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. Trimethoprim: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. 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.
Psychiatric disorders: Insomnia, restlessness. There was no difference in response for men and women or in patients over or under 65 years of age. As a selective and competitive, nonpeptide angiotensin II receptor antagonist, losartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; losartan interacts reversibly at the AT1 and AT2 receptors of many tissues and has slow dissociation kinetics; its affinity for the AT1 receptor is 1000 times greater than the AT2 receptor. Angiotensin II receptor antagonists may induce a more complete inhibition of the renin-angiotensin system than ACE inhibitors, they do not affect the response to bradykinin, and are less likely to be associated with nonrenin-angiotensin effects eg, cough and angioedema. Losartan increases urinary flow rate and in addition to being natriuretic and kaliuretic, increases excretion of chloride, magnesium, uric acid, calcium, and phosphate.
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. ACE Inhibitors. Angiotensin II Receptor Blockers may increase the serum concentration of ACE Inhibitors. Management: In US labeling, use of telmisartan and ramipril is not recommended. It is not clear if any other combination of an ACE inhibitor and an ARB would be any safer. Consider alternatives to the combination when possible. Although losartan may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking losartan. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.
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. Use cautiously, if at all, with these agents and monitor potassium closely. Tolvaptan: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Losartan inhibits the pressor effect of angiotensin II as well as angiotensin I infusions. A dose of 100 mg inhibits the pressor effect by about 85% at peak with 25 to 40% inhibition persisting for 24 hours. Removal of the negative feedback of angiotensin II causes a doubling to tripling in plasma renin activity and consequent rise in angiotensin II plasma concentration in hypertensive patients. Losartan does not affect the response to bradykinin, whereas ACE inhibitors increase the response to bradykinin. Aldosterone plasma concentrations fall following losartan administration. In spite of the effect of losartan on aldosterone secretion, very little effect on serum potassium was observed.
Initiation of Losartan Potassium and Hydrochlorothiazide is not recommended for patients with hepatic impairment because the appropriate starting dose of losartan, 25 mg, is not available. Losartan Potassium and Hydrochlorothiazide tablets have not been studied in children less than 18 years old. Black patients: When used to reduce the risk of stroke in patients with HTN and LVH, may not be effective in the black population. No. 10 aluminum lake. Take Losartan Potassium and Hydrochlorothiazide tablets exactly as prescribed by your doctor. Your doctor may change your dose if needed. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC. Patient may experience diarrhea, cold-like symptoms, back pain, loss of strength, and energy or rhinorrhea. Have patient report immediately to prescriber signs of kidney problems urinary retention, blood in urine, change in amount of urine passed, weight gain signs of high potassium abnormal heartbeat, confusion, dizziness, passing out, weak, shortness of breath, numbness or tingling feeling signs of low blood sugar dizziness, headache, fatigue, feeling weak, shaking, a fast heartbeat, confusion, hunger, or sweating severe dizziness, passing out, angina, or swelling of arms or legs HCAHPS. CYP2C9 Inhibitors Moderate: May decrease the metabolism of CYP2C9 Substrates. 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. They may harm them. Cannabis: CYP2C9 Inhibitors Moderate may increase the serum concentration of Cannabis. More specifically, tetrahydrocannabinol serum concentrations may be increased. 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. The most common signs and symptoms observed are those caused by electrolyte depletion hypokalemia, hypochloremia, hyponatremia and dehydration resulting from excessive diuresis. If digitalis has also been administered, hypokalemia may accentuate cardiac arrhythmias. The degree to which hydrochlorothiazide is removed by hemodialysis has not been established. What are Losartan Potassium and Hydrochlorothiazide tablets? Side Effects List Losartan POTASSIUM side effects by likelihood and severity.
Potassium Salts: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Losartan plasma levels may be reduced, decreasing the antihypertensive effects. Advise patient to take daily or bid as prescribed, without regard to meals, but to take with food if stomach upset occurs. We have lots of patients who get treated for breast cancer and take anti-hypertensives, so you would expect to see that pop out as an indicator of good outcomes. Persistent dry cough has been associated with ACE-inhibitor use and in practice can be a cause of discontinuation of ACE-inhibitor therapy. Two prospective, parallel-group, double-blind, randomized, controlled trials were conducted to assess the effects of losartan on the incidence of cough in hypertensive patients who had experienced cough while receiving ACE-inhibitor therapy. Neither losartan nor its active metabolite inhibits ACE kininase II, the enzyme that converts angiotensin I to angiotensin II and degrades bradykinin nor do they bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation. Investigations: Liver function abnormalities. What Are Side Effects Associated with Using Losartan?
Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus. 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. Ceritinib: May increase the serum concentration of CYP2C9 Substrates. The gene, AGTR1, caused normal cells to act like highly invasive cells, both in the laboratory and in mice. Blood and the lymphatic system disorders: Anemia, aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis. The University of Michigan has filed a patent on AGTR1 and is seeking commercial partners. Linear pharmacokinetics. Vd is 34 L losartan and 12 L metabolite. Losartan and active metabolite are highly bound to plasma proteins, primarily albumin. Neither losartan or metabolite accumulates in plasma upon repeated daily dosing. Sarilumab: May decrease the serum concentration of CYP3A4 Substrates. The antihypertensive effect of angiotensin II receptor antagonists, including losartan, may be attenuated by NSAIDs, including selective COX-2 inhibitors. Antihepaciviral Combination Products: May increase the serum concentration of Losartan. Management: Per antihepaciviral combination product US prescribing information, consider decreasing the losartan dose and monitoring for evidence of hypotension and worsening renal function if these agents are used in combination. Chest pain 12%; diabetic vascular disease, influenza-like symptoms 10%; infection 5%; diabetic neuropathy, fever, trauma 4%.
The pharmacokinetics of losartan and its active metabolite are linear with oral losartan doses up to 200 mg and do not change over time. Daniel Rhodes, PhD, a research investigator in the Michigan Center for Translational Pathology and the lead author of the study, which appears in the June 1 edition of Proceedings of the National Academy of Sciences. Rhodes is also the founder and CEO of a genomics company, Compendia Biosciences. Instruct patient to inform health care provider if persistent cough develops while taking this medication. Keep Losartan Potassium and Hydrochlorothiazide tablets in a tightly closed container, and keep Losartan Potassium and Hydrochlorothiazide tablets out of the light. Co, Inc, Whitehouse Station, NJ, 2015. Of the randomized patients, 4963 54% were female and 533 6% were Black. Keep container tightly closed. Protect from light. Grapefruit juice may decrease the amount of active losartan in your blood. 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. Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates. Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely particularly therapeutic effects. Genetic testing alone cannot tell you if you have Marfan syndrome, as there are other connective tissue disorders. What are the ingredients in Losartan Potassium and Hydrochlorothiazide tablets? Talk to your doctor about other ways to lower your blood pressure if you plan to become pregnant.
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. At the end of study or at the last visit before a primary endpoint, 77% of the group treated with losartan and 73% of the group treated with atenolol were still taking study medication. After oral administration of hydrochlorothiazide, diuresis begins within 2 hours, peaks in about 4 hours, and lasts about 6 to 12 hours. If combined, monitor potassium, creatinine, and blood pressure closely. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. In patients who experience a decline in renal function, discontinuation of AR antagonist therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with AR antagonists, since therapy can usually be reinstated without difficulty after blood pressure stabilizes. LIFE study patients there were 29 primary endpoints among 263 patients on atenolol 11%, 26 per 1000 patient-years and 46 primary endpoints among 270 patients 17%, 42 per 1000 patient-years on losartan. This finding could not be explained on the basis of differences in the populations other than race or on any imbalances between treatment groups. In addition, blood pressure reductions in both treatment groups were consistent between Black and non-Black patients. Given the difficulty in interpreting subset differences in large trials, it cannot be known whether the observed difference is the result of chance. 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. It may require surgery. Ames microbial mutagenesis assay and the V-79 Chinese hamster lung cell mutagenesis assay. In addition, there was no evidence of direct genotoxicity in the in vitro alkaline elution assay in rat hepatocytes and in vitro chromosomal aberration assay in Chinese hamster ovary cells at noncytotoxic concentrations. Biliary excretion contributes to the elimination of losartan and metabolite. About 4% is excreted unchanged in the urine and 6% excreted as active metabolite in urine. May not be as effective in black hypertensive patients, especially those with left ventricular hypertrophy. The double-blind treatment period lasted up to 8 weeks. The incidence of cough is shown in Table 1 below.
OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Patients receiving the combination of losartan and lisinopril did not obtain any additional benefit compared to monotherapy for the combined endpoint of decline in GFR, end-stage renal disease, or death, but experienced an increased incidence of hyperkalemia and acute kidney injury compared with the monotherapy group. Long arms, legs, fingers, and toes and flexible joints. Canadian labeling: Use is not recommended. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Tetrahydrocannabinol: CYP2C9 Inhibitors Moderate may increase the serum concentration of Tetrahydrocannabinol. Oral: Administer without regard to meals; however, administer consistently with respect to food intake at about the same time every day. Americans. It is found in people of all races and ethnic backgrounds. 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. Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding. Others may need or surgery.
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Chronic kidney disease CKD and hypertension: Regardless of race or diabetes status, the use of an ACE inhibitor ACEI or angiotensin receptor blocker ARB as initial therapy is recommended to improve kidney outcomes. In the general nonblack population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB.
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. WebMD User Reviews should not be considered as medical advice and are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences may be a helpful health information resource but they are never a substitute for professional medical advice from a qualified healthcare provider.
Increases in serum lithium concentrations and lithium toxicity have been reported with concomitant use of angiotensin II receptor antagonists or thiazide diuretics. Monitor lithium levels in patients receiving Losartan Potassium and Hydrochlorothiazide and lithium. 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. Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Skin and subcutaneous tissue disorders: Rash, pruritus, purpura, toxic epidermal necrolysis, urticaria, photosensitivity, cutaneous lupus erythematosus. Shake suspension well before measuring and administering prescribed dose. Use dosing syringe, dosing spoon, or dosing cup to measure and administer dose. Return suspension to refrigerator immediately after measuring dose. Sticklers syndrome. How Is Marfan Syndrome Treated?