What happens if I overdose Kosartan Plus?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; fast or slow heartbeat; severe or unusual dizziness or light-headedness; symptoms of blood electrolyte problems (eg, confusion; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness); symptoms of dehydration (eg, decreased urination; dry mouth or eyes; fast heartbeat; unusual thirst, tiredness, or weakness).
Proper storage of Kosartan Plus:
Store Kosartan Plus at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Kosartan Plus out of the reach of children and away from pets.
Overdose of Kosartan Plus in details
No specific information is available on the treatment of overdosage with Kosartan Plus. Treatment is symptomatic and supportive. Therapy with Kosartan Plus should be discontinued and the patient observed closely. Suggested measures include induction of emesis if ingestion is recent, and correction of dehydration, electrolyte imbalance, hepatic coma and hypotension by established procedures.
Losartan (Kosartan Plus): 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.
Neither Losartan (Kosartan Plus) nor the active metabolite can be removed by hemodialysis.
Hydrochlorothiazide (Kosartan Plus): 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 (Kosartan Plus) is removed by hemodialysis has not been established.
What should I avoid while taking Kosartan Plus?
This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can further lower your blood pressure and may increase certain side effects of Kosartan Plus.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.
Do not use potassium supplements or salt substitutes while you are taking Kosartan Plus, unless your doctor has told you to.
Kosartan Plus warnings
Fetal Toxicity
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 Kosartan Plus as soon as possible.
Thiazides cross the placental barrier and appear in cord blood. Adverse reactions include fetal or neonatal jaundice, thrombocytopenia.
Hypotension in Volume- or Salt-Depleted Patients
In patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of treatment with Kosartan Plus. Correct volume or salt depletion prior to administration of Kosartan Plus. Do not use Kosartan Plus as initial therapy in patients with intravascular volume depletion.
Impaired Renal Function
Changes in renal function including acute renal failure can be caused by drugs that inhibit the reninangiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure on Kosartan Plus. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function on Kosartan Plus.
Hypersensitivity
Hypersensitivity reactions to Hydrochlorothiazide (Kosartan Plus) may occur in patients with or without a history of allergy or bronchial asthma, but are more likely in patients with such a history.
Electrolyte and Metabolic Effects
In double-blind clinical trials of various doses of Kosartan Plus, the incidence of hypertensive patients who developed hypokalemia (serum potassium <3.5 mEq/L) was 6.7% versus 3.5% for placebo; the incidence of hyperkalemia (serum potassium >5.7 mEq/L) was 0.4% versus 0% for placebo.
Kosartan Plus contains Hydrochlorothiazide (Kosartan Plus) which can cause hypokalemia, hyponatremia and hypomagnesemia. Hypomagnesemia can result in hypokalemia which may be difficult to treat despite potassium repletion. Kosartan Plus also contains Losartan (Kosartan Plus) which can cause hyperkalemia. Monitor serum electrolytes periodically.
Hydrochlorothiazide (Kosartan Plus) may alter glucose tolerance and raise serum levels of cholesterol and triglycerides.
Hyperuricemia may occur or frank gout may be precipitated in patients receiving thiazide therapy. Because Losartan (Kosartan Plus) decreases uric acid, Losartan (Kosartan Plus) in combination with Hydrochlorothiazide (Kosartan Plus) attenuates the diuretic-induced hyperuricemia.
Hydrochlorothiazide (Kosartan Plus) decreases urinary calcium excretion and may cause elevations of serum calcium. Monitor calcium levels.
Acute Myopia and Secondary Angle-Closure Glaucoma
Hydrochlorothiazide (Kosartan Plus), a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue Hydrochlorothiazide (Kosartan Plus) as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy.
Systemic Lupus Erythematosus
Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus.
Postsympathectomy Patients
The antihypertensive effects of the drug may be enhanced in the postsympathectomy patient.
What should I discuss with my healthcare provider before taking Kosartan Plus?
You should not use Kosartan Plus if you are allergic to Hydrochlorothiazide (Kosartan Plus) or Losartan (Kosartan Plus), if you are unable to urinate.
If you have diabetes, do not use Kosartan Plus together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).
You may also need to avoid taking Kosartan Plus with aliskiren if you have kidney disease
To make sure Kosartan Plus is safe for you, tell your doctor if you have:
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kidney disease;
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liver disease;
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congestive heart failure;
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glaucoma;
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asthma;
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low or high levels of potassium in your blood;
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gout;
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lupus;
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diabetes; or
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an allergy to sulfa drugs or penicillin.
Do not use Kosartan Plus if you are pregnant. Stop using and tell your doctor right away if you become pregnant. Kosartan Plus can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control.
It is not known whether Kosartan Plus passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Kosartan Plus precautions
Fetal Toxicity
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 Kosartan Plus as soon as possible.
Thiazides cross the placental barrier and appear in cord blood. Adverse reactions include fetal or neonatal jaundice, thrombocytopenia.
Hypotension in Volume- or Salt-Depleted Patients
In patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of treatment with Kosartan Plus. Correct volume or salt depletion prior to administration of Kosartan Plus. Do not use Kosartan Plus as initial therapy in patients with intravascular volume depletion.
Impaired Renal Function
Changes in renal function including acute renal failure can be caused by drugs that inhibit the reninangiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure on Kosartan Plus. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function on Kosartan Plus.
Hypersensitivity
Hypersensitivity reactions to Hydrochlorothiazide (Kosartan Plus) may occur in patients with or without a history of allergy or bronchial asthma, but are more likely in patients with such a history.
Electrolyte and Metabolic Effects
In double-blind clinical trials of various doses of Kosartan Plus, the incidence of hypertensive patients who developed hypokalemia (serum potassium <3.5 mEq/L) was 6.7% versus 3.5% for placebo; the incidence of hyperkalemia (serum potassium >5.7 mEq/L) was 0.4% versus 0% for placebo.
Kosartan Plus contains Hydrochlorothiazide (Kosartan Plus) which can cause hypokalemia, hyponatremia and hypomagnesemia. Hypomagnesemia can result in hypokalemia which may be difficult to treat despite potassium repletion. Kosartan Plus also contains Losartan (Kosartan Plus) which can cause hyperkalemia. Monitor serum electrolytes periodically.
Hydrochlorothiazide (Kosartan Plus) may alter glucose tolerance and raise serum levels of cholesterol and triglycerides.
Hyperuricemia may occur or frank gout may be precipitated in patients receiving thiazide therapy. Because Losartan (Kosartan Plus) decreases uric acid, Losartan (Kosartan Plus) in combination with Hydrochlorothiazide (Kosartan Plus) attenuates the diuretic-induced hyperuricemia.
Hydrochlorothiazide (Kosartan Plus) decreases urinary calcium excretion and may cause elevations of serum calcium. Monitor calcium levels.
Acute Myopia and Secondary Angle-Closure Glaucoma
Hydrochlorothiazide (Kosartan Plus), a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue Hydrochlorothiazide (Kosartan Plus) as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy.
Systemic Lupus Erythematosus
Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus.
Postsympathectomy Patients
The antihypertensive effects of the drug may be enhanced in the postsympathectomy patient.
What happens if I miss a dose of Kosartan Plus?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
References
- DailyMed. "AMLODIPINE BESYLATE; HYDROCHLOROTHIAZIDE; OLMESARTAN MEDOXOMIL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DailyMed. "LOSARTAN POTASSIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "hydrochlorothiazide". http://www.drugbank.ca/drugs/DB00999 (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
