Losartan hctz 50 12 mg
Primary hyperaldosteronism Patients with primary aldosteronism generally will not respond to antihypertensive drugs acting through inhibition of the renin-angiotensin system. Coronary heart disease and cerebrovascular disease: As with any antihypertensive agents, losartan hctz 50 12 mg, excessive blood pressure decrease in patients with ischaemic cardiovascular and cerebrovascular disease could result in a myocardial infarction or stroke.
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 50 MG/12.5 MG FILM-COATED TABLETS
In patients with heart failure, with or without renal impairment, there is - as with other drugs acting on the renin-angiotensin system - a risk of severe arterial hypotension, and often acute renal impairment. Aortic and mitral valve stenosis, losartan hctz 50 12 mg, obstructive hypertrophic cardiomyophathy As with other vasodilators, special price of amlodipine besylate is indicated in patients suffering from aortic or mitral stenosis, or obstructive hypertrophic cardiomyopathy.
Ethnic differences As observed for angiotensin converting enzyme inhibitors, losartan and the other angiotensin antagonists are apparently less effective in lowering blood pressure in black people than hctz non-blacks, possibly because of higher prevalence of low-renin states in the black hypertensive population.
Dual blockade of the renin-angiotensin-aldosterone system RAAS There is evidence that the concomitant use of ACE-inhibitors, angiotensin II losartan blockers or aliskiren increases the risk of hypotension, hyperkalaemia and decreased renal function including acute renal failure, losartan hctz 50 12 mg.
If dual blockade therapy is considered absolutely necessary, losartan hctz 50 12 mg, this should only occur under specialist supervision and subject losartan frequent close monitoring of renal function, electrolytes and blood pressure.
Patients should be observed for clinical signs of fluid or electrolyte imbalance, e. Periodic determination of serum electrolytes should be performed hctz appropriate intervals in such patients. Dilutional hyponatraemia may occur in oedematous patients in hot weather, losartan hctz 50 12 mg.
Metabolic and endocrine effects Thiazide therapy may impair glucose tolerance. Dosage adjustment of antidiabetic agents, including insulin, may be required see section 4. Latent diabetes mellitus may become manifest during thiazide therapy.
Thiazides may decrease urinary calcium excretion and may cause intermittent and slight elevation of serum calcium. Marked hypercalcemia may be evidence of hidden hyperparathyroidism. Thiazides should be discontinued before carrying out tests for parathyroid function. Increases in cholesterol and triglyceride levels losartan be associated with thiazide diuretic therapy.
Because losartan decreases uric acid, losartan in combination with hydrochlorothiazide attenuates the diuretic induced hyperuricemia. Hepatic impairment Thiazides should be used with caution in patients with impaired hepatic function or progressive liver losartan, as it may cause intrahepatic cholestasis, and since minor alterations of fluid and electrolyte balance may precipitate hepatic coma.
Other In patients receiving thiazides, hypersensitivity reactions may occur with or without a hctz of allergy or bronchial asthma. Exacerbation or hctz of systemic lupus erythematosus has been reported with the use of thiazides. Excipient This medicinal product contains lactose.
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine see section 6. The clinical consequences of these interactions have not been evaluated.
As with other drugs that block angiotensin II or its effects, concomitant use of potassium-sparing diuretics e. Co-medication is not advisable.
As with other medicines which affect the excretion of sodium, lithium excretion may be reduced, losartan hctz 50 12 mg. Therefore, serum lithium levels should be monitored carefully if lithium salts are to be coadministered with angiotensin II receptor antagonists. Concomitant use of angiotensin II antagonists or diuretics and NSAIDs may lead to an increased risk of worsening of renal function, including possible acute losartan failure, and an increase in serum potassium, hctz in patients with poor pre-existing renal function.
The combination should be administered with caution, especially in the elderly. Patients should be adequately hydrated and consideration should be given to monitoring renal function after initiation of concomitant therapy, and periodically thereafter. Hctz some patients with compromised renal function who are being treated with non-steroidal anti-inflammatory drugs, including anafranil retard 75 mg cyclooxygenase-2 inhibitors, the co-administration of angiotensin II losartan antagonists may result in a further deterioration of renal function.
This drug may make you dizzy. Alcohol or marijuana can make you more dizzy. Do not drive, losartan hctz 50 12 mg, use machinery, or do anything that needs alertness until you can do it safely, losartan hctz 50 12 mg. Talk to your doctor if you are using marijuana. Severe sweatingdiarrheaor vomiting can increase the risk for lightheadedness or a serious loss of hctz water dehydration. Report prolonged diarrhea or vomiting to your doctor.
To losartan dehydrationdrink plenty of fluids unless your doctor directs you otherwise.
Losartan potassium/Hydrochlorothiazide 50 mg/12.5 mg film-coated tablets
If you have diabeteslosartan hctz 50 12 mg, this product may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. It also stimulates aldosterone secretion by the adrenal cortex. Losartan and its principal active metabolite block the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor found in many losartan e.
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 hctz about 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 Losartan 1 receptor. The active metabolite is 10 to 40 times more potent by weight than losartan and hctz to be a reversible, non-competitive inhibitor of the AT 1 receptor.
Losartan-Hydrochlorothiazide
Neither losartan nor its active metabolite inhibits ACE kininase II, losartan enzyme that converts angiotensin I to angiotensin II and degrades bradykininnor do they bind to or block other losartan receptors or ion channels known to be important in cardiovascular regulation. Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, losartan hctz 50 12 mg, directly increasing excretion of sodium and chloride in approximately equivalent amounts.
Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume, losartan hctz 50 12 mg, with consequent increases in losartan renin activity, losartan hctz 50 12 mg, 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. Pharmacodynamics Losartan Potassium Losartan inhibits the pressor effect of angiotensin II as well as angiotensin I infusions. 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 hctz 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, closest otc to nexium little effect on serum potassium was observed, losartan hctz 50 12 mg.
The effect of losartan is substantially present within one week but in some studies the maximal effect occurred in hctz. In long-term follow-up studies without placebo control the effect of losartan appeared to be maintained for up to a year. There is no apparent rebound effect after abrupt withdrawal of losartan. There was essentially no change in average heart rate in losartan-treated patients in controlled trials.
Hydrochlorothiazide After oral administration of hydrochlorothiazide, diuresis begins within 2 hours, peaks in about 4 hours, and lasts about 6 to 12 hours. Drug Interactions Alcohol, barbiturates, or narcotics — potentiation of orthostatic hypotension may occur.
Other antihypertensive drugs — additive effect or potentiation. Skeletal muscle relaxants, nondepolarizing e. Corticosteroids, ACTH, or glycyrrhizin found in liquorice — intensified electrolyte depletion, particularly hypokalemia. Pharmacokinetics Losartan Potassium Absorption Following oral administration, losartan is well absorbed and undergoes substantial first-pass metabolism. Mean peak concentrations of losartan and its active metabolite are reached in 1 hour and in hours, respectively.
While maximum plasma concentrations of losartan and its active metabolite are approximately equal, losartan hctz 50 12 mg, the AUC area under the curve of the metabolite is about 4 times as great as that of losartan. The pharmacokinetics of losartan and its active metabolite are linear with oral losartan doses up to mg and do hctz change over time.
Distribution The xanax ativan mg of distribution of losartan hctz the active metabolite is about 34 liters and 12 liters, respectively. Both losartan and its active metabolite are highly bound to plasma proteins, primarily albumin, with plasma free fractions of 1.
Plasma protein binding hctz constant over the concentration range achieved with recommended doses. Studies in rats indicate that losartan crosses the blood-brain barrier poorly, losartan hctz 50 12 mg, billig viagra denmark at all. Metabolism Losartan is an orally active agent that undergoes substantial first-pass metabolism by cytochrome P 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.
In addition to the active carboxylic acid metabolite, several inactive metabolites are formed. In vitro studies indicate that cytochrome P 2C9 and 3A4 are involved in the biotransformation of losartan to its metabolites.
The terminal half-life of losartan is about 2 hours and of the metabolite is about hours. Biliary excretion contributes to the elimination of losartan and its metabolites.
Neither losartan nor its metabolite accumulate in plasma upon repeated once-daily dosing. Hydrochlorothiazide Hydrochlorothiazide is not metabolized but is eliminated rapidly by the kidney. When plasma levels have been followed for at least 24 hours, the plasma half-life has been observed to vary between 5, losartan hctz 50 12 mg.
At least 61 percent of the oral dose is eliminated unchanged within 24 hours. Hydrochlorothiazide crosses the placental losartan not the blood-brain barrier and is losartan in renova review a losartan. Special Populations Geriatric and Gender Losartan pharmacokinetics have been investigated in the elderly 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. Race Pharmacokinetic differences due to race have not been studied [see also Use In Specific Hctz ]. Hepatic Insufficiency Following oral administration in patients with mild to moderate alcoholic cirrhosis of the liver, plasma concentrations of losartan hctz its active metabolite were, respectively, 5 times and about 1.
The lower starting dose of losartan recommended for use in patients with hepatic impairment cannot be given using HYZAAR. Drug Interactions Losartan Potassium No clinically significant drug interactions have been found in studies of losartan potassium with hydrochlorothiazide, digoxin, warfarin, cimetidine and phenobarbital.