- Stock: Out Of Stock
- Brand: ACI Pharmaceuticals
- Product ID: Olmesartan Medoxomil + Hydrochlorothiazide
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Abetis Plus 40/12.5mg Tablet — Olmesartan Medoxomil + Hydrochlorothiazide | Beximco Pharmaceuticals
| Generic Name | Olmesartan Medoxomil 40mg + Hydrochlorothiazide 12.5mg |
| Drug Class | ARB + Thiazide Diuretic (Fixed-Dose Combination — High-Dose ARB) |
| Manufacturer | Beximco Pharmaceuticals Ltd. |
| Route | Oral (Tablet) |
| Prescription Status | Prescription Required |
Overview
Abetis Plus 40/12.5mg combines the maximum approved dose of Olmesartan Medoxomil (40mg) with Hydrochlorothiazide 12.5mg in a single fixed-dose tablet. This combination is used in patients with resistant hypertension who are not adequately controlled on either ARB monotherapy (even at 40mg) or lower-dose Abetis Plus formulations. The 40mg olmesartan provides maximal AT1 receptor blockade — the most efficacious ARB dose for both blood pressure reduction and renoprotection — while HCTZ 12.5mg adds volume reduction and complementary BP lowering.
Mechanism of Action
Olmesartan Medoxomil 40mg: Maximum insurmountable AT1 receptor blockade, completely preventing angiotensin II-mediated vasoconstriction and aldosterone release. Provides greatest reduction in intraglomerular pressure, which is particularly important for diabetic patients with significant proteinuria or declining eGFR.
Hydrochlorothiazide 12.5mg: Inhibits NCC in the distal convoluted tubule, reducing plasma volume and peripheral vascular resistance. HCTZ-driven compensatory renin-angiotensin system activation is fully blocked by olmesartan — the key pharmacological synergy of this combination.
Indications
- Resistant hypertension — not controlled on olmesartan 40mg monotherapy alone
- Hypertension requiring ≥2 agents — single-tablet convenience at maximum ARB dose
- Diabetic hypertension with significant proteinuria requiring maximum renoprotection
- Step-up therapy from Abetis Plus 20/12.5mg when BP target not achieved
Dosage
| Indication | Dose | Notes |
|---|---|---|
| Resistant hypertension | 1 tablet (40/12.5mg) once daily | Maximum ARB dose in this combination |
| Uptitration from 20/12.5mg | Switch to 40/12.5mg after 2–4 weeks | If BP target (<130/80) not achieved |
| Further escalation needed | Add amlodipine or switch to 40/25mg | Specialist guidance recommended |
Take in the morning with or without food. Morning dosing preferred to avoid nocturia from diuretic component.
Critical Diabetic Patient Information
- Maximum renoprotection: 40mg olmesartan provides the greatest reduction in proteinuria and intraglomerular pressure in diabetic patients — the strongest available renoprotection from this drug class
- Heightened monitoring requirements: At maximum ARB dose, potassium retention is maximal. Combined with HCTZ's potassium loss, net electrolyte effect may vary. Check K⁺, Na⁺, and creatinine within 1–2 weeks of switching to 40/12.5mg
- Blood pressure targets: At this dose combination, many patients reach <130/80 mmHg. Enhanced hypotension risk — monitor especially on standing (orthostatic hypotension)
- Glucose monitoring: Though HCTZ effect on glucose is small at 12.5mg, the increased antihypertensive effect at this dose combination may improve renal blood flow and alter insulin/drug pharmacokinetics. Monitor glucose
- Volume depletion: At 40mg olmesartan + diuretic, volume depletion and hypotension are more likely. Reduce diuretic or ARB dose during acute illness with vomiting/diarrhoea and resume when recovered
Side Effects
| System | Side Effect | Severity |
|---|---|---|
| Cardiovascular | Hypotension, dizziness, orthostatic symptoms — more pronounced at 40mg | Common — Mild to Moderate |
| Electrolytes | Variable K⁺ (HCTZ loses K⁺; olmesartan retains K⁺ — monitor individually) | Moderate — monitor |
| Renal | Elevated creatinine (ARB-mediated, expected) | Common — usually acceptable |
| Metabolic | Hyperuricaemia, mild hyperglycaemia (HCTZ) | Mild at 12.5mg dose |
| GI | Nausea, olmesartan-associated enteropathy (rare — severe diarrhoea) | Rare |
| Skin | Photosensitivity (HCTZ) — use SPF sun protection | Rare |
Drug Interactions
| Drug | Interaction |
|---|---|
| ACE inhibitors / aliskiren | Absolutely contraindicated — dual RAS blockade at maximum ARB dose |
| Lithium | HCTZ reduces lithium excretion — significant toxicity risk; monitor levels closely |
| NSAIDs | Significantly attenuate both antihypertensive and diuretic effect; increase nephrotoxicity |
| Antidiabetics | HCTZ may impair glucose control; 40mg ARB may improve insulin sensitivity — monitor closely |
| Other antihypertensives | Enhanced hypotensive effect — use with caution; titrate carefully |
| Potassium-sparing diuretics | Risk of unpredictable K⁺ — monitor carefully |
Contraindications
- Pregnancy (second and third trimester — absolute)
- Hypersensitivity to olmesartan, HCTZ, or sulfonamides
- Anuria or eGFR <30
- Severe hepatic impairment
- Combination with aliskiren in diabetics or eGFR <60
- Bilateral renal artery stenosis
- Refractory hypokalaemia or hyponatraemia
Storage
Store below 30°C. Protect from light and moisture. Keep out of reach of children.
Frequently Asked Questions
Q: Is Abetis Plus 40/12.5mg stronger than Abetis Plus 20/12.5mg?
A: Yes — the olmesartan dose doubles from 20mg to 40mg (maximum), providing greater blood pressure reduction and stronger renoprotection. The HCTZ component remains the same at 12.5mg.
Q: My BP is still high on Abetis Plus 40/12.5mg — what next?
A: Discuss adding amlodipine (calcium channel blocker) or switching to a 40/25mg formulation with your physician. Do not add another ARB or ACE inhibitor.
Q: How often do I need blood tests on this combination?
A: Check renal function, electrolytes (K⁺, Na⁺), and glucose within 1–2 weeks of starting or any dose change. Thereafter, every 3 months if stable (eGFR <60) or every 6 months if eGFR >60.
Medical Disclaimer: Abetis Plus 40/12.5mg (Olmesartan 40mg + Hydrochlorothiazide 12.5mg) is a prescription-only medicine. This is a high-dose combination requiring close medical supervision. Contraindicated in pregnancy and anuria. Monitor electrolytes and renal function closely. Do not combine with ACE inhibitors or aliskiren. This information is for educational purposes only. Always follow your physician's instructions.
