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. 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. Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor 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 can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. cheap motilium order shopping otc
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. Instruct patient to immediately discontinue drug and notify health care provider if any of the following occur: swelling of the face, lips, eyelids, or tongue, difficulty breathing, or difficulty swallowing.
There may be new information. This leaflet does not take the place of talking with your doctor about your condition and treatment. May use alone or in combination with other antihypertensive agents. 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.
No. 10 aluminum lake. 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.
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. CYP2C8 Substrates: CYP2C8 Inhibitors Moderate may decrease the metabolism of CYP2C8 Substrates. 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. When unstented bilateral renal artery stenosis is present, use is generally avoided due to the elevated risk of deterioration in renal function unless possible benefits outweigh risks. Administer without regard to meals. Administer with food if GI upset occurs. 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. They may harm them.
This information is generalized and not intended as specific medical advice. 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. 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. 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. Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides. rizatriptan
Nervous system disorders: Dysgeusia, headache, migraine, paraesthesias. The NTP, however, found equivocal evidence for hepatocarcinogenicity in male mice. 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. 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%. Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Hydrochlorothiazide is not metabolized but is eliminated rapidly by the kidney. 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. Losartan Potassium and Hydrochlorothiazide tablets and certain other medicines may interact with each other. Use cautiously, if at all, with these agents and monitor potassium closely. Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. esro.info nimotop
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. 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 plasma levels may be reduced, decreasing the antihypertensive effects. CYP2C9 Inhibitors Strong: May decrease the metabolism of CYP2C9 Substrates. 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. What are the ingredients in 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. 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. Are There Physical Traits in People With Marfan Syndrome? 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. Hypertension with left ventricular hypertrophy: Oral: Initial: 50 mg once daily; can be increased to 100 mg once daily based on blood pressure response. II receptor blocker acting on the AT 1 receptor subtype and a diuretic, hydrochlorothiazide. Thiazides cross the placental barrier and appear in cord blood. Following oral administration, the AUC for hydrochlorothiazide is increased by 70 and 700% for patients with mild and moderate renal insufficiency, respectively. In this study, renal clearance of hydrochlorothiazide decreased by 45 and 85% in patients with mild and moderate renal impairment, respectively. Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. mail order geodon australia
Plasma concentrations may be increased by losartan, resulting in an increase in the pharmacologic and adverse effects of lithium. Rate and magnitude of losartan metabolism to its active metabolite may be decreased, possibly reducing the efficacy; however, based on available data, a clinically important interaction is unlikely. Cases of cough, including positive re-challenges, have been reported with the use of losartan in postmarketing experience. Consult your healthcare professional before taking or discontinuing any drug, changing your diet or commencing any course of treatment. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. There was no significant effect on heart rate. 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. 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. Instruct patient to lie or sit down if they experience dizziness or light-headedness when standing. Siltuximab: May decrease the serum concentration of CYP3A4 Substrates. Refer to adult dosing. 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. order now azelastine online
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. Losartan Potassium and Hydrochlorothiazide tablets may be administered with other antihypertensive agents. Sticklers syndrome. How Is Marfan Syndrome Treated? Drospirenone: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of Drospirenone. 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. Safety and effectiveness of Losartan Potassium and Hydrochlorothiazide in pediatric patients have not been established. Musculoskeletal and connective tissue disorders: Muscle cramps, muscle spasm, myalgia, arthralgia.
