximum daily dosage that any adult patient should be prescribed is a combination of 10 mg of amlodipine, 25 mg of hydrochlorothiazide, and 40 mg of olmesartan
  • For geriatric patients who are at the age of 75 or older, an initial safe dosage should begin with 2.5 mg of amlodipine, to be followed up with a maintenance dosage of 5 to 10 mg of amlodipine, 12.5 to 25 mg of hydrochlorothiazide, and 20 to 40 mg of olmesartan, to be taken orally once each day. As in the case of adult patients at younger ages, the maximum beneficial effects of this combination medicine will be achieved starting at two weeks, so if no improvement is shown in blood pressure readings, either an adjustment to dosage may be necessary, or some other strategy for treatment.

Interactions

There are a number of interactions possible with other medications you may be taking, and if such interactions do occur, it can diminish the effectiveness of either or both, or it could cause serious side effects to appear in you, the patient. Obviously, none of these interactions are desirable, so both you and your doctor will have to take steps to prevent them.

You can do your part by compiling a list of all other medications you are currently taking, including over-the-counter medications, other prescription medications, vitamins, and herbal supplements, along with all the dosages of each of these. Your doctor will then review this list and identify where the potential exists for interaction with your combination medicine for treating high blood pressure.

You should keep a copy of this list at home so that you can take it with you if you ever have to go to a healthcare clinic where your primary care doctor is not in residence, or if you have to make an unscheduled trip to the emergency room. Any doctor at one of these facilities can review your medication list, and make sure that no drug interactions take place with a drug that he/she prescribed for your treatment.

The drugs which are most commonly checked for possible interaction with your combination medicine are those in the list below:

  • Ezetimibe
  • Cholecalciferol
  • Cyanocobalamin
  • Esomeprazole
  • Alcohol
  • Glimepiride
  • Testosterone
  • Mometasone
  • Aspirin
  • Celecoxib
  • Carvedilol
  • Omeprazole
  • Insulin glargine
  • Metformin
  • Sitagliptin
  • Linagliptin
  • Levothyroxine
  • Omega-3 polyunsaturated fatty acids.

In addition, there are a number of medical conditions which can be impacted by using your triple medicine, and that means that you should avoid taking the medicine if you have any of these conditions in your medical history:

  • Diabetes
  • Asthma
  • Kidney disease
  • Liver disease
  • Hyperparathyroidism
  • Hyperuricemia
  • Hypotension
  • Cardiogenic shock
  • Electrolyte losses
  • Lupus erythematosus
  • Renal disorders
  • Angioedema
  • Renal artery stenosis
  • Hyperlipidemia
  • Thyroid function tests
  • CHF/AMI
  • Hyperkalemia
  • CHF
  • Anuria
  • Coronary artery disease.

Warnings

Before taking this medication, there are a few precautions you should observe so that you don't trigger a medical condition worse than the one you're treating. For instance, make sure to let your doctor know if you know you are allergic to olmesartan, amlodipine or hydrochlorothiazide. If you have any other kind of allergies, such as to pets, foods, preservatives or fabrics, let your doctor know that as well, since certain ingredients in any of the three medicines you're taking could trigger your other allergic reactions.

Prior to agreeing to treatment with this combination medicine, you should have a thorough consultation with your doctor about your medical history, so that any potential trouble spots can be identified and avoided. You should especially alert your doctor to the fact that you have any of the following medical conditions in your past history: kidney disease, severe loss of minerals or water, gout, lupus, aortic stenosis, high or low potassium levels, low magnesium levels or high calcium levels.

There is a possibility that this drug will make you dizzy or disoriented shortly after ingestion, that means you should avoid driving a motor vehicle or operating any kind of machinery. You could become a danger to yourself and to others if you lose concentration while driving or operating machinery. You should not drink alcohol when taking this medication because that can have the effect of compounding any side effects which would normally be imparted by the medicine, especially those of dizziness or disorientation, and that could increase the danger to yourself and others.

