Gut – Various

Some people have gut side effects from olmesartan

Olmesartan medoxomil is also sold as Olmetec, Benicar and other brand names. It is metabolized, during its absorption in the digestive tract, to the active drug olmesartan, which is an angiotensin receptor ll antagonist, used the treatment of hypertension (high blood pressure).

Gut. 2015 Aug 6. pii: gutjnl-2015-309690. doi: 10.1136/gutjnl-2015-309690.
Severe intestinal malabsorption associated with olmesartan: a French nationwide observational cohort study.
Basson M1, Mezzarobba M1, Weill A1, Ricordeau P1, Allemand H1, Alla F1, Carbonnel F2.   LINK

Their Aim:

• “To assess, in a nationwide patient cohort, the risk of hospitalisation for intestinal malabsorption associated with olmesartan compared with other angiotensin receptor blockers (ARB) and ACE inhibitors (ACEIs).”

Their Conclusion:

• “Olmesartan is associated with an increased risk of hospitalisation for intestinal malabsorption and coeliac disease”
• the absolute risk was very small (218 events of being hospitalized for intestinal malabsorption in a cohort of 4.5 million patients)
• however, if such severe malabsorption can occur that a person is hospitalized, it is reasonable to suspect that less severe levels of symptoms can also occur, and this may be something that is being missed.
• the risk was actually lower with use under a year, but increased quickly in the second year of use and beyond

From a paper by a group in Italy in 2014:

Aliment Pharmacol Ther. 2014 Jul;40(1):16-23. doi: 10.1111/apt.12780.  LINK
Systematic review: Sprue-like enteropathy associated with olmesartan.

• ” Almost all patients presented with diarrhoea and weight loss.
• Normocytic normochromic anaemia and hypoalbuminaemia were the commonest laboratory defects at presentation.
• Antibody testing for coeliac disease was always negative.
• Variable degrees of duodenal villous atrophy were present in 98% of patients, while increased intra-epithelial lymphocytes were documented in only 65% of cases.
• After discontinuation of olmesartan, all reported patients achieved resolution of signs and symptoms. “

There are number of other reports in recent years, including:

“Gastrointestinal Disorder Associated with Olmesartan Mimics Autoimmune Enteropathy.“

PLoS One. 2015 Jun 23;10(6):e0125024. doi: 10.1371/journal.pone.0125024. LINK to full text

• “Olmesartan is an angiotensin II receptor antagonist used to treat arterial hypertension. Several cases of chronic diarrhea with weight loss, anaemia and low serum albuminemia have been reported after the use of olmesartan [1]. The Mayo Clinic was the first to report 22 cases of severe Sprue-like enteropathy associated with olmesartan [2]. All patients displayed villous atrophy and 14/22 had intraepithelial hyperlymphocytosis.”
• “Interestingly, cases of enteropathy related to other angiotensin II receptor inhibitors seem to be much less frequent than OIE [4]. The selective role of olmesartan might be explained by its conversion into the active form in the intestine, its long half-life and its efficacy, 30 fold higher than that of other sartans.”
• “Conclusions: This case-series shows that olmesartan can induce intestinal damage mimicking AIE. OIE usually resolved after olmesartan interruption but immunosuppressive drugs may be necessary to achieve remission. Our data sustain the hypothesis that olmesartan interferes with intestinal immuno regulation in predisposed individuals.”

Note: OIE = olmesartan-induced-enteropathy  AIE = autoimmune-enteropathy