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- Product ID: Olmesartan Medoxomil
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Abetis Plus 20/12.5mg Tablet — Olmesartan Medoxomil + Hydrochlorothiazide | Beximco Pharmaceuticals
| Generic Name | Olmesartan Medoxomil 20mg + Hydrochlorothiazide 12.5mg |
| Drug Class | ARB + Thiazide Diuretic (Fixed-Dose Combination) |
| Manufacturer | Beximco Pharmaceuticals Ltd. |
| Route | Oral (Tablet) |
| Prescription Status | Prescription Required |
Overview
Abetis Plus 20/12.5mg is a fixed-dose combination of Olmesartan Medoxomil 20mg (ARB) and Hydrochlorothiazide (HCTZ) 12.5mg (thiazide diuretic). The combination provides complementary and synergistic antihypertensive mechanisms — olmesartan blocks the renin-angiotensin system while HCTZ promotes renal sodium excretion — achieving greater blood pressure reduction than either agent alone. Importantly, olmesartan counteracts the potassium-wasting and metabolic adverse effects of thiazides, making this a rational combination for hypertensive diabetic patients.
Mechanism of Action
Olmesartan Medoxomil: Selectively blocks the AT1 angiotensin II receptor, preventing vasoconstriction, aldosterone secretion, and sodium retention. Also reduces intraglomerular pressure — key for diabetic nephropathy protection.
Hydrochlorothiazide 12.5mg: Inhibits sodium-chloride reabsorption in the distal convoluted tubule, increasing urinary sodium and water excretion, reducing plasma volume and peripheral vascular resistance. HCTZ also activates the renin-angiotensin system (a compensatory mechanism), which is directly countered by olmesartan — explaining the superior efficacy of this combination.
Indications
- Hypertension not adequately controlled on olmesartan 20mg monotherapy
- Hypertension requiring multiple agents — to reduce pill burden
- Diabetic hypertension with fluid retention or oedema component
- Second-step therapy when ARB monotherapy is insufficient
Dosage
| Indication | Dose | Notes |
|---|---|---|
| Inadequate BP control on olmesartan 20mg alone | 1 tablet (20/12.5mg) once daily | Replace olmesartan monotherapy |
| If further control needed | Uptitrate to Abetis Plus 40/12.5mg or 40/25mg | After 2–4 weeks assessment |
Take at the same time each day with or without food. Morning dosing preferred to avoid nocturia from diuretic component.
Critical Diabetic Patient Information
- HCTZ and blood glucose: Thiazide diuretics can worsen insulin resistance and raise blood glucose — particularly at higher doses (>25mg). At 12.5mg HCTZ in this combination, this effect is minimal but monitor glucose after initiating
- Electrolyte balance: HCTZ causes potassium loss; olmesartan causes potassium retention. The net effect is usually neutral at 12.5mg HCTZ, but check K⁺ and Na⁺ at 2–4 weeks after starting
- Uric acid: HCTZ raises uric acid. In diabetic patients with gout risk or hyperuricaemia, monitor uric acid levels
- Dehydration risk: Diuretic component increases risk of volume depletion, especially in hot weather or with gastrointestinal illness. Educate patient to maintain hydration
- Renoprotection maintained: Despite the addition of HCTZ, the olmesartan component continues to provide renoprotection in diabetics via AT1 blockade
- No dual RAS blockade: Do not add an ACE inhibitor or aliskiren to this combination
Side Effects
| System | Side Effect | Severity |
|---|---|---|
| Renal/Electrolytes | Hypokalaemia (HCTZ), hyperkalaemia (olmesartan) — usually balanced at 12.5mg dose | Mild — monitor |
| Metabolic | Mild hyperglycaemia, hyperuricaemia, dyslipidaemia (from HCTZ — minimal at 12.5mg) | Mild |
| Cardiovascular | Hypotension, dizziness (especially first dose) | Common — Mild |
| Renal | Elevated creatinine (expected from ARB component) | Common — usually acceptable |
| GI | Nausea, olmesartan-associated enteropathy (rare) | Rare |
| Skin | Photosensitivity (HCTZ) | Rare — use sun protection |
Drug Interactions
| Drug | Interaction |
|---|---|
| ACE inhibitors / aliskiren | Contraindicated — dual RAS blockade |
| Lithium | HCTZ reduces lithium excretion — toxicity risk; monitor levels |
| NSAIDs | Attenuate diuretic and antihypertensive effect; increase nephrotoxicity |
| Potassium-sparing diuretics | May partially counteract HCTZ K⁺ loss — monitor K⁺ |
| Antidiabetics | HCTZ may impair glycaemic control; adjust antidiabetic dose if needed |
| Cholestyramine / colestipol | Reduce HCTZ absorption — take 1 hour before or 4–6 hours after |
Contraindications
- Pregnancy (second and third trimester)
- Known hypersensitivity to olmesartan, HCTZ, or sulfonamides
- Anuria or severe renal impairment (eGFR <30 — HCTZ becomes ineffective)
- Severe hepatic impairment
- Combination with aliskiren in diabetics or eGFR <60
- Refractory hypokalaemia or hyponatraemia
Storage
Store below 30°C. Protect from light and moisture. Keep out of reach of children.
Frequently Asked Questions
Q: Why has my doctor combined olmesartan with a water tablet (HCTZ)?
A: HCTZ reduces blood pressure by a different mechanism to olmesartan. Combining them gives greater BP reduction than either alone, while olmesartan counteracts the electrolyte imbalances HCTZ can cause — making it a very rational combination.
Q: Will the water tablet component affect my diabetes?
A: At 12.5mg, the glucose-raising effect of HCTZ is minimal. Monitor blood glucose in the first few weeks after starting. If your glucose control worsens significantly, inform your physician.
Q: Do I need extra blood tests on this combination?
A: Yes — check renal function, potassium, sodium, and glucose within 2–4 weeks of starting, then every 3–6 months. More frequent checks if you have CKD.
Medical Disclaimer: Abetis Plus 20/12.5mg (Olmesartan + Hydrochlorothiazide) is a prescription-only medicine. Contraindicated in pregnancy, anuria, and severe renal/hepatic impairment. Monitor electrolytes, renal function, and glucose regularly. Do not combine with ACE inhibitors or aliskiren. This information is for educational purposes only. Always follow your physician's instructions.
