Losartan + Hidroclorotiazida Eplit Uses

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What is Losartan + Hidroclorotiazida Eplit?

Losartan + Hidroclorotiazida Eplit contains a combination of Losartan + Hidroclorotiazida Eplit. Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention. Losartan (Losartan + Hidroclorotiazida Eplit) is an angiotensin II receptor antagonist. Losartan (Losartan + Hidroclorotiazida Eplit) keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

Losartan + Hidroclorotiazida Eplit is used to treat high blood pressure (hypertension). It is also used to lower the risk of stroke in certain people with heart disease.

Losartan + Hidroclorotiazida Eplit may also be used for purposes not listed in this medication guide.

Losartan + Hidroclorotiazida Eplit indications

Hypertension

Losartan + Hidroclorotiazida Eplit® is 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 (Losartan + Hidroclorotiazida Eplit) and Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit).

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. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

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.

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.

Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.

This fixed dose combination is not indicated for initial therapy of hypertension, except when the hypertension is severe enough that the value of achieving prompt blood pressure control exceeds the risk of initiating combination therapy in these patients.

Losartan + Hidroclorotiazida Eplit may be administered with other antihypertensive agents.

Hypertensive Patients With Left Ventricular Hypertrophy

Losartan + Hidroclorotiazida Eplit is indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, but there is evidence that this benefit does not apply to Black patients.

How should I use Losartan + Hidroclorotiazida Eplit?

Use Losartan + Hidroclorotiazida Eplit as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Losartan + Hidroclorotiazida Eplit.

Uses of Losartan + Hidroclorotiazida Eplit in details

Use: Labeled Indications

Hypertension: Management of hypertension.

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.

Losartan + Hidroclorotiazida Eplit description

Each tablet contains Losartan (Losartan + Hidroclorotiazida Eplit) potassium 50 or 100 mg and Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) 12.5 mg.

Losartan (Losartan + Hidroclorotiazida Eplit) Potassium: Losartan (Losartan + Hidroclorotiazida Eplit) potassium, a nonpeptide molecule, is chemically described as 2-butyl-4-chloro-1-[[2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl]methyl]-1H-imidazole-5-methanol monopotassium salt.

Its empirical formula is C22H22ClKN6O.

Losartan (Losartan + Hidroclorotiazida Eplit) potassium is a white to off-white free-flowing crystalline powder with a molecular weight of 461.01. It is freely soluble in water, soluble in alcohols, and slightly soluble in common organic solvents eg, acetonitrile and methyl ethyl ketone.

Oxidation of the 5-hydroxymethyl group on the imidazole ring results in the active metabolite of Losartan (Losartan + Hidroclorotiazida Eplit).

Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit): Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) is 6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide.

Its empirical formula is C7H8ClN3O4S2.

It is a white, or practically white, crystalline powder with a molecular weight of 297.74, which is slightly soluble in water, but freely soluble in sodium hydroxide solution.

Losartan + Hidroclorotiazida Eplit dosage

Hypertension

The usual starting dose of Losartan + Hidroclorotiazida Eplit is 50/12.5 (Losartan (Losartan + Hidroclorotiazida Eplit) 50 mg/Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) 12.5 mg) once daily. The dosage can be increased after 3 weeks of therapy to a maximum of 100/25 (Losartan (Losartan + Hidroclorotiazida Eplit) 100 mg/Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) 25 mg) once daily as needed to control blood pressure.

Initiate a patient whose blood pressure is not adequately controlled with Losartan (Losartan + Hidroclorotiazida Eplit) 50 mg monotherapy with Losartan + Hidroclorotiazida Eplit 50/12.5 once daily. If blood pressure remains uncontrolled after about 3 weeks of therapy, the dosage may be increased to two tablets of Losartan + Hidroclorotiazida Eplit 50/12.5 once daily or one tablet of Losartan + Hidroclorotiazida Eplit 100/25 once daily.

Initiate a patient whose blood pressure is not adequately controlled with Losartan (Losartan + Hidroclorotiazida Eplit) 100 mg monotherapy with Losartan + Hidroclorotiazida Eplit 100/12.5 (Losartan (Losartan + Hidroclorotiazida Eplit) 100 mg/Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) 12.5 mg) once daily. If blood pressure remains uncontrolled after about 3 weeks of therapy, increase the dose to two tablets of Losartan + Hidroclorotiazida Eplit 50/12.5 once daily or one tablet of Losartan + Hidroclorotiazida Eplit 100/25 once daily.

Initiate a patient whose blood pressure is inadequately controlled with Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) 25 mg once daily, or is controlled but who experiences hypokalemia with this regimen, on Losartan + Hidroclorotiazida Eplit 50/12.5 once daily, reducing the dose of Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) without reducing the overall expected antihypertensive response. Evaluate the clinical response to Losartan + Hidroclorotiazida Eplit 50/12.5 and, if blood pressure remains uncontrolled after about 3 weeks of therapy, increase the dose to two tablets of Losartan + Hidroclorotiazida Eplit 50/12.5 once daily or one tablet of Losartan + Hidroclorotiazida Eplit 100/25 once daily.

Hypertensive Patients with Left Ventricular Hypertrophy

In patients whose blood pressure is not adequately controlled on 50 mg Losartan (Losartan + Hidroclorotiazida Eplit) potassium, initiate treatment with Losartan + Hidroclorotiazida Eplit 50/12.5. If additional blood pressure reduction is needed, increase the dose to Losartan + Hidroclorotiazida Eplit 100/12.5, followed by Losartan + Hidroclorotiazida Eplit 100/25. For further blood pressure reduction add other antihypertensives.

Losartan + Hidroclorotiazida Eplit interactions

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What other drugs will affect Losartan + Hidroclorotiazida Eplit?

Agents Increasing Serum Potassium

Coadministration of Losartan (Losartan + Hidroclorotiazida Eplit) with other drugs that raise serum potassium levels may result in hyperkalemia. Monitor serum potassium in such patients.

Lithium

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 + Hidroclorotiazida Eplit and lithium.

Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors

Losartan (Losartan + Hidroclorotiazida Eplit) Potassium

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 (Losartan + Hidroclorotiazida Eplit)) 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 (Losartan + Hidroclorotiazida Eplit) and NSAID therapy.

The antihypertensive effect of angiotensin II receptor antagonists, including Losartan (Losartan + Hidroclorotiazida Eplit), may be attenuated by NSAIDs, including selective COX-2 inhibitors.

Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit)

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 + Hidroclorotiazida Eplit 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.

In patients receiving diuretic therapy, coadministration of NSAIDs with angiotensin receptor blockers, including Losartan (Losartan + Hidroclorotiazida Eplit), 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 (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit), Losartan (Losartan + Hidroclorotiazida Eplit), and NSAID therapy.

Dual Blockade Of The Renin-Angiotensin System (RAS)

Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy.

The Veterans Affairs Nephropathy in Diabetes (VA NEPHRON-D) trial enrolled 1448 patients with type 2 diabetes, elevated urinary-albumin-to-creatinine ratio, and decreased estimated glomerular filtration rate (GFR 30 to 89.9 mL/min), randomized them to lisinopril or placebo on a background of Losartan (Losartan + Hidroclorotiazida Eplit) therapy and followed them for a median of 2.2 years. Patients receiving the combination of Losartan (Losartan + Hidroclorotiazida Eplit) and lisinopril did not obtain any additional benefit compared to monotherapy for the combined endpoint of decline in GFR, end-stage renal disease, or death, but experienced an increased incidence of hyperkalemia and acute kidney injury compared with the monotherapy group.

Closely monitor blood pressure, renal function, and electrolytes in patients on Losartan + Hidroclorotiazida Eplit and other agents that affect the RAS.

Do not coadminister aliskiren with Losartan + Hidroclorotiazida Eplit in patients with diabetes. Avoid use of aliskiren with Losartan + Hidroclorotiazida Eplit in patients with renal impairment (GFR < 60 mL/min).

The Use Of Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) With Other Drugs

When administered concurrently, the following drugs may interact with thiazide diuretics :

Antidiabetic drugs (oral agents and insulin) — dosage adjustment of the antidiabetic drug may be required.

Cholestyramine and colestipol resins — Absorption of Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind the Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) and reduce its absorption from the gastrointestinal tract by up to 85 and 43 percent, respectively. Stagger the dosage of Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) and the resin such that Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) is administered at least 4 hours before or 4 to 6 hours after the administration of the resin.

Losartan + Hidroclorotiazida Eplit side effects

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What are the possible side effects of Losartan + Hidroclorotiazida Eplit?

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Losartan (Losartan + Hidroclorotiazida Eplit) potassium-Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) 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. In controlled clinical trials, discontinuation of therapy due to clinical adverse events was required in only 2.8% and 2.3% of patients treated with the combination and placebo, respectively.

In these double-blind controlled clinical trials, adverse reactions occurring in greater than 2% of subjects treated with Losartan (Losartan + Hidroclorotiazida Eplit)-Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) and at a greater rate than placebo were: back pain (2.1% vs 0.6%), dizziness (5.7% vs 2.9%), and upper respiratory infection (6.1% vs 4.6%).

The following additional adverse reactions have been reported in clinical trials with Losartan + Hidroclorotiazida Eplit and/or the individual components:

Blood and the lymphatic system disorders: Anemia, aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis.

Metabolism and nutrition disorders: Anorexia, hyperglycemia, hyperuricemia, electrolyte imbalance including hyponatremia and hypokalemia.

Psychiatric disorders: Insomnia, restlessness.

Nervous system disorders: Dysgeusia, headache, migraine, paraesthesias.

Eye disorders: Xanthopsia, transient blurred vision.

Cardiac disorders: Palpitation, tachycardia.

Vascular disorders: Dose-related orthostatic effects, necrotizing angiitis (vasculitis, cutaneous vasculitis).

Respiratory, thoracic and mediastinal disorders: Nasal congestion, pharyngitis, sinus disorder, respiratory distress (including pneumonitis and pulmonary edema).

Gastrointestinal disorders: Dyspepsia, abdominal pain, gastric irritation, cramping, diarrhea, constipation, nausea, vomiting, pancreatitis, sialoadenitis.

Hepato-biliary disorders: Jaundice (intrahepatic cholestatic jaundice).

Skin and subcutaneous tissue disorders: Rash, pruritus, purpura, toxic epidermal necrolysis, urticaria, photosensitivity, cutaneous lupus erythematosus.

Musculoskeletal and connective tissue disorders: Muscle cramps, muscle spasm, myalgia, arthralgia.

Renal and urinary disorders: Glycosuria, renal dysfunction, interstitial nephritis, renal failure.

Reproductive system and breast disorders: Erectile dysfunction/impotence.

General disorders and administration site conditions: Chest pain, edema/swelling, malaise, fever, weakness.

Investigations: Liver function abnormalities.

Cough

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 (Losartan + Hidroclorotiazida Eplit) on the incidence of cough in hypertensive patients who had experienced cough while receiving ACE-inhibitor therapy. Patients who had typical ACE-inhibitor cough when challenged with lisinopril, whose cough disappeared on placebo, were randomized to Losartan (Losartan + Hidroclorotiazida Eplit) 50 mg, lisinopril 20 mg, or either placebo (one study, n=97) or 25 mg Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) (n=135). The double-blind treatment period lasted up to 8 weeks. The incidence of cough is shown in Table 1 below.

Table 1:
*
Demographics = (89% Caucasian, 64% female)
Demographics = (90% Caucasian, 51% female)
Study 1* HCTZ Losartan (Losartan + Hidroclorotiazida Eplit) Lisinopril
Cough 25% 17% 69%
Study 2† Placebo Losartan (Losartan + Hidroclorotiazida Eplit) Lisinopril
Cough 35% 29% 62%

These studies demonstrate that the incidence of cough associated with Losartan (Losartan + Hidroclorotiazida Eplit) therapy, in a population that all had cough associated with ACE-inhibitor therapy, is similar to that associated with Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit) or placebo therapy.

Cases of cough, including positive re-challenges, have been reported with the use of Losartan (Losartan + Hidroclorotiazida Eplit) in postmarketing experience.

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of Losartan + Hidroclorotiazida Eplit. 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.

Digestive: Hepatitis has been reported rarely in patients treated with Losartan (Losartan + Hidroclorotiazida Eplit).

Hematologic: Thrombocytopenia.

Hypersensitivity: 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 (Losartan + Hidroclorotiazida Eplit); some of these patients previously experienced angioedema with other drugs including ACE inhibitors. Vasculitis, including Henoch-Schönlein purpura, has been reported with Losartan (Losartan + Hidroclorotiazida Eplit). Anaphylactic reactions have been reported.

Musculoskeletal: rhabdomyolysis

Skin: Erythroderma

Losartan + Hidroclorotiazida Eplit contraindications

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What is the most important information I should know about Losartan + Hidroclorotiazida Eplit?

Hypersensitivity to Losartan (Losartan + Hidroclorotiazida Eplit), sulphonamide-derived substances (as Hydrochlorothiazide (Losartan (Losartan + Hidroclorotiazida Eplit) + Hidroclorotiazida Eplit)) or to any of the excipients of Losartan + Hidroclorotiazida Eplit.

Therapy resistant hypokalemia or hypercalcemia; severe hepatic impairment; cholestasis and biliary obstructive disorders; refractory hyponatremia; symptomatic hyperuricemia/gout; 2nd and 3rd trimester of pregnancy; lactation; severe renal impairment (ie, creatinine clearance <30 mL/min); anuria.

Excipient: Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take Losartan + Hidroclorotiazida Eplit.

Use in lactation: It is not known whether Losartan (Losartan + Hidroclorotiazida Eplit) is excreted in human milk. However, Losartan (Losartan + Hidroclorotiazida Eplit) is excreted in the milk of lactating rats. Because no information is available regarding the use of Losartan (Losartan + Hidroclorotiazida Eplit) during breastfeeding, Losartan (Losartan + Hidroclorotiazida Eplit) is not recommended and alternative treatments with better established safety profiles during breastfeeding are preferable, especially while nursing a newborn or preterm infant.

Thiazides pass into human milk and may inhibit lactation. Because of the potential for adverse effects on the nursing infant, Losartan (Losartan + Hidroclorotiazida Eplit)/HCTZ is contraindicated during breastfeeding.

Active ingredient matches for Losartan + Hidroclorotiazida Eplit:

Hydrochlorothiazide/Losartan in Portugal.

List of Losartan + Hidroclorotiazida Eplit substitutes (brand and generic names)

Sort by popularity
Unit description / dosage (Manufacturer)Price, USD
Tablet; Oral; Losartan Potassium 50 mg; Hydrochlorothiazide 12.5 mg
Losartar-H Losartan K , Hydrochlorothiazide TAB / 10 (Shrrishti HC)$ 0.60
10's (Shrrishti HC)$ 0.60
LOSARTAR-H tab 10's (Shrrishti HC)$ 0.60
Losartas HT Hydrochlorothiazide 12.5mg, Losartan K 50mg TAB / 7$ 0.69
Losartas HT Tablet (Intas Pharmaceuticals Ltd)$ 0.11
Losasis-H 50mg/12.5mg Tablet (CHS Formulations)$ 0.08
Losastal-H Tablet (Stallion Laboratories Pvt Ltd)$ 0.08
LOSASUN HT TABLET 1 strip / 10 tablets each (Sunij Pharma Pvt Ltd)$ 0.35
LOSATAN H TABLET 1 strip / 10 tablets each (Biochem Pharmaceutical Industries)$ 0.60

References

  1. 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).
  2. 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).
  3. PubChem. "losartan". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).

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