Losartan and Hydrochlorothiazide

Pronunciation

(loe SAR tan & hye droe klor oh THYE a zide)


U.S. Brand Names

Hyzaar®



Synonyms

Hydrochlorothiazide and Losartan



Generic Available

No



Canadian Brand Names

Hyzaar®; Hyzaar® DS



Use

Treatment of hypertension



Pregnancy Risk Factor

C/D (2nd and 3rd trimesters)



Pregnancy Implications

See individual agents.



Lactation

Enters breast milk/contraindicated



Contraindications

Based on losartan component: Hypersensitivity to losartan or any component of the formulation; hypersensitivity to other A-II receptor antagonists; bilateral renal artery stenosis; pregnancy (2nd and 3rd trimesters)

Based on hydrochlorothiazide component: Hypersensitivity to hydrochlorothiazide, thiazides, sulfonamide-derived drugs, or any component of the formulation; anuria; renal decompensation; pregnancy (2nd and 3rd trimesters)

Warnings/Precautions

Based on losartan component: Avoid use or use a smaller dose in patients who are volume depleted; correct depletion first. Deterioration in renal function can occur with initiation. Use with caution in unilateral renal artery stenosis and pre-existing renal insufficiency; significant aortic/mitral stenosis.

Based on hydrochlorothiazide component: Avoid in severe renal disease (ineffective). Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.

Adverse Reactions

See individual agents.



Drug Interactions

Losartan: (major) of CYP2C8/9, 3A4; CYP1A2 (weak), 2C8/9 (moderate), 2C19 (weak), 3A4 (weak)

SubstrateInhibits

Also see individual agents.

Pharmacodynamics/Kinetics

See individual agents.



Dosage

Oral (dosage must be individualized): Adults: 1 tablet daily



Patient Education

See individual agents. Inform prescriber if you are or intend to become pregnant. Do not breast-feed.

Pregnancy/breast-feeding precautions:

Cardiovascular Considerations

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for losartan and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. See Special Cardiovascular Considerations for individual agents.



Dental Health: Effects on Dental Treatment

No significant effects or complications reported



Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions



Mental Health: Effects on Mental Status

May cause dizziness or insomnia; may rarely cause anxiety, confusion, depression, and sleep disorders



Mental Health: Effects on Psychiatric Treatment

Barbiturates may decrease the effects of losartan; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels



Dosage Forms

Tablet [film coated]:

50-12.5: Losartan potassium 50 mg and hydrochlorothiazide 12.5 mg

100-25: Losartan potassium 100 mg and hydrochlorothiazide 25 mg

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure,"Am J Cardiol, 1999, 83(2A):1A-38A.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

International Brand Names

Hyzaar® (CA); Hyzaar® DS (CA)



Review Date: 1969-12-31 Reviewed By: Keywords: ,
Adam Data Copyright The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only--they do not constitute endorsements of those other sites. © 1997- 2010 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

For information 410.787.4000

© 2013 UM Baltimore Washington Medical Center.  All rights reserved.

301 Hospital Drive, Glen Burnie, MD 21061 | 410-787-4000 | TTY 410-787-4498