Olmesartan (Benicar) has two actions. It palliates symptoms by reducing inflammation, and it activates the innate immune response. Patients who begin the Marshall Protocol (MP) may experience either, both, or neither. According to one rough estimate, 25% of patients who begin the MP experience immediate symptomatic relief when they begin the olmesartan blockade, about 25% feel no different, and the other 50% will experience some adjustment symptoms. Even for MP patients who have a minimal initial reaction to olmesartan, the medication almost always ultimately has strong antibacterial effects resulting in immunopathology. For olmesartan to be effective, it has to be dosed regularly: 40mg every 6-8 hours.
A patient's level of 1,25-D lowers dramatically after beginning olmesartan. For a period of up to two weeks, patients may find an increase in neurological symptoms. These symptoms are due to fluctuations in the hormone 1,25-D and may include photosensitivity, fatigue, headache, irritability, sleep disturbances, and brain fog. At least in the first week or two, none of these symptoms are due to bacterial die-off.
Once the body's mechanisms for regulating hormones has adjusted to regular doses of olmesartan, patients may find that they experience immunopathology or an increase in symptoms of disease. It is often the case that this is due to olmesartan's molecular actions. In its role as Vitamin D Receptor agonist, olmesartan activates the innate immune response, which leads to the transcription of anti-microbial peptides, the body's broad-spectrum antibacterials. This results in bacterial die-off and an unpleasant increase in symptoms.
Though the immunopathological reaction to olmesartan is near universal in the MP cohort, nothing that would suggest an increase in symptoms is listed in the monograph for olmesartan. In fact, the only adverse event in which olmesartan had a higher incidence than a placebo is for dizziness (3% vs. 1%). However, it should be noted, the patients in these studies were given Benicar only once a day.
This discrepancy underscores how crucial regular dosing of olmesartan is for achieving an immune response.
During bouts of hypotension, some physicians may be reluctant to continue prescribing olmesartan (Benicar), a medication which is otherwise used to reduce blood pressure. But, it is important that they do. Olmesartan has an excellent safety profile and is only a weak hypotensive, reducing diastolic pressure by no more than 12 mm Hg in the dosages suggested by the Marshall Protocol guidelines.
Patients and their physicians are advised not to be overly concerned with symptoms of low blood pressure. They resolve as the disease does. Also, the symptoms thought to be due to low blood pressure have been shown to resolve even if the low blood pressure persists.
Olmesartan is classified as an Angiotensin II Receptor Blocking (ARB) drug. When olmesartan binds and blocks the Angiotensin Receptor, it prevents fibrotic tissue from forming and decreases levels of Nuclear Factor Kappa B, a protein that stimulates the release of inflammatory cytokines - proteins that generate pain and fatigue. The drop in cytokines results in less inflammation and oxidative stress.