A fixed-dose triple-drug combination therapy for hypertension, offering complementary mechanisms of action: Olmesartan (Angiotensin II Receptor Blocker), Cilnidipine (L/N-type Calcium Channel Blocker), and Chlorthalidone (Thiazide-like Diuretic). This combination provides potent, synergistic blood pressure reduction, improved compliance, and is particularly suited for Indian patients with moderate to severe hypertension, salt sensitivity, or those requiring multiple agents for control.
Adult: One tablet (Olmesartan 20mg + Cilnidipine 10mg + Chlorthalidone 12.5mg) once daily, preferably in the morning. Dose should be individualized. Not for initial therapy.
Note: Swallow whole with a glass of water, with or without food. Take at the same time each day, preferably in the morning to avoid nocturia. Do not crush or chew.
Triple-action blockade of key hypertensive pathways: 1) Olmesartan selectively blocks the binding of angiotensin II to the AT1 receptor, inhibiting vasoconstriction, aldosterone secretion, and sodium retention. 2) Cilnidipine blocks both L-type (vascular) and N-type (neuronal) voltage-gated calcium channels, causing vasodilation and potentially reducing sympathetic outflow. 3) Chlorthalidone inhibits sodium reabsorption in the distal convoluted tubule, promoting natriuresis and diuresis, reducing plasma volume and peripheral vascular resistance.
Pregnancy: CONTRANDICATED in second and third trimesters (Pregnancy Category D). Drugs that act directly on the RAAS can cause injury and death to the developing fetus, including oligohydramnios, renal failure, skull hypoplasia, and death. Discontinue as soon as pregnancy is detected.
Driving: Caution advised, especially during initiation of therapy or dose adjustment, as dizziness, lightheadedness, or fatigue may occur, impairing ability to drive or operate machinery.
| Other Antihypertensives (e.g., ACEi, Beta-blockers) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Eplerenone), Potassium supplements, Salt substitutes | Increased risk of hyperkalemia (due to Olmesartan). | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac, Naproxen) | May reduce antihypertensive effect, increase risk of renal impairment, and antagonize diuretic effect. | Major |
| Lithium | Chlorthalidone reduces renal clearance of lithium, increasing risk of lithium toxicity. | Major |
| Digoxin | Hypokalemia or hypomagnesemia from Chlorthalidone can predispose to digoxin toxicity. | Moderate |
| Corticosteroids, ACTH | Intensify electrolyte depletion (especially hypokalemia). | Moderate |
| Cholestyramine, Colestipol | May reduce absorption of Chlorthalidone. | Moderate |
| Strong CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) | May increase Cilnidipine plasma levels, increasing risk of adverse effects. | Moderate |
| Strong CYP3A4 Inducers (e.g., Rifampicin, Phenytoin, Carbamazepine) | May decrease Cilnidipine plasma levels, reducing efficacy. | Moderate |
| Allopurinol | Increased risk of hypersensitivity reactions when combined with Chlorthalidone. | Moderate |
Same composition (Olmesartan Medoxomil (20mg) + Cilnidipine (10mg) + Chlorthalidone (12.5mg)), different brands: