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Losartan / hydrochlorothiazide

Class
Antihypertensives
Subclass
Angiotensin receptor blocker / thiazide combination
Generic name
Losartan / hydroCHLOROthiazide
Brand names
Hyzaar®
Contains
Hydrochlorothiazide
Losartan
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Treatment
Hypertension
•
Start at: 50/12.5 mg PO daily
•
Maintenance: 50-100/12.5-25 mg PO daily
•
Maximum: 100/25 mg per day
Titrate every 3 weeks based on response and tolerability.
Prevention
Prevention of stroke in patients with hypertensive LVH
•
Start at: 50/12.5 mg PO daily
•
Maintenance: 50-100/12.5-25 mg PO daily
•
Maximum: 100/25 mg per day
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
•
Prevention of stroke in patients with hypertensive LVH
Safety risks
Boxed warnings
Fetal toxicity, neonatal morbidity and mortality
Contraindications
Hypersensitivity to losartan potassium/hydrochlorothiazide or any of its components
Anuria
Coadministration with aliskiren in patients with diabetes
Warnings and precautions
Acute angle-closure glaucoma, acute transient myopia
•
Use caution in patients with hypersensitivity to sulfonamide or penicillin.
Exacerbation of SLE
•
Use caution in patients with SLE.
Hypotension
•
Use caution in patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics).
Low urine output
•
Use caution in patients with renal artery stenosis, CKD, severe congestive HF, or volume depletion.
Specific populations
Renal impairment
CrCl > 30 mL/min
•
Use with caution.
CrCl 10-30 mL/min
•
Avoid use.
CrCl < 10 mL/min
•
Do not use.
Renal replacement therapy
Any modality
•
Avoid use.
Hepatic impairment
Any severity
•
Do not use. Losartan potassium / hydrochlorothiazide is not recommended for patients with hepatic impairment because the appropriate starting dose of losartan, 25 mg, is not available.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Avoid use. Evidence of fetal harm in humans. Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.
Breastfeeding
Consider alternative agents that may be safer.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
↓ serum potassium, back pain, dizziness, upper respiratory tract infections
Uncommon < 1%
•
↑ serum potassium
Unknown frequency
•
AKI, abnormal oral glucose tolerance test, acute angle-closure glaucoma, acute pancreatitis, agranulocytosis, allergic reactions, anaphylaxis, anemia, angioedema, aplastic anemia, basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous lupus erythematosus, ↓ WBC count, ↓ platelet count, ↓ serum magnesium, ↓ serum sodium, ↓ serum uric acid, gout, hemolytic anemia, hepatitis, hypotension, ↑ blood glucose, ↑ serum calcium, ↑ serum cholesterol, ↑ serum triglycerides, ↑ urine glucose, jaundice, merkel cell carcinoma, myopia, necrotizing vasculitis, non-melanoma skin cancer, photosensitivity of skin, renal failure, abdominal pain, asthenia, blurred vision, change in taste, chest pain, cough, erectile dysfunction, generalized pruritus, generalized pruritus, headache, indigestion, loss of appetite, malaise, muscle spasms, nasal congestion, nausea, palpitations, paresthesia, skin rash, vomiting, rhabdomyolysis, systemic lupus erythematosus, tachycardia, toxic epidermal necrolysis, tubulointerstitial nephritis, urticaria, vasculitis
Interactions
Drug(s)
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