Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Angiotensin II receptor AR antagonists can cause renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic hypotension can occur in susceptible individuals, which may compromise renal and myocardial perfusion. 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.
Others may need or surgery. Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in light-headedness or fainting. II receptor blocker acting on the AT 1 receptor subtype and a diuretic, hydrochlorothiazide. The pharmacodynamic consequences of concomitant use of losartan and inhibitors of P450 2C9 have not been examined. Subjects who do not metabolize losartan to active metabolite have been shown to have a specific, rare defect in cytochrome P450 2C9. These data suggest that the conversion of losartan to its active metabolite is mediated primarily by P450 2C9 and not P450 3A4.
Advise patient to try to take each dose at about the same time each day. No carcinogenicity studies have been conducted with the losartan potassium-hydrochlorothiazide combination. There was no significant effect on heart rate. Do not use a household spoon because you may not get the correct dose. Hydrochlorothiazide is not metabolized but is eliminated rapidly by the kidney.
Advise patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Advise patient to take record of BP and pulse to each follow-up visit. Drospirenone: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Drospirenone. Losartan Potassium and Hydrochlorothiazide. Correct volume or salt depletion prior to administration of Losartan Potassium and Hydrochlorothiazide. Do not use Losartan Potassium and Hydrochlorothiazide as initial therapy in patients with intravascular volume depletion. 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. 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. Losartan plasma levels may be elevated, increasing the antihypertensive and adverse effects. How often did hospital staff describe possible side effects in a way you could understand? Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, severe loss of body water and minerals dehydration. Your doctor may do blood tests from time to time while you are taking Losartan Potassium and Hydrochlorothiazide tablets. HFSA, 2010; Konstam, 2009. Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Herbs Hypotensive Properties: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Do not stop taking any medications without consulting your healthcare provider. What are the possible side effects of Losartan Potassium and Hydrochlorothiazide tablets?
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. Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Safety and effectiveness of Losartan Potassium and Hydrochlorothiazide in pediatric patients have not been established. Long arms, legs, fingers, and toes and flexible joints. How Does Marfan Sydrome Affect Lifestyle Choices? Canagliflozin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Canagliflozin may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides. After 6 weeks of therapy, more patients who received the combination regimen reached target diastolic blood pressure than those who received the monotherapy regimen 29. bupropion
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. Brimonidine Topical: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Eye disorders: Xanthopsia, transient blurred vision. The administration of a non-steroidal anti-inflammatory agent including a selective COX-2 inhibitor can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Therefore, when Losartan Potassium and Hydrochlorothiazide and non-steroidal anti-inflammatory agents including selective COX-2 inhibitors are used concomitantly, observe closely to determine if the desired effect of the diuretic is obtained. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function including acute renal failure compared to monotherapy. Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue Losartan Potassium and Hydrochlorothiazide, unless it is considered lifesaving for the mother. Fetal testing may be appropriate, based on the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. Mitotane: May decrease the serum concentration of CYP3A4 Substrates. Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Coadministration of losartan with other drugs that raise serum potassium levels may result in hyperkalemia. Monitor serum potassium in such patients. 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. Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Digestive: Hepatitis has been reported rarely in patients treated with losartan. maxem.info diltiazem-ointment
Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Losartan belongs to a class of drugs called ARBs. It works by relaxing blood vessels so that blood can flow more easily. Those with dilation of the aorta will be asked to avoid high intensity team sports, contact sports, and isometric exercises such as . Ask your cardiologist about activity guidelines for you. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. Do not coadminister aliskiren with Losartan Potassium and Hydrochlorothiazide in patients with diabetes. 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. Sodium Phosphates: Angiotensin II Receptor Blockers may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with ARBs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Ora-Plus and Ora-Sweet SF; add to tablet and water mixture in the bottle and shake for 1 minute. Label "shake well" and "refrigerate". Return promptly to refrigerator after each use. Stable for 4 weeks when stored in amber polyethylene terephthalate prescription bottles and refrigerated Cozaar prescribing information, 2015. Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. In the Losartan Intervention For Endpoint reduction in hypertension LIFE study, Black patients with hypertension and left ventricular hypertrophy treated with atenolol had a lower risk of stroke, the primary composite endpoint, as compared with Black patients treated with losartan both cotreated with hydrochlorothiazide in the majority of patients. What is the most important information I should know about Losartan Potassium and Hydrochlorothiazide tablets? Blood pressure reduction measured at trough was similar for both treatment groups but blood pressure was not measured at any other time of the day. At the end of study or at the last visit before a primary endpoint, the mean blood pressures were 144. Cataract 7%; nasal congestion 2%. Educate patient about signs of a significant reaction eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Note: This is not a comprehensive list of all side effects. Patients should consult prescriber for additional questions.
