AGTR1 shrunk by 30% within eight weeks. Losartan potassium and hydrochlorothiazide has been evaluated for safety in 858 patients treated for essential hypertension and 3889 patients treated for hypertension and left ventricular hypertrophy. Most adverse reactions have been mild and transient in nature and have not required discontinuation of therapy. Back pain 12%; muscular weakness 7%; knee pain, leg pain 5%; muscle cramp 1%; rhabdomyolysis postmarketing. Within 1 to 2 weeks after initiation, reassess blood pressure including postural blood pressure changes renal function, and serum potassium; follow closely after dose changes. osel.info digoxin
Documentation of allergenic cross-reactivity for angiotensin receptor blockers is limited. Advise patient that medication may cause dizziness or light-headedness and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined. CYP2C9 Inducers Strong: May increase the metabolism of CYP2C9 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. The University of Michigan has filed a patent on AGTR1 and is seeking commercial partners.
This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. Metabolism and nutrition disorders: Anorexia, hyperglycemia, hyperuricemia, electrolyte imbalance including hyponatremia and hypokalemia. Blocks vasoconstriction and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the angiotensin II receptor AT 1 receptor in vascular smooth muscle and the adrenal gland. Nervous system disorders: Dysgeusia, headache, migraine, paraesthesias.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. II receptor blocker acting on the AT 1 receptor subtype and a diuretic, hydrochlorothiazide. Losartan Potassium and Hydrochlorothiazide contains hydrochlorothiazide which can cause hypokalemia, hyponatremia and hypomagnesemia. Hypomagnesemia can result in hypokalemia which may be difficult to treat despite potassium repletion. Losartan Potassium and Hydrochlorothiazide also contains losartan which can cause hyperkalemia.
Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first. Make dose adjustments as needed unless the patient is volume depleted. HFSA, 2010; Konstam, 2009. At least 61 percent of the oral dose is eliminated unchanged within 24 hours. Hydrochlorothiazide crosses the placental but not the blood-brain barrier and is excreted in breast milk. What are the ingredients in Losartan Potassium and Hydrochlorothiazide tablets? LVH. Losartan Potassium and Hydrochlorothiazide tablets may not help Black patients with this problem. In this study, renal clearance was reduced by 55 to 85% for both losartan and its active metabolite in patients with mild or moderate renal insufficiency. Neither losartan nor its active metabolite can be removed by hemodialysis. Hypotension 7%; orthostatic hypotension 4%.
No clinically significant drug interactions have been found in studies of losartan potassium with hydrochlorothiazide, digoxin, warfarin, cimetidine and phenobarbital. However, rifampin has been shown to decrease the AUC of losartan and its active metabolite by 30% and 40%, respectively. Fluconazole, an inhibitor of cytochrome P450 2C9, decreased the AUC of the active metabolite by approximately 40%, but increased the AUC of losartan by approximately 70% following multiple doses. Conversion of losartan to its active metabolite after intravenous administration is not affected by ketoconazole, an inhibitor of P450 3A4. Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Losartan Potassium and Hydrochlorothiazide. As a result, a greater proportion of the patients on Losartan Potassium and Hydrochlorothiazide reached the target diastolic blood pressure 17. Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use Losartan Potassium and Hydrochlorothiazide tablets for a condition for which it was not prescribed. Do not give Losartan Potassium and Hydrochlorothiazide tablets to other people, even if they have the same symptoms that you have. Hypertension with left ventricular hypertrophy: To reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy LVH. Evidence suggests that this benefit does not apply to black patients. Scapa E. Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers. There was no significant effect on heart rate. Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function. Hepatic impairment: Use with caution in patients with hepatic impairment or a history of hepatic impairment; dose adjustment needed. There is also an AT 2 receptor found in many tissues but it is not known to be associated with cardiovascular homeostasis. Neither losartan nor its principal active metabolite exhibits any partial agonist activity at the AT 1 receptor, and both have much greater affinity about 1000-fold for the AT 1 receptor than for the AT 2 receptor. In vitro binding studies indicate that losartan is a reversible, competitive inhibitor of the AT 1 receptor. The active metabolite is 10 to 40 times more potent by weight than losartan and appears to be a reversible, non-competitive inhibitor of the AT 1 receptor. What is the most important information I should know about Losartan Potassium and Hydrochlorothiazide tablets? Losartan Potassium and Hydrochlorothiazide tablets and certain other medicines may interact with each other. Lithium: Angiotensin II Receptor Blockers may increase the serum concentration of Lithium. Management: Lithium dosage reductions will likely be needed following the addition of an angiotensin II receptor antagonist. Do not coadminister aliskiren with Losartan Potassium and Hydrochlorothiazide in patients with diabetes. priligy
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. In these cases, surgery to replace or repair the is necessary. If surgery is performed early, before the valves are damaged, the aortic or mitral valve may be repaired and preserved. If the valves are damaged, they may need to be replaced. Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus. Patients on monotherapy were titrated from losartan 50 mg to losartan 100 mg to losartan 150 mg, as needed. Hg is reasonable for the secondary prevention of cardiovascular events.
