Sarlotan Plus F Uses

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What is Sarlotan Plus F?

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

Sarlotan Plus F is used to treat high blood pressure (hypertension). It is also used to lower the risk of stroke in certain people with heart disease.

Sarlotan Plus F may also be used for purposes not listed in this medication guide.

Sarlotan Plus F indications

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Hypertension

Sarlotan Plus F® 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 (Sarlotan Plus F) and Hydrochlorothiazide (Sarlotan Plus F).

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.

Sarlotan Plus F may be administered with other antihypertensive agents.

Hypertensive Patients With Left Ventricular Hypertrophy

Sarlotan Plus F 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 Sarlotan Plus F?

Use Sarlotan Plus F 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 Sarlotan Plus F.

Uses of Sarlotan Plus F in details

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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.

Sarlotan Plus F description

Each tablet contains Losartan (Sarlotan Plus F) potassium 50 or 100 mg and Hydrochlorothiazide (Sarlotan Plus F) 12.5 mg.

Losartan (Sarlotan Plus F) Potassium: Losartan (Sarlotan Plus F) 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 (Sarlotan Plus F) 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 (Sarlotan Plus F).

Hydrochlorothiazide (Sarlotan Plus F): Hydrochlorothiazide (Sarlotan Plus F) 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.

Sarlotan Plus F dosage

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Hypertension

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

Initiate a patient whose blood pressure is not adequately controlled with Losartan (Sarlotan Plus F) 50 mg monotherapy with Sarlotan Plus F 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 Sarlotan Plus F 50/12.5 once daily or one tablet of Sarlotan Plus F 100/25 once daily.

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

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

Hypertensive Patients with Left Ventricular Hypertrophy

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

Sarlotan Plus F interactions

See also:
What other drugs will affect Sarlotan Plus F?

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Agents Increasing Serum Potassium

Coadministration of Losartan (Sarlotan Plus F) 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 Sarlotan Plus F and lithium.

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

Losartan (Sarlotan Plus F) 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 (Sarlotan Plus F)) 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 (Sarlotan Plus F) and NSAID therapy.

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

Hydrochlorothiazide (Sarlotan Plus F)

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 Sarlotan Plus F 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 (Sarlotan Plus F), 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 (Sarlotan Plus F), Losartan (Sarlotan Plus F), 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 (Sarlotan Plus F) therapy and followed them for a median of 2.2 years. Patients receiving the combination of Losartan (Sarlotan Plus F) 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 Sarlotan Plus F and other agents that affect the RAS.

Do not coadminister aliskiren with Sarlotan Plus F in patients with diabetes. Avoid use of aliskiren with Sarlotan Plus F in patients with renal impairment (GFR < 60 mL/min).

The Use Of Hydrochlorothiazide (Sarlotan Plus F) 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 (Sarlotan Plus F) is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind the Hydrochlorothiazide (Sarlotan Plus F) and reduce its absorption from the gastrointestinal tract by up to 85 and 43 percent, respectively. Stagger the dosage of Hydrochlorothiazide (Sarlotan Plus F) and the resin such that Hydrochlorothiazide (Sarlotan Plus F) is administered at least 4 hours before or 4 to 6 hours after the administration of the resin.

Sarlotan Plus F side effects

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What are the possible side effects of Sarlotan Plus F?

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 (Sarlotan Plus F) potassium-Hydrochlorothiazide (Sarlotan Plus F) 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 (Sarlotan Plus F)-Hydrochlorothiazide (Sarlotan Plus F) 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 Sarlotan Plus F 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 (Sarlotan Plus F) 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 (Sarlotan Plus F) 50 mg, lisinopril 20 mg, or either placebo (one study, n=97) or 25 mg Hydrochlorothiazide (Sarlotan Plus F) (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 (Sarlotan Plus F) Lisinopril
Cough 25% 17% 69%
Study 2† Placebo Losartan (Sarlotan Plus F) Lisinopril
Cough 35% 29% 62%

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

Cases of cough, including positive re-challenges, have been reported with the use of Losartan (Sarlotan Plus F) in postmarketing experience.

Postmarketing Experience

The following adverse reactions have been identified during post-approval use of Sarlotan Plus F. 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 (Sarlotan Plus F).

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 (Sarlotan Plus F); some of these patients previously experienced angioedema with other drugs including ACE inhibitors. Vasculitis, including Henoch-Schönlein purpura, has been reported with Losartan (Sarlotan Plus F). Anaphylactic reactions have been reported.

Musculoskeletal: rhabdomyolysis

Skin: Erythroderma

Sarlotan Plus F contraindications

See also:
What is the most important information I should know about Sarlotan Plus F?

Hypersensitivity to Losartan (Sarlotan Plus F), sulphonamide-derived substances (as Hydrochlorothiazide (Sarlotan Plus F)) or to any of the excipients of Sarlotan Plus F.

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 Sarlotan Plus F.

Use in lactation: It is not known whether Losartan (Sarlotan Plus F) is excreted in human milk. However, Losartan (Sarlotan Plus F) is excreted in the milk of lactating rats. Because no information is available regarding the use of Losartan (Sarlotan Plus F) during breastfeeding, Losartan (Sarlotan Plus F) 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 (Sarlotan Plus F)/HCTZ is contraindicated during breastfeeding.



Active ingredient matches for Sarlotan Plus F:

Hydrochlorothiazide/Losartan in South Korea.


List of Sarlotan Plus F substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
SARPOT H TABLET 1 strip / 10 tablets each (Mitoch Pharma Pvt Ltd)$ 0.59
Sartan-H film-coated tab 30's (Renata)
Tablet, Film-Coated; Oral; Hydrochlorothiazide 12.5 mg; Losartan Potassium 50 mg (Laboratorios chile)
Tablet, Film-Coated; Oral; Hydrochlorothiazide 25 mg; Losartan Potassium 100 mg (Laboratorios chile)
10's (Khandelwal Laboratories Pvt Ltd.)$ 0.48
Strok Rok 50+12.5 Tablet (Khandelwal Laboratories Pvt Ltd.)$ 0.05
Strok Rok Hydrochlorothiazide 12.5 mg, Losartan potassium 50 mg. TAB / 10 (Khandelwal Laboratories Pvt Ltd.)$ 0.48
STROK ROK 50MG/12.5MG TABLET 1 strip / 10 tablets each (Khandelwal Laboratories Pvt Ltd.)$ 0.48
STROK ROK tab 10's (Khandelwal Laboratories Pvt Ltd.)$ 0.48
Strok Rok Hydrochlorothiazide 12.5 mg, Losartan potassium 50 mg. TAB / 10 (Khandelwal Laboratories Pvt Ltd.)$ 0.48
Strok Rok 50 mg/12.5 mg Tablet (Khandelwal Laboratories Pvt Ltd.)$ 0.05
Synzar

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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Information checked by Dr. Sachin Kumar, MD Pharmacology

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