Bosentan: CYP2C9 Inhibitors Moderate may increase the serum concentration of Bosentan. Management: Concomitant use of both a CYP2C9 inhibitor and a CYP3A inhibitor or a single agent that inhibits both enzymes with bosentan is likely to cause a large increase in serum concentrations of bosentan and is not recommended. See monograph for details. Potassium Salts: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. RifAMPin: May decrease the serum concentration of Losartan. Keep Losartan Potassium and Hydrochlorothiazide tablets and all medicines out of the reach of children. What Are Side Effects Associated with Using Losartan? Losartan Potassium and Hydrochlorothiazide tablets can cause harm or death to an unborn baby. 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. Neither losartan nor its active metabolite can be removed by hemodialysis. Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Canadian labeling: Use is not recommended. generic curacne capsules
When losartan is taken with grapefruit juice, the grapefruit juice may decrease the ability of your body to activate losartan. This decreased amount of activated losartan may be insufficient to control your blood pressure. 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. 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. Inform patient that drug controls, but does not cure, hypertension and to continue taking drug as prescribed even when BP is not elevated. May use alone or in combination with other antihypertensive agents. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. 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. How should I take Losartan Potassium and Hydrochlorothiazide tablets? 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. Gastrointestinal disorders: Dyspepsia, abdominal pain, gastric irritation, cramping, diarrhea, constipation, nausea, vomiting, pancreatitis, sialoadenitis. 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. benemid buy online usa
Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding. Grapefruit juice may decrease the amount of active losartan in your blood. Musculoskeletal and connective tissue disorders: Muscle cramps, muscle spasm, myalgia, arthralgia. 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. 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. They may harm them. 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. The NTP, however, found equivocal evidence for hepatocarcinogenicity in male mice. Untreated chronic maternal hypertension is also associated with adverse events in the fetus, infant, and mother. The use of angiotensin II receptor blockers is not recommended to treat chronic uncomplicated hypertension in pregnant women and should generally be avoided in women of reproductive potential ACOG, 2013. Losartan is used to treat high blood pressure hypertension and to help protect the kidneys from damage due to diabetes. It is also used to lower the risk of strokes in patients with high blood pressure and an enlarged heart. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Losartan belongs to a class of drugs called angiotensin receptor blockers ARBs. It works by relaxing blood vessels so that blood can flow more easily. While you are taking this medicine, you should avoid eating grapefruit or drinking grapefruit juice. You may choose an alternative citrus beverage such as orange juice.
