The NTP, however, found equivocal evidence for hepatocarcinogenicity in male mice. Low blood pressure hypotension. Low blood pressure may cause you to feel faint or dizzy. Lie down if you feel faint or dizzy. Call your doctor right away. Store tablets at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. HER2 in order to develop more targeted treatments for women whose breast cancers are not HER2-positive and therefore do not respond to Herecptin. This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.
In a controlled clinical study for the reduction in the combined risk of cardiovascular death, stroke and myocardial infarction in hypertensive patients with left ventricular hypertrophy, 2857 patients 62% were 65 years and over, while 808 patients 18% were 75 years and over. In an effort to control blood pressure in this study, patients were coadministered losartan and hydrochlorothiazide 74% of the total time they were on study drug. No overall differences in effectiveness were observed between these patients and younger patients. What are Losartan Potassium and Hydrochlorothiazide tablets? Thiazides cross the placental barrier and appear in cord blood. There is a risk of fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions that have occurred in adults.
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. Use caution in treating patients whose renal function may depend on the renin-angiotension-aldosterone system eg, patients with severe CHF. Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Minor increases in BUN or serum creatinine, small decreases in Hgb and Hct, occasional elevations in liver enzymes and serum bilirubin postmarketing.
Heparin Low Molecular Weight: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Tell your doctor if your condition does not improve or if it worsens for example, your blood pressure readings increase. The primary endpoint was the first occurrence of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction.
In patients receiving diuretic therapy, coadministration of NSAIDs with angiotensin receptor blockers, including losartan, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving hydrochlorothiazide, losartan, and NSAID therapy. 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. AGTR1 shrunk by 30% within eight weeks. The scans can also be used to check the lower back for signs of dural ectasia, a back problem that is common in people with Marfan syndrome. It may require surgery. Herbs Hypertensive Properties: May diminish the antihypertensive effect of Antihypertensive Agents. AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased. Dizziness or lightheadedness may occur as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. The following adverse reactions have been identified during post-approval use of Losartan Potassium and Hydrochlorothiazide. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency reliably or to establish a causal relationship to drug exposure. 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. Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. CYP2C9 Inhibitors Strong: May decrease the metabolism of CYP2C9 Substrates. Marfan syndrome requires a treatment plan that is individualized to the patient's needs. In patients who are hypersensitive to any component of this product.
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. There was no difference in response for men and women or in patients over or under 65 years of age. Fluconazole: May decrease the serum concentration of Losartan. Specifically, fluconazole may decrease the serum concentration of E3174, the more potent active metabolite of losartan. Anaphylactic reactions, angioedema including swelling of the larynx and glottis, swelling of the face, lips, pharynx, and tongue vasculitis including Henoch-Schönlein purpura postmarketing. Medications are typically not used to treat Marfan syndrome. However, your doctor may prescribe a beta-blocker, which decreases the forcefulness of the heartbeat and the pressure within the arteries, thus preventing or slowing the enlargement of the aorta. Beta-blocker therapy is usually started when the person with Marfan syndrome is young. Dronabinol: CYP2C9 Inhibitors Moderate may increase the serum concentration of Dronabinol. 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. Long arms, legs, fingers, and toes and flexible joints. 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. Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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. There was no significant effect on heart rate. cabergoline
Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Losartan Potassium and Hydrochlorothiazide can pass into your milk and may harm your baby. You and your doctor should decide if you will take Losartan Potassium and Hydrochlorothiazide tablets or breastfeed. You should not do both. AHA 2013 heart failure guidelines recommend an initial dose of 25 to 50 mg once daily; target dose: 150 mg once daily Yancy, 2013. The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism may have low potassium levels; those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected prior to initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower thiazide dosage, potassium supplementation, or combined use with a potassium-sparing diuretic. Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in light-headedness or fainting. Keep Losartan Potassium and Hydrochlorothiazide tablets in a tightly closed container, and keep Losartan Potassium and Hydrochlorothiazide tablets out of the light. 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. 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. Hypoglycemia 14%; hyperkalemia 7%; weight gain 4%; hyponatremia postmarketing. Losartan Potassium and Hydrochlorothiazide tablets are indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular CV events, primarily strokes and myocardial infarction. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including losartan and hydrochlorothiazide. 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. 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. vdom.info travatan
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. Respective AUCs for losartan, its active metabolite and hydrochlorothiazide at these dosages in rats were approximately 35, 10 and 10 times greater than those achieved in humans with the administration of 100 mg of losartan in combination with 25 mg hydrochlorothiazide. Vascular disorders: Dose-related orthostatic effects, necrotizing angiitis vasculitis, cutaneous vasculitis. Grapefruit juice may decrease the amount of active losartan in your blood. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC. The gene, AGTR1, caused normal cells to act like highly invasive cells, both in the laboratory and in mice. Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. 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. 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.
