ARB and enteropathy

Q: 58 years old male with history of hypertension but stable on a single medicine for the last two years is admitted to ICU with worsening diarrhea, hypovolemia, and impending kidney failure. Which of the following anti-hypertensive is more prone to produce "sprue-like enteropathy"? (select one)

A) Irbesartan (Avapro)

B) Losartan (Cozaar)

C) Olmesartan (Benicar)

D) Valsartan (Diovan)

E) Candesartan (Atacand)

 Answer: C

  One of the popular angiotensin II receptor blockers (ARBs) olmesartan is associated with "sprue-like enteropathy". Although intestinal biopsy shows villous atrophy, though antibody testing for celiac disease stays negative. Diagnosis is based on rechallenging the drug, clinical symptoms, and intestinal biopsy. ACE inhibitors or other ARBs have not been implicated yet.

#pharmacology

#GI

References:

1. Ianiro G, Bibbò S, Montalto M, et al. Systematic review: Sprue-like enteropathy associated with olmesartan. Aliment Pharmacol Ther 2014; 40:16.

2. Basson M, Mezzarobba M, Weill A, et al. Severe intestinal malabsorption associated with olmesartan: a French nationwide observational cohort study. Gut 2016; 65:1664.

3. Talley NJ. Use of olmesartan for ≥ 1 year was associated with hospitalization for intestinal malabsorption. Ann Intern Med 2015; 163:JC13.