Dronabinol: CYP2C9 Inhibitors Moderate may increase the serum concentration of Dronabinol. Hyperuricemia may occur or frank gout may be precipitated in patients receiving thiazide therapy. Because losartan decreases uric acid, losartan in combination with hydrochlorothiazide attenuates the diuretic-induced hyperuricemia. 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. Tell your doctor about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Limited data are available in regard to overdosage in humans. The most likely manifestation of overdosage would be hypotension and tachycardia; bradycardia could occur from parasympathetic vagal stimulation. If symptomatic hypotension should occur, supportive treatment should be instituted. CYP2C9 Inhibitors Moderate: May decrease the metabolism of CYP2C9 Substrates. 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. 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. No. 10 aluminum lake. Losartan pharmacokinetics have been investigated in the elderly 65 to 75 years and in both genders. Plasma concentrations of losartan and its active metabolite are similar in elderly and young hypertensives. Plasma concentrations of losartan were about twice as high in female hypertensives as male hypertensives, but concentrations of the active metabolite were similar in males and females. This medication may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist. Other diagnostic tests for Marfan syndrome include a slit lamp in which the doctor will check for dislocated lenses. online stromectol kopen zonder recept
Co, Inc, Whitehouse Station, NJ, 2015. In most cases, Marfan syndrome is inherited from a parent, but 1 in 4 cases occurs in people with no known family history of the disease. It occurs equally in men and women, who have a 50% risk of passing on the gene to their children. Marfan syndrome is present at birth, but may not be diagnosed until adolescence or later. Everyone with Marfan syndrome has the same defective gene, but not everyone experiences the same symptoms to the same degree. St John's Wort: May decrease the serum concentration of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Losartan Potassium and Hydrochlorothiazide tablets are not usually the first medicine used to treat high blood pressure. Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. 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. Chest pain 12%; diabetic vascular disease, influenza-like symptoms 10%; infection 5%; diabetic neuropathy, fever, trauma 4%. Losartan Potassium and Hydrochlorothiazide tablets have not been studied in children less than 18 years old. Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Well absorbed. Food decreases absorption but has only minor effects on losartan AUC or AUC of active metabolite. Systemic bioavailability is about 33%. T max is 1 h losartan and 3 to 4 h metabolite. About FAERS: The FDA Adverse Event Reporting System FAERS is used by FDA for activities such as looking for new safety concerns that might be related to a marketed product, evaluating a manufacturer's compliance to reporting regulations and responding to outside requests for information. Reporting of adverse events is a voluntary process, and not every report is sent to FDA and entered into FAERS. clomipramine
It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding. Black patients: When used to reduce the risk of stroke in patients with HTN and LVH, may not be effective in the black population. Make dose adjustments as needed unless the patient is volume depleted. 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. MiFEPRIStone: May increase the serum concentration of CYP2C9 Substrates. Management: Use CYP2C9 substrates at the lowest recommended dose, and monitor closely for adverse effects, during and in the 2 weeks following mifepristone treatment. Allergic reaction. Symptoms of an allergic reaction are swelling of the face, lips, throat, or tongue. Get emergency medical help right away and stop taking Losartan Potassium and Hydrochlorothiazide tablets. Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Losartan Potassium and Hydrochlorothiazide tablets and certain other medicines may interact with each other. Hypertension with left ventricular hypertrophy: Oral: Initial: 50 mg once daily; can be increased to 100 mg once daily based on blood pressure response. Losartan plasma levels may be reduced, decreasing the antihypertensive effects. 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. Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Tell your doctor if your condition does not improve or if it worsens for example, your blood pressure readings increase. Hepatic impairment: Use with caution in patients with hepatic impairment or a history of hepatic impairment; dose adjustment needed. Respiratory, thoracic and mediastinal disorders: Nasal congestion, pharyngitis, sinus disorder, respiratory distress including pneumonitis and pulmonary edema. flagyl
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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. 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. Hydrochlorothiazide USP is a white or practically white, practically odorless, crystalline powder with a molecular weight of 297.
Herbs Hypertensive Properties: May diminish the antihypertensive effect of Antihypertensive Agents. Oral: Administer without regard to meals; however, administer consistently with respect to food intake at about the same time every day. There may be new information. This leaflet does not take the place of talking with your doctor about your condition and treatment. USP and 25 mg of hydrochlorothiazide USP. Inactive ingredients are colloidal silicon dioxide, hydroxypropyl cellulose, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinisedstarchmaize and titanium dioxide.
Documentation of allergenic cross-reactivity for angiotensin receptor blockers is limited. 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. F. Protect from light.
Patients on monotherapy were titrated from losartan 50 mg to losartan 100 mg to losartan 150 mg, as needed. Hepato-biliary disorders: Jaundice intrahepatic cholestatic jaundice. Caution patient not to take any prescription or OTC medications, potassium-containing salt substitutes, potassium supplements, dietary supplements, or herbal preparations unless advised by health care provider.