Health professionals are advised that the Product Information documents for olmesartan-containing products have been updated with a precaution for sprue-like enteropathy.
Olmesartan is a selective AT1 subtype angiotensin II receptor antagonist, which is used to treat hypertension. It has been on the Australian Register of Therapeutic Goods since 2005 and is listed on the Pharmaceutical Benefits Scheme.
Case series
A TGA investigation was conducted after the publication of a case series involving 22 patients experiencing chronic diarrhoea and enteropathy while taking olmesartan.1
Each patient suffered chronic diarrhoea for more than four weeks and had no other identified cause for enteropathy, such as coeliac disease or tropical sprue.
All patients experienced weight loss, with an average loss of 18 kg, and intestinal biopsy revealed villous atrophy in each case. In some instances the adverse events experienced were severe, with 14 of the 22 patients hospitalised to manage severe dehydration. Four of the patients suffered acute renal failure and four required total parenteral nutrition.
Where information was available, the mean duration of olmesartan use prior to onset of diarrhoea was 3.1 years.
All of the patients demonstrated clinical improvement after stopping olmesartan treatment.
Product Information update
The Product Information (PI) for olmesartan-containing products had previously listed diarrhoea and gastroenteritis as potential adverse events, but not more severe forms of enteropathy.
The updated PI includes a precaution for sprue-like enteropathy and lists it in the adverse effects section, under ‘Post-marketing experience’.
Adverse event reports
Between 2005 and 31 January 2014, the TGA received 10 reports of diarrhoea in patients being treated with olmesartan, including four which were serious. Two reports involved enterocolitis and acute renal failure, another described villous atrophy and dehydration, and the fourth included acute renal failure, villous atrophy and Clostridium difficile colitis. All four patients experiencing these serious adverse events recovered after discontinuing olmesartan treatment.
Information for health professionals
Advise patients who are being treated with olmesartan to contact you if they develop severe, chronic diarrhoea with weight loss, even if these symptoms arise months or years after they started taking the drug.
If a patient experiences severe, chronic diarrhoea with weight loss while taking olmesartan, exclude other potential causes. If no other aetiology is identified, consider discontinuation of olmesartan.
In many reported cases in Australia and overseas, stopping olmesartan treatment has resulted in clinical improvement of sprue-like enteropathy symptoms in patients.