The loss of too much body fluid can make it dangerous for you to take this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child, particularly in the second or third trimester. Talk to your health care professional or pharmacist for more information. You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you.
Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can make you more drowsy and dizzy. This medicine may affect your blood sugar level. If you have diabetes, check with your doctor or health care professional before changing the dose of your diabetic medicine. Biliary excretion contributes to the elimination of losartan and its metabolites.
Neither losartan nor its metabolite accumulate in plasma upon repeated once-daily dosing. Hydrochlorothiazide Hydrochlorothiazide is not metabolized but is eliminated rapidly by the kidney. When plasma levels have been followed for at least 24 hours, the plasma half-life has been observed to vary between 5.
At least 61 percent of the oral dose is eliminated unchanged within 24 hours. Hydrochlorothiazide crosses the placental but not the blood-brain barrier and is excreted in breast milk. Special Populations Geriatric and Gender Losartan pharmacokinetics have been investigated in the elderly years and in both genders. Plasma concentrations of losartan and its active metabolite are similar in elderly and young hypertensives.
Plasma concentrations of losartan were about twice as high in female hypertensives as male hypertensives, but concentrations of the active metabolite were similar in males and females. Race Pharmacokinetic differences due to race have not been studied [see also Use In Specific Populations ]. Hepatic Insufficiency Following oral administration in patients with mild to moderate alcoholic cirrhosis of the liver, plasma concentrations of losartan and its active metabolite were, respectively, 5 times and about 1.
The lower starting dose of losartan recommended for use in patients with hepatic impairment cannot be given using HYZAAR. Drug Interactions Losartan Potassium No clinically significant drug interactions have been found in studies of losartan potassium with hydrochlorothiazide, digoxin, warfarin, cimetidine and phenobarbital.
Conversion of losartan to its active metabolite after intravenous administration is not affected by ketoconazole, an inhibitor of P 3A4. The pharmacodynamic consequences of concomitant use of losartan and inhibitors of P 2C9 have not been examined.
Subjects who do not metabolize losartan to active metabolite have been shown to have a specific, rare defect in cytochrome P 2C9. These data suggest that the conversion of losartan to its active metabolite is mediated primarily by P 2C9 and not P 3A4.
The LIFE study was a multinational, double-blind study comparing losartan and atenolol in hypertensive patients with ECG -documented left ventricular hypertrophy. Patients with myocardial infarction or stroke within six months prior to randomization were excluded. Patients were randomized to receive once daily losartan 50 mg or atenolol 50 mg.
If necessary, other antihypertensive treatments e. In efforts to control blood pressure, the patients in both arms of the LIFE study were coadministered hydrochlorothiazide the majority of time they were on study drug The mean length of follow-up was 4. Blood pressure reduction measured at trough was similar for both treatment groups but blood pressure was not measured at any other time of the day. At the end of study or at the last visit before a primary endpoint, the mean blood pressures were The primary endpoint was the first occurrence of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction.
Patients with nonfatal events remained in the trial, so that there was also an examination of the first event of each type even if it was not the first event e. Losartan Potassium-Hydrochlorothiazide The 3 controlled studies of losartan and hydrochlorothiazide included over patients assessing the antihypertensive efficacy of various doses of losartan 25, 50 and mg and concomitant hydrochlorothiazide 6.
Another study investigated the dose-response relationship of various doses of hydrochlorothiazide 6. The third study investigated the dose-response relationship of various doses of losartan 25, 50 and mg or placebo on a background of hydrochlorothiazide 25 mg in patients not adequately controlled SiDBP mmHg on hydrochlorothiazide 25 mg alone.
These studies showed an added antihypertensive response at trough 24 hours post-dosing of hydrochlorothiazide Similarly, there was an added antihypertensive response at trough when losartan 50 or mg was added to hydrochlorothiazide 25 mg of 9.
There was no significant effect on heart rate. There was no difference in response for men and women or in patients over or under 65 years of age. Black patients had a larger response to hydrochlorothiazide than non-Black patients and a smaller response to losartan.
The overall response to the combination was similar for Black and non-Black patients. Patients on monotherapy were titrated from losartan 50 mg to losartan mg to losartan mg, as needed. The mean age was 53 years. After 4 weeks of therapy, the mean SiDBP was 3. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Talk to your doctor if you are using marijuana. Severe sweating , diarrhea , or vomiting can increase the risk for lightheadedness or a serious loss of body water dehydration.
Report prolonged diarrhea or vomiting to your doctor. To prevent dehydration , drink plenty of fluids unless your doctor directs you otherwise. If you have diabetes , this product may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Avoid a diet high in salt. Too much salt may cause your body to retain water and may decrease the effects of the medication.
Do not use salt substitutes or take potassium supplements without first talking to your doctor. Losartan can affect potassium levels in your body. Avoid prolonged exposure to sunlight. This medication may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Avoid becoming overheated in hot weather.
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