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Home > Drug Category > Blood Pressure Medication (Angiotensin Receptor Blocker) > Benicar HCT and Equivalent

Benicar HCT (Olmesartan Medoxomil and Hydrochlorothiazide) Information

Benicar HCT is a combination medication containing two active ingredients: olmesartan medoxomil (an Angiotensin II Receptor Blocker or ARB) and hydrochlorothiazide (HCT) (a thiazide diuretic). It is indicated for the treatment of hypertension (high blood pressure) in patients for whom combination therapy is appropriate. This fixed-dose combination is typically used when blood pressure is not adequately controlled with either component alone. Olmesartan medoxomil is a prodrug that converts to the active ARB, olmesartan, while HCT works to eliminate excess fluid. Benicar HCT is administered orally, typically once daily.

The mechanism of action involves the synergistic effects of the two components: Olmesartan blocks the binding of Angiotensin II to the AT1 receptor. This inhibits vasoconstriction and aldosterone release, promoting vasodilation (widening of blood vessels) and the excretion of sodium and water, which reduces systemic vascular resistance. Hydrochlorothiazide (HCT) is a diuretic that works primarily in the distal convoluted tubules of the kidney. It increases the excretion of sodium, chloride, and water, thereby reducing plasma volume. By combining these two mechanisms, Benicar HCT provides a more potent and comprehensive reduction in blood pressure than either drug alone, as the diuretic effect of HCT augments the ARB's blood pressure-lowering effect.

Benicar HCT Side Effects

Benicar HCT combines the side effect profiles of both olmesartan and hydrochlorothiazide. Common side effects often reported include dizziness, particularly when standing up quickly (orthostatic dizziness), headache, nausea, upper respiratory tract infection, and fatigue.

However, more serious side effects can occur, leading to significant monitoring protocols. If any of the following symptoms are experienced, the patient should stop taking the medication and seek immediate medical attention:
• Angioedema: A rare but severe and potentially life-threatening swelling of the face, lips, tongue, or throat, which can impair breathing. This requires immediate emergency medical attention.
• Enteropathy (Severe, Chronic Diarrhea): A unique, severe gastrointestinal side effect of olmesartan involving chronic, severe diarrhea and significant weight loss, sometimes occurring months to years after starting the drug.
• Fetal Toxicity (Boxed Warning): Use during pregnancy is associated with significant harm to the developing fetus, including fetal death, hypotension, renal failure, and skull hypoplasia. The drug must be discontinued immediately upon confirmed pregnancy.
• Renal Impairment/Failure: In patients whose kidney function is dependent on the renin-angiotensin system, the combination may cause acute kidney failure or worsening renal function.
• Severe Electrolyte Imbalances: The ARB component may cause hyperkalemia (high potassium), while the HCT component may cause hypokalemia (low potassium), hyponatremia (low sodium), or hypercalcemia (high calcium). These imbalances can affect heart function and require immediate medical management.
• Symptomatic Hypotension: Excessive lowering of blood pressure, especially in patients who are volume-depleted, which may lead to fainting (syncope).

Benicar HCT Precautions

Due to the risk of fetal harm, Benicar HCT carries a Boxed Warning regarding use during pregnancy and must be discontinued as soon as pregnancy is detected. Women of childbearing age should discuss appropriate contraceptive use or alternative therapies if they are planning to become pregnant. It is contraindicated in patients with a history of hypersensitivity to olmesartan, sulfonamide-derived drugs (HCT is a sulfonamide), or a history of anuria (inability to urinate). Caution is advised when initiating therapy in patients who are volume-depleted or salt-depleted, as they are at a greater risk for symptomatic hypotension, which may require correction before starting the drug. The concurrent use of Benicar HCT with the drug aliskiren is contraindicated in patients with diabetes or moderate to severe renal impairment (GFR less than 60 milliliters' per minute). Due to the diuretic component, patients prone to electrolyte disturbances, gout, or lupus should be monitored carefully. If unexplained, severe, chronic diarrhea develops, the drug should be immediately discontinued and olmesartan enteropathy considered.

Do I need a prescription to order Benicar HCT?

Yes, a prescription is required from your physician to order Benicar HCT.