Hydrochlorothiazide decreases urinary calcium excretion and may cause elevations of serum calcium. Monitor calcium levels. Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly. Anaphylactic reactions, angioedema including swelling of the larynx and glottis, swelling of the face, lips, pharynx, and tongue vasculitis including Henoch-Schönlein purpura postmarketing. Antifungal Agents Azole Derivatives, Systemic: May decrease the metabolism of Losartan. Applicable Isavuconazonium considerations are addressed in separate monographs. Exceptions: Isavuconazonium Sulfate. RifAMPin: May decrease the serum concentration of Losartan. The AUC of active metabolite following oral losartan was not affected by erythromycin, an inhibitor of P450 3A4, but the AUC of losartan was increased by 30%. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions. Who should not take Losartan Potassium and Hydrochlorothiazide tablets? Metabolism: Losartan is an orally active agent that undergoes substantial first-pass metabolism by cytochrome P450 enzymes. It is converted, in part, to an active carboxylic acid metabolite that is responsible for most of the angiotensin II receptor antagonism that follows losartan treatment. About 14% of an orally-administered dose of losartan is converted to the active metabolite. In addition to the active carboxylic acid metabolite, several inactive metabolites are formed. In vitro studies indicate that cytochrome P450 2C9 and 3A4 are involved in the biotransformation of losartan to its metabolites. These dosages have been shown to provide respective systemic exposures AUCs for losartan, its active metabolite and hydrochlorothiazide that are approximately 60, 60 and 30 times greater than those achieved in humans with 100 mg of losartan potassium in combination with 25 mg of hydrochlorothiazide. Genetic testing alone cannot tell you if you have Marfan syndrome, as there are other connective tissue disorders. Marfan syndrome can rupture the inner layers of the aorta, causing dissection that leads to bleeding in the wall of the vessel. Aortic dissection can be deadly. Surgery may be required to replace the affected part of the aorta. Hypersensitivity reactions to hydrochlorothiazide may occur in patients with or without a history of allergy or bronchial asthma, but are more likely in patients with such a history. betapace order now payment otc
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Losartan plasma levels may be elevated, increasing the antihypertensive and adverse effects. Keep Losartan Potassium and Hydrochlorothiazide tablets in a tightly closed container, and keep Losartan Potassium and Hydrochlorothiazide tablets out of the light. ACE inhibitors. Vasculitis, including Henoch-Schönlein purpura, has been reported with losartan. Anaphylactic reactions have been reported. Investigations: Liver function abnormalities. Instruct patient to continue taking other BP medications as prescribed by health care provider. Heparin Low Molecular Weight: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding. F. Protect from light. The mean age was 53 years. Losartan Potassium and Hydrochlorothiazide tablets can be taken with or without food. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates. Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. High Blood Pressure hypertension. Blood pressure is the force in your blood vessels when your heart beats and when your heart rests. You have high blood pressure when the force is too much. The losartan ingredient in Losartan Potassium and Hydrochlorothiazide tablets can help your blood vessels relax so your blood pressure is lower. The hydrochlorothiazide ingredient in Losartan Potassium and Hydrochlorothiazide tablets work by making your kidneys pass more water and salt. The double-blind treatment period lasted up to 8 weeks. The incidence of cough is shown in Table 1 below. Potassium-Sparing Diuretics: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. CYP2C9 Substrates: CYP2C9 Inhibitors Moderate may decrease the metabolism of CYP2C9 Substrates. How should I store Losartan Potassium and Hydrochlorothiazide tablets? Store tablets at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. In efforts to control blood pressure, the patients in both arms of the LIFE study were coadministered hydrochlorothiazide the majority of time they were on study drug 73. Hypertension with left ventricular hypertrophy: Oral: Initial: 50 mg once daily; can be increased to 100 mg once daily based on blood pressure response. Brimonidine Topical: May enhance the hypotensive effect of Blood Pressure Lowering Agents. TiZANidine: CYP1A2 Inhibitors Weak may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. buy generic allopurinol pharmacy
Ora-Plus and Ora-Sweet SF. Combine 10 mL of purified water and ten losartan 50 mg tablets in a 240 mL amber polyethylene terephthalate bottle. Shake well for at least 2 minutes. Allow concentrate to stand for 1 hour, then shake for 1 minute. If you have kidney problems, you may see a worsening in how well your kidneys work. Call your doctor if you get swelling in your feet, ankles, or hands, or unexplained weight gain. Use cautiously, if at all, with these agents and monitor potassium closely. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. When pregnancy is detected, discontinue losartan as soon as possible. Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine.
Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue hydrochlorothiazide as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Emphasize importance of other modalities of BP control: moderate intake of alcohol and salt, regular exercise, smoking cessation, and weight control. Black patients: When used to reduce the risk of stroke in patients with HTN and LVH, may not be effective in the black population. The incidence of some adverse reactions varied based on the underlying disease state. Notations are made, where applicable, for data derived from trials conducted in type 2 diabetic nephropathy and hypertensive patients, respectively. Hypotension: Symptomatic hypotension may occur upon initiation in patients who are salt or volume depleted eg, those treated with high-dose diuretics; correct volume depletion prior to administration. This transient hypotensive response is not a contraindication to further treatment with losartan. Cough 11%; bronchitis 10%; upper respiratory tract infection 8%; sinusitis 6%; dry cough postmarketing. Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine. Plasma concentrations may be increased by losartan, resulting in an increase in the pharmacologic and adverse effects of lithium. Continued How Is Marfan Syndrome Diagnosed? Clifford Hudis, MD, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York. May use alone or in combination with other antihypertensive agents. Your doctor may do blood tests from time to time while you are taking Losartan Potassium and Hydrochlorothiazide tablets. Sarilumab: May decrease the serum concentration of CYP3A4 Substrates. ciprofloxacin
Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Symptomatic Hypotension: Advise patients that lightheadedness can occur, especially during the first days of therapy, and to report this symptom to a healthcare provider. Inform patients that dehydration from inadequate fluid intake, excessive perspiration, vomiting, or diarrhea may lead to an excessive fall in blood pressure. Distribution: The volume of distribution of losartan and the active metabolite is about 34 liters and 12 liters, respectively. AHA 2013 heart failure guidelines recommend an initial dose of 25 to 50 mg once daily; target dose: 150 mg once daily Yancy, 2013. ACE inhibitors, angiotensin II antagonists, or beta-blockers were added to the treatment regimen to reach the goal blood pressure. No carcinogenicity studies have been conducted with the losartan potassium-hydrochlorothiazide combination. Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind the hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by up to 85 and 43 percent, respectively. Stagger the dosage of hydrochlorothiazide and the resin such that hydrochlorothiazide is administered at least 4 hours before or 4 to 6 hours after the administration of the resin. Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium and chloride in approximately equivalent amounts. Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of an angiotensin II receptor antagonist tends to reverse the potassium loss associated with these diuretics. The mechanism of the antihypertensive effect of thiazides is unknown. Heparin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Hydrochlorothiazide USP is a white or practically white, practically odorless, crystalline powder with a molecular weight of 297. Psychiatric disorders: Insomnia, restlessness. American Heart Association with specific antibiotic guidelines. Adults: No dosage adjustment necessary unless the patient is volume depleted; monitor closely.
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Reduction in the Risk of Stroke: The LIFE study was a multinational, double-blind study comparing losartan and atenolol in 9193 hypertensive patients with ECG-documented left ventricular hypertrophy. Patients with myocardial infarction or stroke within six months prior to randomization were excluded. Eplerenone: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Warning: The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used as the sole basis for selecting a new medication. As with any medical decision, be sure to work with your doctor to ensure the best choices are made for your condition. generic clamoxin vs clamoxin
Hydrochlorothiazide was not genotoxic in vitro in the Ames mutagenicity assay of Salmonella typhimurium strains TA 98, TA 100, TA 1535, TA 1537, and TA 1538 and in the Chinese Hamster Ovary CHO test for chromosomal aberrations, or in vivo in assays using mouse germinal cell chromosomes, Chinese hamster bone marrow chromosomes, and the Drosophila sex-linked recessive lethal trait gene. Very important. A change in your diet, medicine, or dosage may be necessary. Promptly consult your doctor or pharmacist. Surgical patients: In patients on chronic angiotensin receptor blocker ARB therapy, intraoperative hypotension may occur with induction and maintenance of general anesthesia; however, discontinuation of therapy prior to surgery is controversial. If continued preoperatively, avoidance of hypotensive agents during surgery is prudent Hillis, 2011.
The terminal half-life of losartan is about 2 hours and of the metabolite is about 6 to 9 hours. After single doses of losartan administered orally, about 4% of the dose is excreted unchanged in the urine and about 6% is excreted in urine as active metabolite. Biliary excretion contributes to the elimination of losartan and its metabolites. Following oral 14C-labeled losartan, about 35% of radioactivity is recovered in the urine and about 60% in the feces. Following an intravenous dose of 14C-labeled losartan, about 45% of radioactivity is recovered in the urine and 50% in the feces. Neither losartan nor its metabolite accumulate in plasma upon repeated once-daily dosing.
Neonates with a history of in utero exposure to Losartan Potassium and Hydrochlorothiazide: If oliguria or hypotension occurs, direct attention toward support of blood pressure and renal perfusion. Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death. When pregnancy is detected, discontinue losartan as soon as possible. These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy. Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents. Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.