Indications & Dose:
Treatment of hypertension, for patients in whom combination therapy is appropriate.
Usual starting and maintenance : One tablet 50-12.5 (losartan 50mg/hydrochlorothiazide 12.5mg) once daily. For patients who do not respond adequately the dosage may be increased to two tablets 50-12.5 once daily. The maximum dose is two tablets of 50- 12.5 once daily. May be administered with or without food. May be administered with other antihypertensive agents
Contraindications:
Hypersensitive to any component of this product, patients with anuria, patients who are hypersensitive to other sulfonamide-derived drugs, who are intravascularly volume-depleted (e.g., those treated with high-dose diuretics). With severe renal impairment (creatinine clearance 30 mL/min) or for patients with hepatic impairment.
Side Effects:
Hypersensitivity: Anaphylactic reactions, angioedema including swelling of the larynx and glottis causing airway obstruction and/or swelling of the face, lips, pharynx and/or tongue has been reported rarely in patients treated with losartan; some of these patients previously experienced angio-edema with other drugs including ACE inhibitors.
Gastrointestinal: Hepatitis has been reported rarely in patients treated with losartan, diarrhea.
Respiratory: Cough
Cautions:
Precautions:
Pregnancy: Used in pregnancy during the second and third trimesters, drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus. When pregnancy is detected, should be discontinued as soon as possible.
Breast feeding, paediatrics: Safety and effectiveness have not been established.
Elderly: Can be used with great cautions.
Interaction:
Drugs
Hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbitol
Alcohol, barbiturates, or narcotics potentiation of orthostatic hypotension may occur.
Ketoconazole and erythromycin. Rifampin and fluconazole have been reported to reduce levels of active metabolite.
Spironolactone, triamterence, amiloride, potassium supplements, or salt substitutes containing potas-sium may lead to increases in serum potassium.
Indomethacin: Attenuated.
Antidiabetic drugs (oral agents and insulin) – dosage adjustment of the antidiabetic drug may be required.
Other antihypertensive drugs – additive effect.
Cholestyramine and colestipol resins – 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.
Corticosteroids, ACTH – intensified electrolyte depletion, particularly hypokalemia.
Pressor amines (e.g. adrenaline) – possible decreased response to pressor amines but not sufficient to preclude their use.
Skeletal muscle relaxants, nondepolarising (e.g. tubocurarine) – possible increased responsiveness to the muscle relaxant.
Lithium – Diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity; concomitant use is not recommended. Refer to the package inserts for lithium preparations before use of such preparations.
Non-Steroidal Anti-inflammatory Drugs – In some patients, the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of diuretics
Warnings:
Adverse Effects:
Lactations:
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Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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