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. 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. 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. Injury or death of unborn babies. See “What is the most important information I should know about Losartan Potassium and Hydrochlorothiazide tablets? Concomitant use of potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium. 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. CYP2C8 Substrates: CYP2C8 Inhibitors Moderate may decrease the metabolism of CYP2C8 Substrates. Losartan Potassium and Hydrochlorothiazide. Monitor renal function periodically in these patients. Coadministration of losartan with other drugs that raise serum potassium levels may result in hyperkalemia. Monitor serum potassium in such patients. Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides. Tell your doctor if you get any side effect that bothers you or that won't go away. This is not a complete list of side effects. For a complete list, ask your doctor or pharmacist. bukkit lost chloramphenicol
There are no dosage adjustments provided in the manufacturer's labeling. Ceritinib: May increase the serum concentration of CYP2C9 Substrates. Dapoxetine: May enhance the orthostatic hypotensive effect of Angiotensin II Receptor Blockers. If combined, monitor potassium, creatinine, and blood pressure closely. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. Losartan plasma levels may be elevated, increasing the antihypertensive and adverse effects. benemid online pharmacy reviews
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. Enzalutamide: May decrease the serum concentration of CYP2C9 Substrates. Management: Concurrent use of enzalutamide with CYP2C9 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP2C9 substrate should be performed with caution and close monitoring. 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. Compared to normal subjects, the total plasma clearance of losartan in patients with hepatic insufficiency was about 50% lower, and the oral bioavailability was about doubled. The lower starting dose of losartan recommended for use in patients with hepatic impairment cannot be given using Losartan Potassium and Hydrochlorothiazide. See “What is the most important information I should know about Losartan Potassium and Hydrochlorothiazide tablets? Discuss specific use of drug and side effects with patient as it relates to treatment. HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? 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. Herbs Hypotensive Properties: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Aliskiren: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Aliskiren may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Because AGTR1 is involved in the constriction of vessels, its activity is blocked by a class of drugs called angiotensin receptor blockers, which include losartan, the drug tested in this study. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Siltuximab: May decrease the serum concentration of CYP3A4 Substrates. Losartan potassium was not carcinogenic when administered at maximally tolerated dosages to rats and mice for 105 and 92 weeks, respectively. 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. These effects can occur even if grapefruit is not consumed at the same time of the losartan dose. This interaction may occur at any time in your treatment with losartan if grapefruit or grapefruit juice is consumed.
Distribution: The volume of distribution of losartan and the active metabolite is about 34 liters and 12 liters, respectively. Read the Patient Information Leaflet if available from your pharmacist before you start taking losartan and each time you get a refill. If you have any questions, ask your doctor or pharmacist. 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. Side Effects List Losartan POTASSIUM side effects by likelihood and severity. 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. baclofen online store order now
This leaflet summarizes the most important information about Losartan Potassium and Hydrochlorothiazide tablets. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information that is written for health professionals. If you are using the liquid form of this medication, shake the bottle well before each dose. 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. Marfan syndrome is caused by a change in the gene that controls how the body makes fibrillin, an essential component of connective tissue that contributes to its strength and elasticity. CYP3A4 Inducers Moderate: May decrease the serum concentration of CYP3A4 Substrates. etodolac
Use is not recommended. Losartan Potassium and Hydrochlorothiazide is available for oral administration in three tablet combinations of losartan and hydrochlorothiazide. 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. CYP3A4 Inducers Strong: May increase the metabolism of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Make dose adjustments as needed unless the patient is volume depleted. 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. 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. The decision to perform surgery is based on the size of the aorta, expected normal size of the aorta, rate of aortic growth, age, height, gender, and family history of aortic dissection. Surgery involves replacing the dilated portion of the aorta with a graft, a piece of man-made material that is inserted to replace the damaged or weak area of the blood vessel.
Losartan Potassium and Hydrochlorothiazide tablets have not been studied in children less than 18 years old. 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. Total plasma Cl of losartan is reduced about 50% and oral bioavailability is increased 2 times. A lower starting dose is recommended. Pregnancy: Advise female patients of childbearing age about the consequences of exposure to Losartan Potassium and Hydrochlorothiazide during pregnancy. Discuss treatment options with women planning to become pregnant. 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. tamsulosin
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The antihypertensive effects of the drug may be enhanced in the postsympathectomy patient. In patients who are elderly, volume-depleted including those on diuretic therapy or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists including losartan may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving losartan and NSAID therapy. Instruct patient to inform health care provider if persistent cough develops while taking this medication.
Losartan plasma levels may be reduced, decreasing the antihypertensive effects. 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. 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.
Closely monitor blood pressure, renal function, and electrolytes in patients on Losartan Potassium and Hydrochlorothiazide and other agents that affect the RAS. Absorption: Following oral administration, losartan is well absorbed and undergoes substantial first-pass metabolism. The systemic bioavailability of losartan is approximately 33%. Mean peak concentrations of losartan and its active metabolite are reached in 1 hour and in 3 to 4 hours, respectively. While maximum plasma concentrations of losartan and its active metabolite are approximately equal, the AUC area under the curve of the metabolite is about 4 times as great as that of losartan.
Metabolism and nutrition disorders: Anorexia, hyperglycemia, hyperuricemia, electrolyte imbalance including hyponatremia and hypokalemia. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Hypertension with left ventricular hypertrophy: Oral: Initial: 50 mg once daily; can be increased to 100 mg once daily based on blood pressure response. These considerations may guide selection of therapy.