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. The mean age was 53 years. Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding. 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. 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. Sarilumab: May decrease the serum concentration of CYP3A4 Substrates. What should I tell my doctor before taking Losartan Potassium and Hydrochlorothiazide tablets? Do not use a household spoon because you may not get the correct dose. Cardiac disorders: Palpitation, tachycardia. Psychiatric disorders: Insomnia, restlessness. DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. 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. 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. buy crixivan email
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Plasma losartan concentrations are about twice as high in hypertensive women as hypertensive men, but plasma concentrations of active metabolite are similar. May not be as effective in black hypertensive patients, especially those with left ventricular hypertrophy. 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. Genetic testing alone cannot tell you if you have Marfan syndrome, as there are other connective tissue disorders. 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? Instruct patient to inform health care provider if persistent cough develops while taking this medication. Eye problems. One of the medicines in Losartan Potassium and Hydrochlorothiazide tablets can cause eye problems that, if left untreated, may lead to vision loss. Symptoms of eye problems can happen within hours to weeks of starting Losartan Potassium and Hydrochlorothiazide tablets. LVH. Losartan Potassium and Hydrochlorothiazide tablets may not help Black patients with this problem. Plasma protein binding is constant over the concentration range achieved with recommended doses. Studies in rats indicate that losartan crosses the blood-brain barrier poorly, if at all. Losartan Potassium and Hydrochlorothiazide tablets are not usually the first medicine used to treat high blood pressure. Ora-Plus and Ora-Sweet SF and shake for 1 min to disperse ingredients. Caution patient not to change the dose or stop taking unless advised by health care provider. buy adapalene indicacao
Do not share this medication with others. Renal impairment: Use with caution with preexisting renal insufficiency. 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. 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. This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects. 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. Bosentan: May decrease the serum concentration of CYP3A4 Substrates. 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. Hg is reasonable for the secondary prevention of cardiovascular events. Undergoes substantial first-pass metabolism by CYP-450 2C9 and 3A4 enzymes. Fourteen percent of an oral dose is converted to an active carboxylic acid metabolite that is responsible for most of the angiotensin II receptor antagonist activity. 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. Heparin Low Molecular Weight: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Emphasize importance of other modalities of BP control: moderate intake of alcohol and salt, regular exercise, smoking cessation, and weight control. 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. femara
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. The goal of surgery for Marfan syndrome is to prevent aortic dissection or rupture and to treat problems affecting the heart's valves, which control the flow of blood in and out of the heart and between the heart's chambers. Back pain 12%; muscular weakness 7%; knee pain, leg pain 5%; muscle cramp 1%; rhabdomyolysis postmarketing. In these cases, another medication called a may be recommended. Hydrochlorothiazide USP is a white or practically white, practically odorless, crystalline powder with a molecular weight of 297. 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 Potassium and Hydrochlorothiazide as soon as possible. Trimethoprim: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Keep container tightly closed. Protect from light. Do not stop taking any medications without consulting your healthcare provider. How Does Marfan Sydrome Affect Lifestyle Choices? Some products may contain potassium. bicalutamide
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. AHA 2013 heart failure guidelines recommend an initial dose of 25 to 50 mg once daily; target dose: 150 mg once daily Yancy, 2013. 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. Hepatic impairment: Use with caution in patients with hepatic impairment or a history of hepatic impairment; dose adjustment needed. 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. Keep Losartan Potassium and Hydrochlorothiazide tablets in a tightly closed container, and keep Losartan Potassium and Hydrochlorothiazide tablets out of the light. There was no difference in response for men and women or in patients over or under 65 years of age. Resveratrol: May decrease serum concentrations of the active metabolites of Losartan. Resveratrol may increase the serum concentration of Losartan. 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. 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. Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents.
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Renal and urinary disorders: Glycosuria, renal dysfunction, interstitial nephritis, renal failure. Long arms, legs, fingers, and toes and flexible joints. Dabrafenib: May decrease the serum concentration of CYP2C9 Substrates. Management: Seek alternatives to the CYP2C9 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely particularly therapeutic effects. Dronabinol: CYP2C9 Inhibitors Moderate may increase the serum concentration of Dronabinol. Use is not recommended.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, severe loss of body water and minerals dehydration. Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. The exposed fetus should be monitored for fetal growth, amniotic fluid volume, and organ formation. Infants exposed in utero should be monitored for hyperkalemia, hypotension, and oliguria exchange transfusions or dialysis may be needed. These adverse events are generally associated with maternal use in the second and third trimesters.
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. ASH 2015 scientific statement for the treatment of hypertension in patients with coronary artery disease CAD recommends the use of an ARB or ACE inhibitor as part of a regimen in patients with hypertension and chronic stable angina if there is prior MI, LV systolic dysfunction, diabetes mellitus, or CKD. Hypoglycemia 14%; hyperkalemia 7%; weight gain 4%; hyponatremia postmarketing. Advise patient to take daily or bid as prescribed, without regard to meals, but to take with food if stomach upset occurs.
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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. 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.