- Stock: Out Of Stock
- Brand: ACI Pharmaceuticals
- Product ID: Amlodipine + Olmesartan Medoxomil
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Abecab 40/5mg Tablet — Olmesartan Medoxomil 40mg + Amlodipine Besilate 5mg | Beximco Pharmaceuticals
| Generic Name | Olmesartan Medoxomil 40mg + Amlodipine Besilate 5mg |
| Drug Class | ARB (Maximum Dose) + Dihydropyridine Calcium Channel Blocker |
| Manufacturer | Beximco Pharmaceuticals Ltd. |
| Route | Oral (Tablet) |
| Prescription Status | Prescription Required |
Overview
Abecab 40/5mg combines the maximum approved dose of Olmesartan Medoxomil (40mg) with Amlodipine Besilate 5mg in a single fixed-dose tablet. This is used as step-up therapy when Abecab 20/5mg fails to achieve target blood pressure. The 40mg olmesartan provides maximum AT1 receptor blockade — the highest level of RAS suppression and renoprotection achievable with this drug class — while amlodipine 5mg adds complementary vasodilation. This combination is highly effective for resistant hypertension in diabetic patients with nephropathy, where tight BP control and maximum renoprotection are both essential.
Mechanism of Action
Olmesartan Medoxomil 40mg: At maximum dose, achieves near-complete and sustained AT1 receptor occupancy throughout the 24-hour dosing interval. Provides the greatest available reduction in intraglomerular pressure, the most significant proteinuria lowering, and maximum cardiovascular risk reduction from this drug class. Fully blocks the compensatory RAAS activation caused by amlodipine-induced vasodilation.
Amlodipine Besilate 5mg: Long-acting dihydropyridine CCB (half-life 35–50h). Provides sustained peripheral vasodilation via L-type calcium channel blockade — no reflex tachycardia, smooth 24-hour coverage. Adds antianginal and anti-atherosclerotic benefits. At 5mg, ankle oedema risk is lower than at 10mg.
Indications
- Resistant hypertension — not controlled on Abecab 20/5mg or olmesartan 40mg monotherapy
- Diabetic nephropathy with significant proteinuria requiring maximum ARB renoprotection
- Hypertension with high cardiovascular risk requiring tight BP control (<130/80 mmHg)
- Step-up from Abecab 20/5mg when target BP not achieved after 2–4 weeks
Dosage
| Indication | Dose | Notes |
|---|---|---|
| Resistant hypertension | 1 tablet (40/5mg) once daily | Maximum olmesartan dose in combination |
| Uptitration from 20/5mg | Switch to 40/5mg after 2–4 weeks | If target BP not achieved |
| Further escalation | Uptitrate amlodipine to 10mg (Abecab 40/10mg) | Before adding a third agent |
Take once daily at the same time with or without food. Amlodipine half-life is very long — BP effect builds over 1–2 weeks after dose change.
Critical Diabetic Patient Information
- Maximum renoprotection: 40mg olmesartan provides the greatest reduction in proteinuria and intraglomerular pressure. Diabetic patients with macroalbuminuria or declining eGFR benefit most from this dose
- Enhanced monitoring at 40mg: Potassium retention is maximal at 40mg olmesartan. Check K⁺ and creatinine within 1–2 weeks of switching to this formulation, then every 3 months if eGFR <60
- Hypotension risk: Maximum ARB dose + CCB combined can cause significant BP reduction. Monitor closely on standing — especially in elderly, volume-depleted, or those on diuretics. Sit or lie down if dizzy
- Metabolically superior to diuretic-based combinations: At 40mg olmesartan + amlodipine, no adverse metabolic effects on glucose, lipids, or uric acid — critical for diabetic patients where metabolic control is paramount
- Do not add ACE inhibitor or aliskiren: Absolute prohibition of dual RAS blockade, especially at maximum ARB dose
Side Effects
| System | Side Effect | Severity |
|---|---|---|
| Blood pressure | Hypotension, dizziness — more pronounced at maximum ARB dose | Common — Mild to Moderate |
| Peripheral | Ankle/pedal oedema (amlodipine) — vasodilatory, not cardiac | Common (~10%) — Mild |
| Cardiovascular | Flushing, palpitations (amlodipine) | Common — Mild |
| Renal | Elevated creatinine (ARB-mediated, expected at 40mg) | Common — monitor closely |
| Electrolytes | Hyperkalaemia — more likely at 40mg olmesartan | Moderate — monitor |
| GI | Olmesartan-associated enteropathy (rare — severe diarrhoea) | Rare — may require discontinuation |
| Serious (rare) | Angioedema — discontinue immediately | Rare — Serious |
Drug Interactions
| Drug | Interaction |
|---|---|
| ACE inhibitors / aliskiren | Absolutely contraindicated at maximum ARB dose |
| CYP3A4 inhibitors (clarithromycin, itraconazole, grapefruit juice) | Increase amlodipine levels significantly — risk of severe hypotension |
| CYP3A4 inducers (rifampicin) | Substantially reduce amlodipine efficacy |
| Simvastatin | Amlodipine raises simvastatin AUC — limit to 20mg/day or use atorvastatin |
| NSAIDs | Blunt antihypertensive effect; increase renal risk at maximum ARB dose |
| Potassium-sparing diuretics / K⁺ supplements | Significant hyperkalaemia risk at 40mg olmesartan |
| Other antihypertensives | Enhanced hypotension — titrate carefully |
Contraindications
- Pregnancy (second and third trimester — absolute)
- Hypersensitivity to olmesartan, amlodipine, or dihydropyridines
- Severe aortic stenosis
- Cardiogenic shock
- Combination with aliskiren in diabetics or eGFR <60
- Bilateral renal artery stenosis
Storage
Store below 30°C. Protect from light and moisture. Keep out of reach of children.
Frequently Asked Questions
Q: What is the difference between Abecab 20/5mg and Abecab 40/5mg?
A: The olmesartan dose doubles from 20mg to 40mg (maximum). This provides greater blood pressure reduction and stronger renoprotection in diabetic patients with nephropathy. The amlodipine 5mg dose stays the same.
Q: Is 40mg olmesartan + amlodipine safe long-term?
A: Yes, when appropriately prescribed and monitored. Regular blood tests (renal function, K⁺) every 3–6 months are required. This combination has an excellent long-term safety profile in diabetic patients.
Q: My BP still isn't controlled on Abecab 40/5mg — what is next?
A: The next step is usually uptitrating amlodipine to 10mg (Abecab 40/10mg) before adding a third-class agent. Discuss with your specialist.
Medical Disclaimer: Abecab 40/5mg (Olmesartan 40mg + Amlodipine 5mg) is a prescription-only high-dose combination requiring close medical supervision. Contraindicated in pregnancy and severe aortic stenosis. Monitor renal function and potassium regularly. Do not combine with ACE inhibitors or aliskiren. This information is for educational purposes only. Always follow your physician's instructions.
