A triple-drug, fixed-dose combination (FDC) antihypertensive therapy containing an angiotensin II receptor blocker (ARB), a dual L/N-type calcium channel blocker (CCB), and a long-acting thiazide-like diuretic. This combination provides synergistic blood pressure lowering through complementary mechanisms, offering enhanced efficacy, improved compliance, and a favorable side effect profile, particularly for Indian patients with moderate to severe hypertension or those uncontrolled on dual therapy.
Adult: One tablet (Olmesartan 40mg + Cilnidipine 10mg + Chlorthalidone 12.5mg) once daily, preferably in the morning. Dose titration should be done under medical supervision. Initiation with this FDC is recommended only in patients whose blood pressure is not adequately controlled on dual combinations.
Note: Swallow the tablet whole with a glass of water, with or without food. To minimize nocturia, take in the morning. Do not crush or chew. Ensure adequate hydration unless contraindicated.
This combination exerts a multi-pronged attack on hypertension: 1) Olmesartan blocks the AT1 receptor, inhibiting angiotensin II-mediated vasoconstriction, aldosterone secretion, and sympathetic outflow. 2) Cilnidipine blocks L-type calcium channels on vascular smooth muscle, causing vasodilation, and uniquely blocks N-type calcium channels on sympathetic nerve terminals, reducing norepinephrine release. 3) Chlorthalidone inhibits sodium reabsorption in the distal convoluted tubule, causing natriuresis, diuresis, and reduced plasma volume. The net effect is a potent reduction in peripheral vascular resistance and blood volume.
Pregnancy: CONTRANDICATED in second and third trimesters (Category D). Drugs that act directly on the RAAS can cause injury and death to the developing fetus. Discontinue as soon as pregnancy is detected. First-trimester use should be avoided unless no alternative exists.
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Other Antihypertensives (ACEi, Beta-blockers, Alpha-blockers) | Additive hypotensive effect. Risk of severe hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Eplerenone), Potassium supplements | Increased risk of hyperkalemia, especially with 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 induced by chlorthalidone can predispose to digitalis toxicity. | Moderate |
| Corticosteroids, ACTH | Intensify electrolyte depletion (particularly hypokalemia). | Moderate |
| Antidiabetic drugs (Insulin, Sulfonylureas) | Chlorthalidone may decrease glucose tolerance, requiring dose adjustment. | Moderate |
| Cholestyramine, Colestipol | May reduce absorption of chlorthalidone. Separate administration by at least 4 hours. | Moderate |
| Strong CYP3A4 Inhibitors (Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) | May increase cilnidipine plasma levels, increasing risk of adverse effects. | Moderate |
| Alcohol, Barbiturates, Opioids | Potentiation of orthostatic hypotension. | Moderate |
Same composition (Olmesartan Medoxomil (40mg) + Cilnidipine (10mg) + Chlorthalidone (12.5mg)), different brands: