Olmesartan-Hydrochlorothiazide

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jan 24, 2024

Warnings

Olmesartan Hydrochlorothiazide (Benicar HCT) Risks, Warnings, and Complications

Olmesartan hydrochlorothiazide can cause or worsen health problems in some people. Talk to your doctor or pharmacist about taking other medications to control high blood pressure if you are at increased risk of adverse reactions or complications from this combination therapy.

FETAL AND MATERNAL RISK: Olmesartan hydrochlorothiazide acts on the renin-angiotensin system and can be harmful to an unborn baby if it is used during the second and third trimesters of pregnancy. It can lead to impaired renal function in the fetus and oligohydramnios (decreased amniotic fluid volume), which can lead to birth defects and congenital abnormalities. In addition, in patients receiving thiazide therapy, the drug can cross the placenta and cause fetal or neonatal jaundice and thrombocytopenia (low platelet count). Due to the significant fetal risk associated with olmesartan hydrochlorothiazide, this medication is not prescribed to pregnant women. Tell your doctor if you are pregnant before starting treatment with this combination medicine. Stop taking olmesartan hydrochlorothiazide and call your doctor immediately if you become pregnant while on this medicine.
LOW BLOOD PRESSURE: Taking olmesartan hydrochlorothiazide can result in hypotension (low blood pressure). Hypotension occurs more commonly in people who are dehydrated or have fluid or electrolyte imbalance and those taking high doses of the medicine. Low blood pressure is more likely to occur when you first start taking olmesartan hydrochlorothiazide and after the dose is increased. Closely monitor your blood pressure at home. Tell your doctor if you have diarrhea, vomiting, or excessive sweating while on this drug. Call your doctor if you develop dizziness, lightheadedness, or tiredness during treatment.
IMPAIRED HEPATIC FUNCTION: Diuretic therapy with hydrochlorothiazide should be used with caution in people with reduced liver function or progressive liver disease. Minor changes in fluid and electrolyte balance in people with moderate hepatic impairment can precipitate hepatic coma. Tell your doctor if you have a history of liver disease. Call your doctor immediately if you develop stomach pain, nausea, itching, or yellowing of the eyes or skin.
COMPROMISED RENAL FUNCTION: Patients receiving olmesartan medoxomil and hydrochlorothiazide can develop kidney problems and worsening kidney disease. This medication is not prescribed to people with severely reduced kidney function, renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion due to the risk of possible acute renal failure. Tell your doctor if you notice any changes in urination while on olmesartan hydrochlorothiazide. Your doctor may discontinue treatment if you develop severe renal impairment (reduction in kidney function).
SPRUE-LIKE ENTEROPATHY: There are reports of a sprue-like enteropathy (severe diarrhea and significant weight loss) in people who took olmesartan. This can happen months to years after starting treatment with the drug. Tell your doctor immediately if you develop these symptoms.
ELECTROLYTE IMBALANCE: Hydrochlorothiazide reduces plasma volume and increases renal excretion of fluid and electrolytes. Taking this drug can lead to hypokalemia (low serum potassium levels) and hyponatremia (low serum sodium levels). In addition, olmesartan can cause hyperkalemia (high potassium). Your healthcare provider will monitor serum electrolytes carefully while you are on olmesartan hydrochlorothiazide. They may also order other blood tests to check for blood glucose and blood cholesterol levels. Keep all your medical and lab appointments while on this combination medicine.
ALLERGIC REACTION: Allergic (hypersensitivity reactions) can occur to hydrochlorothiazide. The risk of this happening is particularly high in people with a history of asthma. Seek emergency medical care if you develop difficulty breathing while on this medicine.
SYSTEMIC LUPUS ERYTHEMATOSUS: Hydrochlorothiazide can activate or worsen lupus (SLE). Tell your doctor if you have a history of this condition.
EYE PROBLEMS : Hydrochlorothiazide can cause eye problems such as the acute onset of myopia (shortsightedness) and acute angle-closure glaucoma (a condition in which intraocular pressure remains uncontrolled). Stop taking the medicine and tell your doctor immediately if you develop ocular pain, swelling, or decreased visual acuity (eye pain or vision problems).
LABORATORY TESTS: Olmesartan and hydrochlorothiazide can cause an increase in creatinine, potassium, blood glucose, and cholesterol levels. Tell your doctor and all laboratory personnel you are on this medication.

Precautions Before Starting Olmesartan Hydrochlorothiazide (Benicar HCT)

Tell your doctor if you have ever had allergic reactions to olmesartan, hydrochlorothiazide, any of the active or inactive ingredients in olmesartan hydrochlorothiazide tablets, other angiotensin II receptor antagonists, other diuretics, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid dangerous drug interactions between your medications.

Give your health care professional a complete medical history. Olmesartan hydrochlorothiazide may not be right for people with certain medical conditions such as kidney disease, liver disease, heart failure, high cholesterol, diabetes, asthma, gout, glaucoma, or lupus (SLE).

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are nursing an infant with breast milk (breast-feeding).

Precautions During Use of Olmesartan Hydrochlorothiazide (Benicar HCT)

Keep all your medical and lab appointments while on this medication. Your healthcare provider may want to keep an eye on kidney function and electrolytes during treatment.

Maintain a log of your blood pressure readings at home and bring it to your healthcare appointments. Your provider may adjust the dose of olmesartan hydrochlorothiazide based on your blood pressure response.

Try to take olmesartan hydrochlorothiazide at least 4 hours before bedtime. This medication can make you urinate more, and taking it later in the day can lead to nighttime awakenings to urinate.

Olmesartan hydrochlorothiazide can cause dizziness, lightheadedness, and drowsiness, especially when you first start taking it and after dose adjustments. Do not drive, operate machinery, or do any other hazardous activity until you know how it affects you. Keep in mind that alcohol can make these side effects worse.

Taking this combination therapy can cause dizziness, lightheadedness, and fainting when going from a sitting or lying position to standing. Get out of bed slowly to avoid falls.

Stay well hydrated during treatment with olmesartan hydrochlorothiazide. Call your doctor if you develop vomiting, diarrhea, excessive sweating, or inability to drink enough fluids. Tell your doctor without delay if you develop dizziness, weakness, and low blood pressure.

Hydrochlorothiazide can increase the sensitivity of your skin to sunlight and increase your risk of melanoma and non-melanoma skin cancer (squamous cell carcinoma and basal cell carcinoma). Avoid unnecessary sun exposure and wear sunscreen, sunglasses, and protective clothing when outdoors.

If you are taking a bile acid sequestering agent (cholesterol-lowering medication) such as cholestyramine or colestipol, make sure you take it away from hydrochlorothiazide (at least 1 hour before or 4 hours after).

If you have high blood sugar and are taking diabetes medication, talk to your doctor about how often you should monitor your blood sugar levels. Olmesartan hydrochlorothiazide can cause changes in glucose tolerance, and your provider may need to adjust your medicine dosages.

Do not stop taking olmesartan hydrochlorothiazide without talking to your doctor. Discontinuing this medication suddenly can lead to dangerously high blood pressure and increase your risk of heart attack and stroke.

Tell your doctor immediately if you become pregnant while on olmesartan hydrochlorothiazide.

Tell all your healthcare providers you are on olmesartan hydrochlorothiazide before any surgery or medical tests, including dental procedures.

Olmesartan Hydrochlorothiazide (Benicar HCT) Drug Interactions

Certain other drugs can affect how the combination of olmesartan hydrochlorothiazide works. Possible drug interactions with other medicines can increase the risk of severe adverse reactions. The following medications can have interactions with olmesartan hydrochlorothiazide:

Angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), lisinopril (in Prinzide), trandolapril (Mavik, in Tarka), enalapril (Vasotec), captopril (Capoten, in Capozide), quinapril (Accupril, in Accuretic, in Quinaretic), fosinopril, perindopril (Aceon), moexipril (Univasc), and ramipril (Altace)
Cholesterol-lowering drugs, including bile acid sequestrants like colesevelam (Welchol) and fibrates like gemfibrozil (Lopid)
Diuretics (water pills)
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
Barbiturates such as phenobarbital and secobarbital (Seconal)
Potassium supplements
Corticosteroids such as dexamethasone (Decadron, Dexpak, Dexasone, others), prednisone (Meticorten, Deltasone, Sterapred, others), prednisolone (Prelone, others), betamethasone (Celestone), cortisone (Cortone), budesonide (Entocort), hydrocortisone (Cortef, Hydrocortone), triamcinolone (Aristocort, Azmacort), fludrocortisone (Florinef), and methylprednisolone (Medrol, Meprolone, others)
Corticotropin (H.P., ACTH, Acthar Gel)
Diabetes medications include insulin and oral medications
Lithium (Eskalith, Lithobid)

The above list may not describe all the potential interactions of olmesartan hydrochlorothiazide. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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