If you are subject to prolonged diarrhea, vomiting, or sweating, all these can significantly add to the risk of dizziness or lightheadedness and can increase any potential for dehydration in your body. To avoid this, you should drink plenty of fluids when you take your combination medicine, and you should report any symptoms like these to your doctor.

If you are a diabetic patient, your blood sugar levels may be affected by this medicine, so you should regularly chuck check your blood sugar and keep your doctor informed about anything which appears abnormal. If any abnormal readings are obtained, your doctor will likely recommend adjusting your diabetes medication, or possibly your diet, to help get things back under control.

There is a potential for this medicine to impact the level of potassium in your body, so before you take any kind of potassium supplements or any supplements which contain potassium, make sure to consult with your family doctor.

It's possible for this combination medicine to make you more sensitive to sunlight, so it's advisable to limit your exposure to sunshine. When you do have to be out in the sun for an extended period of time, you should make every effort to protect skin surfaces with sunscreen or by wearing protective clothing. For the same reason, you should avoid going to tanning salons, because any increased sensitivity will bring about negative results. If you should develop skin blisters or redness despite your best efforts to protect your skin, you should immediately contact your doctor and follow any instructions closely.

If you know that you are going to have surgery coming up during the time frame where you will be taking this triple medicine, you should alert your doctor or dentist to the fact that you are taking it. Your dentist will need to know if any oral surgery is being scheduled so that he/she can avoid any drug interactions with your combination medicine.

In the past, geriatric patients have reported an increased sensitivity to many of this drug's side effects, particularly those relating to urination and to dizziness or disorientation.

It is not recommended for women to use this combination medicine during the first three months of pregnancy, and during the last two months, usage is strongly discouraged. Animal populations which have been studied for the effects of this medication have revealed that there is an increased occurrence of intrauterine deaths, extended gestation and labor times, and lower birth weights. There have also been developmental delays which have appeared prominently in animal studies. While there have been no controlled studies on human populations, it is not recommended to use this combination medicine at all if you are pregnant or thinking of becoming pregnant.

In that same vein, women should avoid taking this medicine if you are already pregnant and you are considering breastfeeding your infant. It is known that this medicine is passed on to nursing infants through breast milk, so it is not at all advisable to be taking this drug while breastfeeding an infant.

Storage

This medication should be stored in a location which is not subject to extremes of heat, cold, moisture, or direct lighting since all of these have the potential to degrade the medicine and diminish its usefulness. It should be kept well out of the reach of pets and small children who might be curious, and if that means storing it in a very high location, that would be ideal. To prevent unwanted access to this medicine, you should never store it in one of the weekly pill reminders which are so popular, because these do not usually come equipped with locking mechanisms which can discourage access.

When your medicine has exceeded its expiration date, you should not take it any longer, because its effectiveness will be completely unpredictable, and it may not be effective at all. If you have unused tablets of this combination medicine, you should not dispose of them by flushing them down the sink or the toilet, but should instead discard them according to proper disposal methods. Your doctor or pharmacist can advise you on proper disposal methods, and if this information is not available, you can also look it up on the FDA website for the safe disposal of medicines.

Summary

The combination medicine of hydrochlorothiazide, olmesartan and amlodipine is used in the treatment of high blood pressure, very often for patients who have not had success using other medications. Together these three deliver a very powerful effect which acts as a single process for the lowering of blood pressure. Olmesartan blocks a substance in the body which can narrow the blood vessels and cause a reduction of circulation, amlodipine is a calcium channel blocker which works to widen blood vessels and improve circulation, and hydrochlorothiazide is a diuretic which prevents the body from retaining too much fluid.

These three medications are not generally taken separately but are available in a single tablet under the commercial name of Tribenzor, to make it easy for patients to ingest all three at once. Normally only one tablet per day is needed by a patient, and the maximum effectiveness of the medicine will be achieved within two weeks of the initial ingestion.