A fixed-dose combination (FDC) antihypertensive agent containing an angiotensin II receptor blocker (ARB), Olmesartan Medoxomil, and a beta-1 selective adrenergic blocker, Metoprolol Succinate (extended-release). This combination provides complementary mechanisms for blood pressure control by blocking the renin-angiotensin-aldosterone system (RAAS) and reducing sympathetic nervous system activity. It is indicated for the management of essential hypertension where single-agent therapy is insufficient. The combination offers improved efficacy, potential for better compliance, and a favorable side effect profile compared to higher doses of monotherapy.
Adult: One tablet (Olmesartan 20mg + Metoprolol Succinate 50mg) once daily. May be increased after 2-4 weeks to a maximum of Olmesartan 40mg + Metoprolol Succinate 100mg once daily, if needed. Usually taken in the morning.
Note: Swallow the tablet whole with a glass of water, with or without food. Do not crush, chew, or split the tablet as it will compromise the extended-release mechanism of metoprolol. Take at the same time each day. If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose.
The combination exerts a dual antihypertensive effect. Olmesartan selectively blocks the binding of angiotensin II to the AT1 receptor, preventing vasoconstriction, aldosterone secretion, and sympathetic activation. Metoprolol succinate is a cardioselective beta-1 adrenergic receptor antagonist that reduces heart rate, myocardial contractility, and renin release from the kidneys. Together, they inhibit both the RAAS and sympathetic nervous system, leading to reduced peripheral vascular resistance and cardiac output.
Pregnancy: CATEGORY C (1st trimester) and CATEGORY D (2nd & 3rd trimesters). Drugs that act on the RAAS can cause fetal injury and death. Olmesartan is contraindicated in 2nd and 3rd trimesters. If pregnancy is detected, discontinue immediately. Can cause oligohydramnios, fetal renal dysfunction, skull hypoplasia, and death.
Driving: May cause dizziness, fatigue, or visual disturbances, especially at initiation of therapy or dose change. Patients should not drive or operate machinery until they know how the medication affects them.
| Other antihypertensives (Diuretics, CCBs, ACEIs) | Additive hypotensive effect, risk of severe hypotension. | Major |
| Digoxin | Metoprolol may increase digoxin concentration; increased risk of bradycardia. | Moderate |
| Antiarrhythmics (Amiodarone, Disopyramide) | Increased risk of bradycardia and myocardial depression. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect of olmesartan; increased risk of renal impairment. | Moderate |
| Potassium supplements / Potassium-sparing diuretics (Spironolactone) | Increased risk of hyperkalemia with olmesartan. | Major |
| Lithium | Olmesartan may increase lithium levels and risk of toxicity. | Major |
| CYP2D6 Inhibitors (Fluoxetine, Paroxetine, Quinidine) | Increase metoprolol plasma levels, enhancing its effects and side effects. | Moderate |
| Clonidine | Risk of severe rebound hypertension if clonidine is withdrawn while on beta-blocker. | Major |
| Insulin / Oral hypoglycemics | Metoprolol may mask tachycardia as a sign of hypoglycemia; may potentiate hypoglycemia. | Moderate |
| Verapamil / Diltiazem | Concurrent use with metoprolol increases risk of bradycardia, AV block, and heart failure. | Major |
Same composition (Olmesartan Medoxomil (20mg) + Metoprolol Succinate (50mg)), different brands: