Lorista n description. What is Lorista medicine for and how to take it

Arterial hypertension (for patients who are indicated for combination therapy). Reducing the risk of cardiovascular morbidity and mortality in patients with arterial hypertension and left ventricular hypertrophy.

Contraindications Lorista H tablets 12.5mg + 50mg

Hypersensitivity to losartan, to drugs that are derivatives of sulfonamides and other components of the drug, anuria, severe renal dysfunction (creatinine clearance (CC) less than 30 ml / min.), Hyperkalemia, dehydration (including against the background of taking high doses of diuretics) , severe liver dysfunction, refractory hypokalemia, pregnancy, lactation, arterial hypotension, age under 18 years (efficacy and safety have not been established), lactase deficiency, galactosemia or glucose / galactose malabsorption syndrome. With caution: violations of the water and electrolyte balance of the blood (hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), bilateral stenosis renal arteries or stenosis of the artery of a single kidney, diabetes, hypercalcemia, hyperuricemia and / or gout, aggravated allergic history (in some patients, angioedema developed earlier when taking other medicinal substances, including ACE inhibitors) and bronchial asthma, systemic blood diseases (including systemic lupus erythematosus), the simultaneous administration of non-steroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-II inhibitors (COX-2 inhibitors). Use during pregnancy and lactation. There are no data on the use of losartan during pregnancy. Fetal renal perfusion, which depends on the development of the renin-angiotensin system, begins to function in the third trimester of pregnancy. The risk to the fetus increases when taking losartan in the second and third trimesters. When pregnancy is established, therapy should be discontinued immediately. If necessary, the appointment of the drug during lactation, it is necessary to stop breastfeeding.

Method of application and dosage Lorista H tablets 12.5mg + 50mg

Inside, regardless of the meal. The drug can be combined with other antihypertensive agents. Arterial hypertension. The initial and maintenance dose is 1 tablet of the drug (50/12.5 mg) 1 time per day. The maximum antihypertensive effect is achieved within three weeks of therapy. To achieve a more pronounced effect, it is possible to increase the dose of the drug up to 2 tablets (50/12.5 mg) 1 time per day. Maximum daily dose- 2 tablets of the drug. In patients with a reduced volume of circulating blood (for example, while taking high doses of diuretics), the recommended initial dose of losartan in patients with hypovolemia is 25 mg once a day. In this regard, therapy should be started after the abolition of diuretics and correction of hypovolemia. In elderly patients and patients with moderate kidney failure, including those on dialysis, no initial dose adjustment is required. Reducing the risk of cardiovascular morbidity and mortality in patients with arterial hypertension and left ventricular hypertrophy. The standard starting dose of losartan is 50 mg once daily. Patients who fail to achieve target blood pressure levels while taking losartan 50 mg / day require selection of therapy by combining losartan with low doses of hydrochlorothiazide (12.5 mg), and, if necessary, increase the dose of losartan to 100 mg per day. in combination with hydrochlorothiazide at a dose of 12.5 mg / day, in the future - increase to 2 tablets of the drug 50 / 12.5 mg in total (100 mg of losartan and 25 mg of hydrochlorothiazide once a day).

INN: Hydrochlorothiazide, Losartan

Manufacturer: Krka, d.d., Novo Mesto

Anatomical-therapeutic-chemical classification: Losartan in combination with diuretics

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 019289

Registration period: 24.10.2017 - 24.10.2022

Instruction

Tradename

Lorista® H 100

International non-proprietary name

Dosage form

Film-coated tablets, 100 mg / 12.5 mg

Compound

One tablet contains

active substances: losartan potassium - 100.00 mg

hydrochlorothiazide - 12.50 mg,

Excipients: pregelatinized starch, microcrystalline cellulose, lactose monohydrate, magnesium stearate,

shell composition: hypromellose, macrogol 4000, titanium dioxide (E171), talc

Description

Oval-shaped, biconvex, film-coated tablets, white

Pharmacotherapeutic group

Drugs affecting the renin-angiotensin system.

Angiotensin II antagonists in combination with diuretics

ATC code С09DA01

Pharmacological properties

Pharmacokinetics

Suction

Losartan well absorbed from gastrointestinal tract. It undergoes significant metabolism during its first pass through the liver, forming an active metabolite with carboxylic acid and other inactive metabolites. Systemic bioavailability is approximately 33%. Taking the drug with food does not have a clinically significant effect on its serum concentrations. Losartan reaches maximum concentrations after 1 hour, and its active metabolite (E3174) - 3-4 hours after ingestion.

Hydrochlorothiazide absorbed mainly in the duodenum and in the upper sections small intestine. The degree of absorption is 70% and it increases by another 10% when hydrochlorothiazide is taken with food. Peak serum concentrations are reached within 1.5 to 5 hours.

Distribution

Losartan: more than 99% of losartan and E3174 bind to plasma proteins, mainly albumin. The volume of distribution of losartan is 34 liters. Losartan crosses the blood-brain barrier very poorly or does not penetrate at all.

Hydrochlorothiazide: the volume of distribution is approximately

3 l/kg. About 40% of the substance binds to plasma proteins. Hydrochlorothiazide accumulates in erythrocytes, but the mechanism of this phenomenon remains unknown.

breeding

Losartan: about 35% of orally administered losartan is excreted by the kidneys and 65% in the feces. With preserved kidney function, only about 5% of losartan is excreted by the kidneys unchanged and another 6% as an active metabolite. The total serum clearance of losartan and its active metabolite is approximately 600 ml/min and 50 ml/min, respectively. The renal clearance of losartan is 75 ml/min, and its active metabolite is 26 ml/min. If losartan is administered orally, about 4% of the dose taken is excreted in the urine unchanged and another 6% as the active metabolite. The half-life of losartan is 1.5 to 2 hours, and its active metabolite is 6 to 9 hours.

It is not known whether losartan and E3174 are excreted in breast milk. They are not removed from the body during hemodialysis.

Hydrochlorothiazide: elimination of hydrochlorothiazide is the result of tubular secretion. Renal clearance is approximately 33 ml/minute. Tubular secretion of hydrochlorothiazide can be competitively reduced by endogenous acid metabolites (usually formed in patients with liver or kidney damage), as well as weak exogenous acids (eg, probenecid, salicylates, and penicillin). Hydrochlorothiazide has a biphasic elimination profile. The plasma half-life is approximately 2.5 hours. total time half-life - from 5.6 to 14.8 hours. More than 95% of unchanged hydrochlorothiazide is excreted in the urine.

Hydrochlorothiazide crosses the placental barrier and is excreted into breast milk. Serum concentrations of hydrochlorothiazide in the umbilical vein are almost the same as in the mother's blood. The content of this substance in the amniotic fluid exceeds the serum concentrations from the umbilical vein (up to 19 times). The content of hydrochlorothiazide in breast milk very low.

Pharmacodynamics

Losartan is oral selective antagonist angiotensin II receptors (type AT1). Angiotensin II binds to AT1 receptors found in various tissues (eg, vascular smooth muscle tissue, adrenal glands, kidneys, and heart) and causes vasoconstriction and aldosterone release. Angiotensin II also stimulates the proliferation of smooth muscle cells.

Losartan and its pharmacologically active metabolite (E3174) block all physiological effects of angiotensin II, regardless of its source and biosynthesis pathway; at the same time, they do not affect autonomic reflexes and do not have a permanent effect on the content of norepinephrine in plasma.

Losartan selectively binds to AT1 receptors and does not block other hormone receptors or ion channels that respond to activity regulation. of cardio-vascular system. Moreover, losartan does not inhibit the activity of angiotensin-converting enzyme (kinase II), an enzyme that is involved in the breakdown of bradykinin. As a result, with losartan therapy, effects indirectly associated with the blockade of AT1 receptors, such as potentiation of bradykinin effects or the development of edema, rarely develop.

Losartan potassium is equally effective in men and women, as well as in older (≥ 65 years) and younger patients (≤ 65 years). Its maximum effect develops 6 hours after administration. The therapeutic effect of losartan lasts 24 hours, so it is enough to take it once a day. The antihypertensive effect develops during the first week of therapy, and then gradually increases and stabilizes after 3-6 weeks.

Hydrochlorothiazide is a diuretic. Thiazide diuretics predominantly inhibit the dilution ability of the kidneys in the distal tubules, preventing the reabsorption of sodium and chloride ions in this part of the nephron. Thus, they increase the excretion of sodium, potassium, chloride and water.

At the beginning of hydrochlorothiazide therapy, the volume of fluid circulating in the vessels decreases due to increased excretion of water and salts, which leads to a decrease in blood pressure and a decrease in cardiac output. The diuretic effect occurs approximately 2 hours after the administration of hydrochlorothiazide and reaches its maximum after 3-4 hours. The diuretic effect persists for 6-12 hours. The hypotensive effect develops after 3-4 days from the start of therapy and reaches a maximum after 3-4 weeks. It persists up to 7 days after discontinuation of treatment.

The frequency of development of adverse effects when taking thiazide diuretics depends on their dose, so mild and moderate arterial hypertension is currently treated with lower doses of thiazide diuretics than in the past.

When taking Lorist® H 100, an additive effect on blood pressure is achieved (pressure reduction is greater than when taking each of the drugs separately).

Due to the diuretic effect of hydrochlorothiazide, plasma renin activity, aldosterone secretion and serum angiotensin II concentrations increase, and the serum potassium content decreases, which partially levels the effectiveness of treatment. Since aldosterone secretion is reduced, losartan reduces potassium excretion, which is usually increased when taking hydrochlorothiazide.

Despite a significant decrease in blood pressure, the use of Lorist® H 100 does not significantly affect the heart rate.

Indications for use

Arterial hypertension in patients not responding to monotherapy

losartan or hydrochlorothiazide - reducing the risk of stroke and cardiovascular mortality in arterial

al hypertension in patients with left ventricular hypertrophy.

Dosage and administration

The drug may be administered with other antihypertensive agents. The tablets can be taken with or without food, with a glass of water.

hypertension Losartan and hydrochlorothiazide are not intended for use as initial therapy, except in patients whose blood pressure does not respond to losartan or hydrochlorothiazide monotherapy. When clinically necessary, in patients whose blood pressure is not adequately controlled, a direct change from monotherapy to a fixed combination may be considered.

The usual maintenance dose is 1 tablet of Lorista® H (losartan 50 mg/hydrochlorothiazide 12.5 mg) once daily. If there is insufficient therapeutic response, the dose of Lorist® H may be increased to one tablet of Lorist® HD (losartan 100 mg / hydrochlorothiazide 25 mg) once daily. The maximum dose is one tablet of Lorista® HD (losartan 100 mg/hydrochlorothiazide 25 mg) once daily. In general, the antihypertensive effect is achieved within three to four weeks after the start of therapy.

Lorista® H 100 (losartan 100 mg / hydrochlorothiazide 12.5 mg) is indicated for patients who have been dosed up to 100 mg losartan and who require additional blood pressure control.

Reduction cardiovascular risk morbidity and mortality in patients with arterial hypertension with left ventricular hypertrophy The usual starting dose is 50 mg losartan once daily.

If the desired blood pressure level is not achieved with losartan 50 mg, treatment should be changed using a combination of losartan with a low dose of hydrochlorothiazide (12.5 mg) and, if necessary, the dose should be increased to 100 mg losartan / 12.5 mg hydrochlorothiazide once per day. If necessary, the dose should be increased to 100 mg of losartan and 25 mg of hydrochlorothiazide once a day.

Lorista H® (50 mg/12.5 mg), Lorista H®100 (100 mg/12.5 mg) and Lorista® HD (100 mg/25) are suitable alternative formulations for patients treated concomitantly with losartan and hydrochlorothiazide .

Usage in patients with kidney failure and patients on hemodialysis There is no need to adjust the dose in patients with a slight decrease in renal function (creatinine clearance 30-50 ml / min). Losartan/hydrochlorothiazide tablets are not recommended for patients on hemodialysis and should not be used in patients with a significant decrease in renal function (creatinine clearance<30 мл/мин).

In patients with hypovolemia The recommended starting dose of losartan is 25 mg once daily. In this regard, therapy with losartan / hydrochlorothiazide tablets should be started after discontinuation of diuretics and correction of hypovolemia. Patients with impaired liver function Losartan/hydrochlorothiazide is contraindicated in patients with severe hepatic impairment. Elderly patients For elderly patients, dose adjustment is not required.

Lorista H® 100 can be taken with or without food. In order not to miss taking the drug, the tablets should be taken at the same time every day. If the patient forgets to take a tablet, do not double the next dose. At the next appointment, the patient should take the usual dose of the drug at the prescribed time.

The duration of treatment is not limited.

Side effects

Often (>1/100 to<1/10):

Headache, dizziness, cephalalgia

Cough, upper respiratory tract infection, nasal congestion,

sinusitis, sinus disease

Abdominal pain, nausea, diarrhea, dyspepsia

- muscle cramps, back pain, leg pain, muscle pain

Asthenia, fatigue, chest pain

Hyperkalemia, slight decrease in hematocrit and hemoglobin

Not often(>1/1,000 up to<1/100):

Anemia, agranulocytosis, aplastic anemia, hemolytic anemia,

leukopenia, purpura, thrombocytopenia

Anorexia, hyperuricemia, hypokalemia, hyponatremia

Insomnia, anxiety, anxiety disorder, panic disorder

mental illness, confusion, depression, painful dreams, sleep disturbances,

drowsiness, memory impairment

Nervousness, paresthesia, peripheral neuropathy, tremor, migraine,

Temporary blurred vision, burning sensation or sharp pain in the eyes,

conjunctivitis, decreased visual acuity, xanthopsia

Vertigo, tinnitus

Hypotension, orthostatic hypotension, sternalgia, angina,

AV block II degree, cerebrovascular disorder, myocardial infarction,

palpitations, arrhythmia (atrial fibrillation, sinus

bradycardia, tachycardia, ventricular tachycardia, ventricular fibrillation

Necrotizing angiitis (vasculitis, cutaneous vasculitis)

pharyngeal discomfort, pharyngitis, laryngitis, difficulty breathing,

bronchitis, epistaxis, rhinitis, respiratory congestion, pneumo-

nit, pulmonary edema

Dry mouth, flatulence, gastritis, vomiting, sialadenitis, constipation, spasms,

stomach irritation, nausea, diarrhea

Alopecia, dermatitis, dry skin, erythema, hyperemia, photosensitive

ness, itching, rash, urticaria, sweating, urticaria, toxic epi-

dermal necrolysis

Arm pain, joint swelling, knee pain, musculoskeletal pain,

shoulder pain, stiffness, arthralgia, arthritis, coxalgia, fibromyalgia

gia, muscle weakness, muscle cramps

Jaundice (intrahepatic cholestasis), pancreatitis

Nocturia, frequent urination, urinary tract infections,

glucosuria, interstitial nephritis, renal failure

Decreased libido, impotence

Facial swelling, fever

Slight increase in serum urea and creatinine levels

Rarely(>1/10,000 to<1/1 000) :

Hyperkalemia, elevated ALT

Anaphylactic reactions, angioedema, allergic rash

Rarely (<1/10 000):

Increased liver enzymes and bilirubin

Henoch-Schonlein disease, ecchymosis, hemolysis

Gout

Contraindications

Hypersensitivity to the components of the drug

Severe arterial hypotension, hypovolemia

Hypokalemia or hypercalcemia not responding to treatment

Refractory hyponatremia

Symptomatic hyperuricemia/gout

severe liver failure; cholestasis and biliary obstruction

Severe renal failure (creatinine clearance< 30 мл/мин)

Pregnancy and lactation

Children and adolescents up to 18 years of age (efficacy and safety

not studied)

Drug Interactions

Losartan Rifampicin and fluconazole have low levels of active metabolites. The clinical implications of these interactions have not been evaluated. As with other drugs that block angiotensin II or its action, moderate potassium diuretics (eg, spironolactone, triamtirene, amiloride), potassium supplements, or potassium-based salt substitutes may increase

potassium in blood serum.

As with other drugs that affect sodium excretion, lithium excretion may be reduced. Therefore, serum lithium levels should be carefully monitored if lithium salts are administered concomitantly with angiotensin II receptor antagonists. non-steroidal anti-inflammatory drugs, there may be a decrease in the antihypertensive effect. The combined use of angiotensin II antagonists or diuretics and non-steroidal anti-inflammatory drugs may lead to an increased risk of impaired renal function, including possible acute renal failure, as well as an increase in serum potassium, especially in patients with poor renal function. The combination should be used with caution, especially in elderly patients. Patients should be adequately hydrated and renal function should be closely monitored after initiation of concomitant therapy, and periodically thereafter.

In some patients with impaired renal function who are treated with non-steroidal anti-inflammatory drugs, including selective inhibitors of cyclooxygenase-2, co-administration of angiotensin II receptor antagonists may lead to further deterioration of renal function. This effect is usually reversible.

Other substances that cause hypotension, such as tricyclic antidepressants, antipsychotics, baclofen, amifostine, which lower blood pressure as a main or side effect, which may increase the risk of hypotension.

Hydrochlorothiazide Drugs that have an effect when used together with thiazide diuretics.

Alcohol, barbiturates, drugs or antidepressants:

may increase orthostatic hypotension.

Antidiabetic medicines (oral drugs and insulin): thiazide treatment may affect glucose tolerance. The dosage of the antidiabetic drug may need to be adjusted. Metformin should be used with caution due to the risk of lactic acidosis caused by possible renal impairment associated with hydrochlorothiazide.

Other antihypertensive drugs: additive effect. Cholestyramine and colestipol resins: in the presence of anion exchange resins, the absorption of hydrochlorothiazide is impaired. A single dose of cholestyramine or colestipol resins binds hydrochlorothiazide and reduces its absorption from the gastrointestinal tract by up to 85% and 43%, respectively. Corticosteroids, adrenal cortex hormone: excretion of blood electrolytes, hypokalemia may develop.

Pressor amines (eg, adrenaline): some decrease in their effectiveness may occur, but not preclude use. Skeletal muscle relaxants that are non-depolarizing (eg, tubocurarine): may increase the response to muscle relaxants. Lithium: diuretics reduce renal clearance of lithium and increase the risk of developing it toxic effect, and therefore, their combined use is not recommended.

Medicines used to treat gout (probenecid, sulfinpyrazone and allopurinol): an adjustment (increase) in the dose of drugs that promote the excretion of uric acid may be necessary, since hydrochlorothiazide can increase the level of uric acid in the blood serum. The combined use of thiazide increases the risk of hypersensitivity reactions to allopurinol.

Anticholinergics (eg, atropine, biperiden): increased bioavailability of thiazide-type diuretics due to decreased gastrointestinal motility and gastric emptying rate. action. Salicylates: at high doses of salicylates, hydrochlorothiazide may increase the toxic effects of salicylates on the central nervous system. Methyldopa: there is some evidence of hemolytic anemia that occurs with the combined use of hydrochlorothiazide and methyldopa. Cyclosporine: combined treatment with cyclosporine may increase the risk of hyperuricemia and complications such as gout .

Digitalis glycosides: Hypokalemia or hypomagnesemia caused by hydrochlorothiazide may contribute to cardiac arrhythmias associated with digitalis.

Drugs that are affected by impaired serum potassium: during the use of losartan / hydrochlorothiazide with drugs that are affected by violations of serum potassium (for example, digitalis glycoside and antiarrhythmic drugs), periodic monitoring of serum potassium and electrocardiograms is recommended. When using drugs that cause flutter-fibrillation (ventricular tachycardia), hypokalemia is a predisposing factor to enhancing these effects; These include:

class Ia antiarrhythmic drugs (such as quinidine, hydroquinidine, disopyramide)

class III antiarrhythmics (amiodarone, sotalol, dofetilide, ibutilide)

certain antipsychotics (thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, sultopride, amisulpride, tiapride, pimozide, haloperidol, droperidol)

others (such as bepridil, cisapride, diphemanil, erythromycin IV,

halofantrine, mizolastine, pentamidine, terfenadine, vincamine IV).

Calcium salts: due to decreased excretion, thiazide diuretics may increase serum calcium levels. If it is necessary to prescribe calcium supplements, it is necessary to monitor and adjust the level of calcium in the blood serum.

Impact on laboratory results: due to their effect on calcium metabolism, thiazides can interfere with the conduction

parathyroid function tests.

Carbamazepine: risk of symptomatic hyponatremia. Requires clinic

chesky and biological monitoring.

Iodine contrast agent: in the case of hypohydration caused by diuretics, there is an increased risk of acute renal failure, especially with high doses of an iodine preparation. Before use in patients

ents must be restored water balance.

AmphotericinB(parenteral), corticosteroids, adrenal hormones, or stimulant laxatives

Hydrochlorothiazide may exacerbate electrolyte imbalances, in particular hypokalemia.

special instructions

Losartan

Angioedema Patients who have had angioedema (swelling of the face, lips, throat and/or tongue) should be under close medical supervision.

Hypotension and depletion of intravascular volume

Symptomatic hypotension, especially after the first dose, may occur in patients with sodium depletion caused by increased diuretic therapy, dietary salt restriction, diarrhea, or vomiting. Before using losartan / hydrochlorothiazide, such symptoms must be eliminated.

Electrolyte imbalance

Electrolyte imbalance is widespread among patients with impaired renal function, diabetes or without, and this must be taken into account. Therefore, creatinine clearance levels and plasma potassium concentrations should be carefully monitored, especially in patients with heart failure and creatinine clearance of 30-50 ml / min.

The use of moderate potassium diuretics, potassium supplements, and potassium-based salt substitutes in conjunction with losartan/hydrochlorothiazide is not recommended.

Impaired liver function

Based on pharmacokinetic data showing a significant increase in plasma concentrations of losartan in patients with liver cirrhosis, losartan should be used with caution in patients with mild to moderate hepatic impairment. There are no therapeutic data on the use of losartan in patients with severe hepatic impairment. Therefore, the losartan/hydrochlorothiazide combination is contraindicated in patients with severe hepatic impairment.

Impaired kidney function

As a result of inhibition of the renin-angiotensin-aldosterone system, changes in renal function, including renal failure, have been observed (in particular, in patients whose kidney function depends on the renin-angiotensin-aldosterone system, with severe heart failure or pre-existing renal dysfunction).

As with other drugs that affect the renin-angiotensin-aldosterone system, increases in serum urea and creatinine have been observed in patients with bilateral renal artery stenosis or stenosis of an artery to one kidney, these changes in renal function may resolve after discontinuation of treatment. Losartan should be used with caution in patients with bilateral renal artery stenosis or single renal artery stenosis.

kidney transplant

There are no data on use in patients undergoing kidney transplantation.

Primary hyperaldosteronism

Patients with primary aldosteronism usually do not respond to antihypertensive drugs that act by inhibiting the renin-angiotensin system. Therefore, the use of losartan/hydrochlorothiazide tablets is not recommended.

Coronary heart disease and cerebrovascular accident

As with any antihypertensive drug, in patients with coronary artery disease and cerebrovascular disease, excessive lowering of blood pressure can lead to myocardial infarction or stroke.

Heart failure

In patients with heart failure, with impaired or normal liver function, there is, as well as with other drugs that act on the renin-angiotensin system, the risk of serious arterial hypertension, and impaired renal function (often acute).

Stenosis of the aortic valve, mitral valve, obstructive hypertrophic cardiomyopathy

As with other vasodilators, special attention should be paid to patients suffering from aortic or mitral valve stenosis or from obstructive hypertrophic cardiomyopathy.

Ethnic features

Angiotensin-converting enzyme inhibitors, losartan and other angiotensin antagonists, have been observed to be less effective in lowering blood pressure in blacks than in others, possibly due to the predominance of low-renin conditions in this hypertensive population.

Pregnancy

The losartan/hydrochlorothiazide combination should not be used during pregnancy. Patients planning pregnancy should be switched to alternative antihypertensive treatment, which should have an approved safety profile for use during pregnancy.

When pregnancy is diagnosed, losartan/hydrochlorothiazide combination therapy should be discontinued immediately and, if appropriate, alternative treatment initiated.

Hydrochlorothiazide

Hypotension and electrolyte/fluid imbalance

As with any antihypertensive treatment, some patients may experience symptomatic hypotension. Patients should be observed for clinical signs of fluid or electrolyte imbalance, such as sodium depletion, hyponatremia, hypochloremic alkalosis, hypomagnesemia, or hypokalemia, which may occur with occasional diarrhea or vomiting. In such patients, it is necessary to periodically, at appropriate intervals, determine the electrolytes of the blood serum. Dilutional hyponatremia may occur in patients prone to edema during the hot season.

Metabolic and endocrine effects

Thiazide treatment may impair glucose tolerance. Adjustment of dosages of antidiabetic agents, including insulin, may be required. With thiazide treatment, latent diabetes mellitus may occur. Thiazides may reduce urinary calcium excretion, and may cause intermittent slight increases in serum calcium. Severe hypercalcemia may indicate latent hyperparathyroidism. Thiazides should be discontinued before parathyroid tests are performed.

An increase in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy.

In some patients, thiazide therapy may exacerbate hyperuricemia and/or gout. Since losartan reduces uric acid levels, losartan in combination with hydrochlorothiazide attenuates diuretic-induced hyperuricemia.

Liver failure

Thiazides should be used with caution in patients with impaired liver function or advanced liver disease, as they can cause intrahepatic cholestasis and, due to slight changes in fluid and electrolyte balance, can cause hepatic coma.

The losartan/hydrochlorothiazide combination is contraindicated in patients with severe hepatic impairment.

Other

In cases of the presence or absence of allergies or bronchial asthma in patients taking thiazides, a hypersensitivity reaction may occur. Exacerbation or activation of systemic lupus erythematosus has been observed after the use of thiazides.

Information about fillers

Lorista® H 100 contains lactose. Patients with rare congenital galactose intolerance, congenital lactose deficiency and malabsorption of glucose-galactose should not use this drug.

Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

Studies of the effect on the ability to drive vehicles and work with mechanisms have not been conducted. However, when driving a vehicle or using various mechanisms, it must be borne in mind that sometimes dizziness or drowsiness may occur when taking antihypertensive drugs, in particular at the beginning of treatment or when the dosage is increased.

Overdose

Symptoms: tachycardia, hypotension, it is also possible to develop bradycardia due to the activation of parasympathetic (vagal) innervation. The main symptoms of overdose include symptoms caused by a decrease in the level of electrolytes (hypokalemia, hypochloremia, hyponatremia), as well as dehydration that occurs due to excessive urination.

Treatment - drug withdrawal. If the drug has been taken recently, perform a gastric lavage. It is necessary to control vital functions, if necessary - symptomatic therapy. Hemodialysis is ineffective.

Release form and packaging

In this article, you can read the instructions for using the drug Lorista. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Lorista in their practice are presented. A big request to actively add your reviews about the drug: did the medicine help or not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Analogues of Lorista in the presence of existing structural analogues. Use for the treatment of high blood pressure in adults, children, as well as during pregnancy and lactation.

Lorista- selective angiotensin 2 type AT1 receptor antagonist of non-protein nature.

Losartan (the active ingredient of Lorista) and its biologically active carboxyl metabolite (EXP-3174) block all physiologically significant effects of angiotensin 2 on AT1 receptors, regardless of the route of its synthesis: it leads to an increase in plasma renin activity, reduces the concentration of aldosterone in blood plasma.

Losartan indirectly causes the activation of AT2 receptors by increasing the level of angiotensin 2. Losartan does not inhibit the activity of kininase 2, an enzyme that is involved in the metabolism of bradykinin.

Reduces OPSS, pressure in the pulmonary circulation; reduces afterload, has a diuretic effect.

Prevents the development of myocardial hypertrophy, increases exercise tolerance in patients with chronic heart failure.

Taking Lorista once a day leads to a statistically significant decrease in systolic and diastolic blood pressure. During the day, losartan evenly controls blood pressure, while the antihypertensive effect corresponds to the natural circadian rhythm. The decrease in blood pressure at the end of the dose of the drug was approximately 70-80% of the effect at the peak of the drug, 5-6 hours after administration. There is no withdrawal syndrome; also, losartan does not have a clinically significant effect on heart rate.

Losartan is effective in men and women, as well as in older (≥ 65 years) and younger patients (≤ 65 years).

Hydrochlorothiazide is a thiazide diuretic, the diuretic effect of which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, and water ions in the distal nephron; delays the excretion of calcium ions, uric acid. Has antihypertensive properties; hypotensive effect develops due to the expansion of arterioles. Virtually no effect on normal blood pressure. The diuretic effect occurs after 1-2 hours, reaches a maximum after 4 hours and lasts 6-12 hours.

The antihypertensive effect occurs after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect.

Compound

Losartan potassium + excipients.

Losartan potassium + Hydrochlorothiazide + excipients (Lorista H and ND).

Pharmacokinetics

The pharmacokinetics of losartan and hydrochlorothiazide with simultaneous use does not differ from that with their separate use.

Losartan

Well absorbed from the gastrointestinal tract. Taking the drug with food does not have a clinically significant effect on its serum concentrations. Practically does not penetrate through the blood-brain (BBB). About 58% of the drug is excreted in the bile, 35% in the urine.

Hydrochlorothiazide

After oral administration, the absorption of hydrochlorothiazide is 60-80%. Hydrochlorothiazide is not metabolized and is rapidly excreted by the kidneys.

Indications

arterial hypertension;
reduced risk of stroke in patients with arterial hypertension and left ventricular hypertrophy;
chronic heart failure (as part of combination therapy, with intolerance or ineffectiveness of therapy with ACE inhibitors);
protection of kidney function in patients with type 2 diabetes mellitus with proteinuria to reduce proteinuria, reduce the progression of kidney damage, reduce the risk of end-stage development (preventing the need for dialysis, the likelihood of an increase in serum creatinine), or death.

Release form

Tablets 12.5 mg, 25 mg, 50 mg and 100 mg.

Lorista N (additionally contains 12.5 mg of hydrochlorothiazide).

Lorista ND (additionally contains 25 mg of hydrochlorothiazide).

Instructions for use and dosage

The drug is taken orally, regardless of food intake, the frequency of administration is 1 time per day.

With arterial hypertension, the average daily dose is 50 mg. The maximum antihypertensive effect is achieved within 3-6 weeks of therapy. It is possible to achieve a more pronounced effect by increasing the dose of the drug to 100 mg per day in two doses or in one dose.

Against the background of taking diuretics in high doses, it is recommended to start therapy with Lorista with 25 mg per day in one dose.

Elderly patients, patients with impaired renal function (including patients on hemodialysis) do not require adjustment of the initial dose of the drug.

In patients with impaired liver function, the drug should be prescribed at a lower dose.

In chronic heart failure, the initial dose of the drug is 12.5 mg per day in one dose. In order to reach the usual maintenance dose of 50 mg per day, the dose must be increased gradually at intervals of 1 week (eg, 12.5 mg, 25 mg, 50 mg per day). Lorista is usually given in combination with diuretics and cardiac glycosides.

To reduce the risk of stroke in patients with arterial hypertension and left ventricular hypertrophy, the standard initial dose is 50 mg per day. In the future, low-dose hydrochlorothiazide may be added and / or the dose of Lorista may be increased to 100 mg per day.

For kidney protection in type 2 diabetic patients with proteinuria, the standard starting dose of Lorista is 50 mg daily. The dose of the drug can be increased to 100 mg per day, taking into account the decrease in blood pressure.

side

dizziness;
asthenia;
headache;
fatigue;
insomnia;
anxiety;
sleep disturbance;
drowsiness;
memory disorders;
peripheral neuropathy;
paresthesia;
hypoesthesia;
migraine;
tremor;
depression;
orthostatic hypotension (dose-dependent);
heartbeat;
tachycardia;
bradycardia;
arrhythmias;
angina;
nasal congestion;
cough;
bronchitis;
swelling of the nasal mucosa;
nausea, vomiting;
diarrhea;
abdominal pain;
anorexia;
dry mouth;
toothache;
flatulence;
constipation;
imperative urge to urinate;
impaired renal function;
decreased libido;
impotence;
convulsions;
pain in the back, chest, legs;
tinnitus;
taste disorder;
visual impairment;
conjunctivitis;
anemia;
purpura of Shenlein-Henoch;
dry skin;
increased sweating;
alopecia;
gout;
hives;
skin rash;
angioedema (including swelling of the larynx and tongue, causing airway obstruction and / or swelling of the face, lips, pharynx).

Contraindications

arterial hypotension;
hyperkalemia;
dehydration;
lactose intolerance;
galactosemia or glucose/galactose malabsorption syndrome;
pregnancy;
lactation period;
age up to 18 years (efficacy and safety in children have not been established);
hypersensitivity to losartan and / or other components of the drug.

Use during pregnancy and lactation

There are no data on the use of Lorist during pregnancy. Renal perfusion of the fetus, which depends on the development of the renin-angiotensin system, begins to function in the 3rd trimester of pregnancy. The risk to the fetus increases when taking losartan in the 2nd and 3rd trimesters. When pregnancy is established, losartan therapy should be discontinued immediately.

There are no data on the allocation of losartan with breast milk. Therefore, the issue of stopping breastfeeding or discontinuing losartan therapy should be considered, taking into account its importance to the mother.

special instructions

Patients with a reduced volume of circulating blood (for example, during therapy with large doses of diuretics) may develop symptomatic arterial hypotension. Before taking losartan, it is necessary to eliminate existing disorders, or start therapy with small doses.

In patients with mild to moderate cirrhosis of the liver, the concentration of losartan and its active metabolite in the blood plasma after oral administration is higher than in healthy people. Therefore, in patients with a history of liver disease, therapy at lower doses is recommended.

Patients with impaired renal function, both with and without diabetes mellitus, often develop hyperkalemia, which should be borne in mind, but only in rare cases do they stop treatment as a result. During the period of treatment, the concentration of potassium in the blood should be regularly monitored, especially in elderly patients, with impaired renal function.

Drugs that act on the renin-angiotensin system may increase serum urea and creatinine in patients with bilateral renal artery stenosis or unilateral stenosis of the artery to a solitary kidney. Changes in renal function may be reversible after discontinuation of therapy. During treatment, it is necessary to regularly monitor the concentration of creatinine in the blood serum at regular intervals.

Influence on the ability to drive vehicles and control mechanisms

There are no data on the effect of Lorist on the ability to drive vehicles or other technical means.

drug interaction

There were no clinically significant drug interactions with hydrochlorothiazide, digoxin, indirect anticoagulants, cimetidine, phenobarbital, ketoconazole and erythromycin.

During simultaneous administration with rifampicin and fluconazole, a decrease in the level of the active metabolite of losartan potassium was noted. The clinical consequences of this phenomenon are unknown.

Simultaneous use with potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride) and potassium preparations increases the risk of hyperkalemia.

The simultaneous use of non-steroidal anti-inflammatory drugs, including selective COX-2 inhibitors, may reduce the effect of diuretics and other antihypertensive drugs.

When Lorista is administered concomitantly with thiazide diuretics, the reduction in blood pressure is approximately additive. Enhances (mutually) the effect of other antihypertensive drugs (diuretics, beta-blockers, sympatholytics).

Analogues of the drug Lorista

Structural analogues for the active substance:

Blocktran;
Brozaar;
Vasotens;
Vero Losartan;
Zisacar;
Cardomine Sanovel;
Carsartan;
Cozaar;
Lakea;
Lozap;
Losarel;
Losartan;
Losartan potassium;
Losacor;
Lotor;
Presartan;
Renicard.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.

Lorista N tablets are an antihypertensive drug that has a combined composition.

One of the active components of the drug is losartan - a selective receptor antagonist, characterized by a non-protein nature.

Thanks to him, the drug provides a quick and effective blocking of all the effects of angiotensin II on AT1 receptors, which play an important role in physiological processes in the human body.

As a result, there is an increase in the activity of renin contained in the blood plasma, as well as a clinically significant decrease in the level of aldosterone.

In addition, the drug reduces the pressure formed in the pulmonary circulation, lowers OPSS and is able to exert a diuretic effect on the body.

By taking this medication, protection is provided against the possible development of myocardial hypertrophy.

Due to the violation of the processes of reabsorption of ions of various chemical elements that occur under the action of hydrochlorothiazide, a diuretic effect is observed.

It occurs about a couple of hours after the first dose of this medication. In most patients, the maximum result occurs after four hours and is maintained for the next twelve hours.

The antihypertensive effect of drug treatment can be seen after a few days. However, it should be noted that it may take about a month to achieve the desired therapeutic result.

Instructions for use

Doctors prescribe these tablets in order to provide effective treatment for the following diseases:

Arterial hypertension - great for patients who require combination therapy.
To reduce the risk of developing diseases of the cardiovascular system.

The drug must be taken orally, regardless of the time of the meal.

For the treatment of arterial hypertension, one tablet is usually prescribed once a day. In this case, the maximum antihypertensive result is observed within about the next three weeks. To increase efficiency, you can increase the dosage of the drug to two tablets per day. However, this is the maximum daily dose that should not be exceeded.

Patients with reduced BCC are required to take an initial dose of 25 mg once a day.

It is not necessary to select an individual dosage of the drug for the elderly, as well as patients who have moderate renal failure.

The drug is available in the form of slightly biconvex tablets. They are oval and have a risk on one side. Tablets can be either yellow or yellowish with a green tint.

The composition of the drug includes such chemicals:

Hydrochlorothiazide is the active ingredient.
Losartan potassium is the active ingredient.
Excipients - lactose monohydrate, pregelatinized starch, magnesium stearate, microcrystalline cellulose, yellow kiniline dye, talc, macrogol 4000, titanium dioxide, hypromellose.

Heart failure is a violation of the function of the heart, when it is not able to provide full blood flow in organs and tissues. Learn how to recognize the disease in time and treat it:

Modern progressive methods of treatment of heart failure.

When combining the drug with different medicines that have a different effect, the following drug interaction is possible:

It is necessary to carefully select drugs for the implementation of combined therapeutic therapy.

Side effects

It is strictly forbidden to use Lorista N tablets for the treatment of people who suffer from such concomitant diseases:

A pronounced violation of the normal functioning of the kidneys.
signs of anuria.
development of hyperkalemia.
Quite a strong dehydration of the body.
Serious violations of the functioning of the liver.
Intensive manifestation of refractory hypokalemia.
Symptoms of arterial hypotension.
Insufficient amount of lactase in the body.
Individual intolerance to any chemical component that is part of the drug.
Malabsorption syndrome of galactose or glucose.
Intensive development of galactosemia.
Carrying a child, the period of breastfeeding.
Patients who at the time of treatment have not reached the age of majority.

There are also some diagnoses, in the presence of which it is necessary to carefully treat with this drug. These include:

Various manifestations of disturbances in the water-electrode balance in the blood.
Alkalosis.
Stenosis of the artery of the only functioning kidney.
Pronounced bilateral stenosis of the arteries of the kidneys.
The development of diabetes.
Manifestation of hyperuricemia.
Gout.
Allergological anamnesis in the burdened form.
The formation of angioedema.
Bronchial asthma.
Various blood diseases that are systemic in nature.

During pregnancy and lactation

Nowadays, there is no information about the use of the drug by pregnant patients. Therefore, it is recommended that you take it very carefully.

As a rule, doctors prescribe these pills only if the risk to the development of the fetus or newborn child will be much lower compared to the benefit that the mother will receive during treatment.

During lactation, it is necessary to interrupt the feeding of the baby with breast milk.

Side effects

The most common side effects include:

Headache.
The appearance of non-systemic or systemic dizziness.
Chronic insomnia.
Too fast fatigue.
Migraine development.
Occurrence of dose-dependent orthostatic hypotension.
Pronounced tachycardia.
Audible heartbeat.
Signs of vasculitis.
Coughing.
Infectious infection of the upper respiratory tract.
development of pharyngitis.
The formation of edema of the mucous membrane of the nasal cavity.
Pain in the back.
Anemia.
Manifestation of dyspepsia.
Diarrhea.
Nausea with bouts of vomiting.
Feeling pain in the abdomen.
The work of the liver worsens.
Hepatitis symptoms.
The intensity of bilirubin movement increases.
The activity of the functions of various liver enzymes increases.
Myalgia with arthralgia.
Intensive manifestation of Henoch-Schonlein purpura.
The level of hemoglobin increases.
The hematocrit concentration may rise sharply.
A slight increase in the level of creatinine and urea in the blood serum.
Severe itching of the skin.
Signs of hives.
The appearance of various anaphylactic reactions.
The formation of angioedema of various parts of the body.
General weakness.
The development of asthenia.
Unpleasant pain in the chest.
The occurrence of peripheral edema.

Terms and conditions of storage

The drug can be used within three years from the date of its release.

Price

To purchase these tablets at any of the pharmacies on the territory of the Russian Federation, you will have to pay about 200-570 rubles, depending on the number of tablets in the package.

Within Ukraine the cost of the drug is from 70 to 190 hryvnia.

Analogues

To date, the following analogues of the drug are actively used:

Instructions for use

Active ingredients

Release form

Tablets

Compound

Active ingredient: Losartan potassium, Hydrochlorothiazide (Hydrochlorothiazide) Active ingredient concentration (mg): 62.5

Pharmacological effect

Combined antihypertensive drug. Losartan is a selective angiotensin II type AT1 receptor antagonist of a non-protein nature. In vivo and in vitro, losartan and its biologically active carboxyl metabolite (EXP-3174) block all physiologically significant effects of angiotensin II on AT1 receptors, regardless of the route of its synthesis: leads to an increase in plasma renin activity, reduces the concentration of aldosterone in the blood plasma. Losartan indirectly causes the activation of AT2 receptors by increasing the level of angiotensin II. Losartan does not inhibit the activity of kininase II, an enzyme that is involved in the metabolism of bradykinin. It reduces OPSS, pressure in the pulmonary circulation; reduces afterload, has a diuretic effect. Prevents the development of myocardial hypertrophy, increases exercise tolerance in patients with chronic heart failure. Taking losartan 1 time / day leads to a statistically significant decrease in systolic and diastolic blood pressure. During the day, losartan evenly controls blood pressure, while the antihypertensive effect corresponds to the natural circadian rhythm. The decrease in blood pressure at the end of the dose of the drug was approximately 70-80% of the effect at the peak of the drug, 5-6 hours after administration. There is no withdrawal syndrome; also, losartan does not have a clinically significant effect on heart rate. Losartan is effective in men and women, as well as in elderly (≥ 65 years) and younger patients (≤ 65 years). Hydrochlorothiazide is a thiazide diuretic, the diuretic effect of which is associated with impaired sodium ion reabsorption , chlorine, potassium, magnesium, water in the distal nephron; delays the excretion of calcium ions, uric acid. Has antihypertensive properties; hypotensive effect develops due to the expansion of arterioles. Virtually no effect on normal blood pressure. The diuretic effect occurs after 1-2 hours, reaches a maximum after 4 hours and lasts 6-12 hours. The antihypertensive effect occurs after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect.

Pharmacokinetics

The pharmacokinetics of losartan and hydrochlorothiazide, when used simultaneously, does not differ from that when they are used separately. Losartan Absorption Well absorbed from the gastrointestinal tract. Taking the drug with food does not have a clinically significant effect on its serum concentrations. Bioavailability is about 33%. Cmax of losartan in blood plasma is reached 1 hour after ingestion, and Cmax of EXP-3174 is reached after 3-4 hours. Distribution More than 99% of losartan and EXP-3174 binds to plasma proteins, mainly to albumin. Vd of losartan is 34 liters. It penetrates very poorly through the BBB. Metabolism It undergoes significant metabolism during the first passage through the liver, forming the active metabolite EXP-3174 (14%) and a number of inactive metabolites. Excretion Plasma clearance of losartan and EXP-3174 is approximately 10 ml / s (600 ml / min) and 0.83 ml/s (50 ml/min), respectively. The renal clearance of losartan and EXP-3174 is about 1.23 ml/s (74 ml/min) and 0.43 ml/s (26 ml/min), respectively. T1 / 2 of losartan and EXP-3174 is 2 hours and 6-9 hours, respectively. About 58% of the drug is excreted in the bile, 35% - by the kidneys. Hydrochlorothiazide Absorption and distribution After oral administration, the absorption of hydrochlorothiazide is 60-80%. Cmax in the blood is achieved 1-5 hours after ingestion. The binding of hydrochlorothiazide to plasma proteins is 64%. Metabolism and excretion Hydrochlorothiazide is not metabolized and is rapidly excreted by the kidneys. T1 / 2 is 5-15 hours.

Indications

symptomatic therapy of painful inflammatory processes of various origins (including postoperative and post-traumatic pain, sciatica, myalgia, sciatica, bruises and muscle strains, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute gout attack, tendosynovitis, bursitis); symptomatic treatment of acute pain syndrome in inflammatory diseases of the musculoskeletal system (only for intramuscular injection)

Contraindications

Hypersensitivity to losartan, to drugs that are derivatives of sulfonamides and other components of the drug, anuria, severe renal dysfunction (Cl creatinine Precautions: disturbances in the water and electrolyte balance of the blood (hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney, diabetes mellitus, hypercalcemia, hyperuricemia and / or gout, aggravated allergic history (development of angioedema earlier when taking other drugs, including ACE inhibitors) and bronchial asthma, systemic blood diseases (incl. systemic lupus erythematosus), simultaneous administration of NSAIDs, including COX-2 inhibitors.

Use during pregnancy and lactation

It can be prescribed together with other antihypertensive drugs. There is no need for a special selection of the initial dose in elderly patients. The drug can increase the concentration of urea and creatinine in the blood plasma in patients with bilateral renal artery stenosis or renal artery stenosis of a single kidney. Hydrochlorothiazide can increase arterial hypotension and water and electrolyte balance disorders (decrease in BCC, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), disrupt glucose tolerance, reduce the excretion of calcium in the urine and cause a transient, slight increase in the concentration of calcium in the blood plasma, increase the concentration of cholesterol and TG, provoke the occurrence of hyperuricemia and / or gout. Lorista N contains lactose, so the drug is not prescribed to patients with lactase deficiency, galactosemia or glucose / galactose malabsorption syndrome. Influence on the ability to drive vehicles and control mechanisms Virtually all patients during therapy with Lorista N can perform activities that require increased attention (for example, driving a car or dangerous t technical means). In some individuals, at the beginning of therapy, the drug can cause arterial hypotension and dizziness and, thus, indirectly affect their psychophysical state. For safety reasons, before starting activities that require increased attention, patients should first evaluate their response to the treatment being carried out.

Dosage and administration

Inside, regardless of food intake. Lorista H can be combined with other antihypertensive agents. Arterial hypertension. Initial and maintenance dose - 1 tab. Lorista N (50/12.5 mg) 1 time per day. The maximum antihypertensive effect is achieved within 3 weeks of therapy. To achieve a more pronounced effect, it is possible to increase the dose of the drug to 2 tablets. Lorista N (50/12.5 mg) 1 time per day. The maximum daily dose is 2 tablets. the drug Lorista N. In patients with reduced BCC (for example, while taking high doses of diuretics), the recommended initial dose of losartan in patients with hypovolemia is 25 mg 1 time per day. In this regard, Lorista N therapy should be started after discontinuation of diuretics and correction of hypovolemia. In elderly patients and patients with moderate renal insufficiency, including those on dialysis, no initial dose adjustment is required. Reducing the risk of cardiovascular morbidity and mortality in patients with arterial hypertension and left ventricular hypertrophy. The standard starting dose of losartan is 50 mg once daily.

Side effects

Losartan In clinical studies, there was no clinically significant pharmacokinetic interaction of losartan with hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole and erythromycin. Rifampicin and fluconazole reduce the level of the active metabolite (this interaction has not been clinically studied). amiloride), potassium-containing supplements or potassium salts can lead to hyperkalemia. NSAIDs, incl. selective COX-2 inhibitors may reduce the effectiveness of diuretics and other antihypertensive drugs, including losartan. In patients with impaired renal function treated with NSAIDs (including COX-2 inhibitors), therapy with angiotensin II receptor antagonists may lead to further deterioration of renal function, including acute renal failure, which is usually reversible. The hypotensive effect of losartan, like other antihypertensive drugs, can be reduced when taking indomethacin. Hydrochlorothiazide When used simultaneously with thiazide diuretics, ethanol, barbiturates and narcotic drugs may potentiate the risk of developing orthostatic hypotension. When used simultaneously with hypoglycemic agents (for oral administration and insulin), dose adjustment of hypoglycemic agents may be required. When taken in combination with other antihypertensive drugs, an additive effect. Colestyramine and colestipol disrupt the absorption of hydrochlorothiazide. When used simultaneously with GCS, ACTH has a pronounced decrease in electrolyte levels, in particular hypokalemia. Hydrochlorothiazide reduces the severity of the response to taking pressor amines (for example, epinephrine, norepinephrine). Hydrochlorothiazide enhances the effect of non-depolarizing muscle relaxants of the type of action (for example, tubocurarine). Diuretics reduce the renal clearance of lithium and increase the risk of developing toxic effects of lithium (simultaneous use is not recommended). NSAIDs (including COX-2 inhibitors) can reduce the diuretic, natriuretic and hypotensive effect of diuretics. Due to the effect on calcium metabolism, taking thiazide diuretics may distort the results of a study of the function of the parathyroid glands.

Overdose

On the part of the blood and lymphatic system: infrequently - anemia, Shenlein-Genoch disease. On the part of the immune system: rarely - anaphylactic reactions, angioedema (including swelling of the larynx and tongue, causing airway obstruction and / or swelling of the face, lips, pharynx). From the side of the central nervous system and peripheral nervous system: often - headache, systemic and non-systemic dizziness, insomnia, fatigue; infrequently - migraine. From the side of the cardiovascular system: often - orthostatic hypotension (dose-dependent), palpitations, tachycardia; rarely - vasculitis. From the respiratory system: often - cough, infections of the upper respiratory tract, pharyngitis, swelling of the nasal mucosa. From the gastrointestinal tract: often - diarrhea, dyspepsia, nausea, vomiting, abdominal pain. From the hepatobiliary system: rarely - hepatitis, impaired liver function. From the side of the skin and subcutaneous fat: infrequently - urticaria, pruritus. From the musculoskeletal system and connective tissue: often - myalgia, back pain; infrequently - arthralgia. Others: often - asthenia, weakness, peripheral edema, chest pain. Laboratory indicators: often - hyperkalemia, increased hemoglobin and hematocrit (clinically not significant); sometimes - a moderate increase in the level of urea and creatinine in the blood serum; very rarely - increased activity of liver enzymes and bilirubin.

Interaction with other drugs

Precautionary measures

special instructions

LosartanSymptoms: pronounced decrease in blood pressure, tachycardia; bradycardia due to parasympathetic (vagal) stimulation. Treatment: forced diuresis, symptomatic therapy, hemodialysis is ineffective. Hydrochlorothiazide Symptoms: the most common symptoms are the result of electrolyte deficiency (hypokalemia, hypochloremia, hyponatremia) and dehydration due to excessive diuresis. With the simultaneous administration of cardiac glycosides, hypokalemia can aggravate the course of arrhythmias. Treatment: symptomatic therapy.