Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Bosentan: May decrease the serum concentration of CYP3A4 Substrates. 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.
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.
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. Warning: The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used as the sole basis for selecting a new medication. As with any medical decision, be sure to work with your doctor to ensure the best choices are made for your condition. Angioedema: Angioedema has been reported rarely with some angiotensin II receptor antagonists ARBs and may occur at any time during treatment especially following first dose. It may involve the head and neck potentially compromising airway or the intestine presenting with abdominal pain. Patients with idiopathic or hereditary angioedema or previous angioedema associated with angiotensin-converting enzyme ACE inhibitor therapy may be at an increased risk. Prolonged frequent monitoring may be required, especially if tongue, glottis, or larynx are involved, as they are associated with airway obstruction. Patients with a history of airway surgery may have a higher risk of airway obstruction. Discontinue therapy immediately if angioedema occurs. Aggressive early management is critical. Intramuscular IM administration of epinephrine may be necessary. Do not readminister to patients who have had angioedema with ARBs.
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. Hypoglycemia 14%; hyperkalemia 7%; weight gain 4%; hyponatremia postmarketing. Heparin: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers.
Losartan plasma levels may be reduced, decreasing the antihypertensive effects. 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. Grapefruit juice may decrease the amount of active losartan in your blood. What Causes Marfan Syndrome? Hydrochlorothiazide is not metabolized but is eliminated rapidly by the kidney. What is the most important information I should know about Losartan Potassium and Hydrochlorothiazide tablets? Siltuximab: May decrease the serum concentration of CYP3A4 Substrates. Total plasma Cl of losartan is reduced about 50% and oral bioavailability is increased 2 times. A lower starting dose is recommended. 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. Co, Inc, Whitehouse Station, NJ, 2015. Oral: Administer without regard to meals; however, administer consistently with respect to food intake at about the same time every day. No. 10 aluminum lake. 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.
GFR is dependent on efferent arteriolar vasoconstriction by angiotensin II; deterioration may result in oliguria, acute renal failure, and progressive azotemia. In these cases, another medication called a may be recommended. Category D second and third trimester; Category C first trimester. If you take too much Losartan Potassium and Hydrochlorothiazide tablets, call your doctor or Poison Control Center, or go to the nearest hospital emergency room right away. Losartan Potassium and Hydrochlorothiazide tablets can cause harm or death to an unborn baby. Losartan Potassium and Hydrochlorothiazide is available for oral administration in three tablet combinations of losartan and hydrochlorothiazide. CYP3A4 Inducers Moderate: May decrease the serum concentration of CYP3A4 Substrates. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. Dapoxetine: May enhance the orthostatic hypotensive effect of Angiotensin II Receptor Blockers. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? salmeterol
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. Eye disorders: Xanthopsia, transient blurred vision. F. Protect from light. 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. This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects. What are the possible side effects of Losartan Potassium and Hydrochlorothiazide tablets? Losartan Potassium and Hydrochlorothiazide tablets may be administered with other antihypertensive agents. Emotional considerations. Learning you have Marfan syndrome may cause you to feel angry, frightened or sad. You may need to make changes in your lifestyle and adjust to having careful medical follow-up the rest of your life. You may have financial concerns. You also need to consider the risk to your future children. The National Marfan Foundation can provide support. At baseline, 1195 13% had diabetes, 1326 14% had isolated systolic hypertension, 1469 16% had coronary heart disease, and 728 8% had cerebrovascular disease. Minor increases in BUN or serum creatinine, small decreases in Hgb and Hct, occasional elevations in liver enzymes and serum bilirubin postmarketing. Eplerenone: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. What should I tell my doctor before taking Losartan Potassium and Hydrochlorothiazide tablets? CycloSPORINE Systemic: Angiotensin II Receptor Blockers may enhance the hyperkalemic effect of CycloSPORINE Systemic. 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? 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. azithromycin in india azithromycin
The mean age was 53 years. If surgery is needed, you should consult with a surgeon who is experienced in surgery for Marfan syndrome. People who have surgery for Marfan syndrome still require life-long follow-up care to prevent future complications associated with the disease. Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly. The effect of losartan is substantially present within one week but in some studies the maximal effect occurred in 3 to 6 weeks. 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. 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.
Vascular disorders: Dose-related orthostatic effects, necrotizing angiitis vasculitis, cutaneous vasculitis. HFSA, 2010; Konstam, 2009. 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. 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. Hepatic impairment: Use with caution in patients with hepatic impairment or a history of hepatic impairment; dose adjustment needed. Adults: No dosage adjustment necessary unless the patient is volume depleted; monitor closely. giba.info griseofulvin
Digestive: Hepatitis has been reported rarely in patients treated with losartan. Scapa E. Effect of grapefruit juice on the pharmacokinetics of losartan and its active metabolite E3174 in healthy volunteers. Tetrahydrocannabinol: CYP2C9 Inhibitors Moderate may increase the serum concentration of Tetrahydrocannabinol. Black patients: When used to reduce the risk of stroke in patients with HTN and LVH, may not be effective in the black population. No 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. is doxepin safe and effective
Losartan Potassium and Hydrochlorothiazide. Monitor renal function periodically in these patients. HER2 in order to develop more targeted treatments for women whose breast cancers are not HER2-positive and therefore do not respond to Herecptin. 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. Use caution in treating patients whose renal function may depend on the renin-angiotension-aldosterone system eg, patients with severe CHF. Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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. Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Neither losartan nor its active metabolite inhibits ACE kininase II, the enzyme that converts angiotensin I to angiotensin II and degrades bradykinin nor do they bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation. Do not use a household spoon because you may not get the correct dose. 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 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. Before having surgery, tell your doctor or dentist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
Antihepaciviral Combination Products: May increase the serum concentration of Losartan. Management: Per antihepaciviral combination product US prescribing information, consider decreasing the losartan dose and monitoring for evidence of hypotension and worsening renal function if these agents are used in combination. May use alone or in combination with other antihypertensive agents. June 1, 2009 -- Researchers at the University of Michigan have identified a gene that may be involved in as many as one in five cancers. And the gene could be blocked by a common drug. How should I store Losartan Potassium and Hydrochlorothiazide tablets? 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. 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. Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. The incidence of some adverse reactions varied based on the underlying disease state. Notations are made, where applicable, for data derived from trials conducted in type 2 diabetic nephropathy and hypertensive patients, respectively. 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. Talk to your doctor about other ways to lower your blood pressure if you plan to become pregnant. 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. Others may need or surgery. Side Effects List Losartan POTASSIUM side effects by likelihood and severity. Safety and effectiveness of Losartan Potassium and Hydrochlorothiazide in pediatric patients have not been established. Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. cheapest neurontin order now store
Cataract 7%; nasal congestion 2%. Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. What Are Side Effects Associated with Using Losartan? 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. 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. 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. Blood and the lymphatic system disorders: Anemia, aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis. cheap cephalexin indication
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How often did hospital staff describe possible side effects in a way you could understand? Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides. 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. ceftin
AHA 2013 heart failure guidelines recommend an initial dose of 25 to 50 mg once daily; target dose: 150 mg once daily Yancy, 2013. Refer to adult dosing. 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. Heparin Low Molecular Weight: May enhance the hyperkalemic effect of Angiotensin II Receptor Blockers.
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. What Is Losartan and How Does It Work? Back pain 12%; muscular weakness 7%; knee pain, leg pain 5%; muscle cramp 1%; rhabdomyolysis postmarketing. DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. 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.
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. Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. There are no dosage adjustments provided in the manufacturer's labeling. Do not stop taking any medications without consulting your healthcare provider. 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.