Lozartan - instructions for use, reviews, analogs and formulations (tablets 12.5 mg, 25 mg, 50 mg and 100 mg of Teva, Richter, H with diuretic) drugs for the treatment of hypertension and pressure reduction in adults, children and in pregnancy
In this article, you can read the instructions for using the drug Losartan. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Losartan in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Losartan in the presence of existing structural analogues. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation.
Losartan antihypertensive agent.It is a non-peptidic blocker of angiotensin 2 receptors. It has high selectivity and affinity for AT1 receptors (with the participation of which the main effects of angiotensin 2 are realized). Blocking these receptors, losartan prevents and eliminates the vasoconstrictive effect of angiotensin 2, its stimulating effect on the secretion of aldosterone by the adrenal glands and some other effects of angiotensin 2. It is characterized by a prolonged action (24 hours or more), which is due to the formation of its active metabolite.
Composition
Losartan potassium + auxiliary substances.
Pharmacokinetics
After oral administration, losartan is rapidly absorbed from the digestive tract. Bioavailability is about 33%. Metabolized at the "first pass" through the liver to form a carboxyl metabolite, which has a more pronounced pharmacological activity than losartan, and a number of inactive metabolites. Binding to plasma proteins of losartan and active metabolite is high - more than 98%. Losartan is excreted in the urine and with feces (with bile) in unchanged form and in the form of metabolites. About 35% is excreted in the urine and about 60% - with feces.
Indications
- arterial hypertension;
- reduction in the risk of associated cardiovascular morbidity and mortality in patients with hypertension and left ventricular hypertrophy, manifested by a decrease in the combined incidence of cardiovascular mortality, stroke and myocardial infarction;
- protection of the kidneys in patients with type 2 diabetes mellitus with proteinuria - slowing the progression of renal failure, manifested by a decrease in the frequency of hypercreatininaemia, the frequency of end-stage renal disease, requiring hemodialysis or kidney transplantation, mortality rates, and a decrease in proteinuria;
- chronic heart failure with ineffective treatment with ACE inhibitors.
Forms of release
Tablets coated with 12.5 mg, 25 mg, 50 mg and 100 mg (manufactured by Richter, Teva, H form with a diuretic hydrochlorothiazide).
Instructions for use and dosage
The drug Losartan is taken orally regardless of food intake. Tablets are swallowed, not liquid, squeezed with water. Multiplicity of admission - 1 time per day.
Arterial hypertension
With arterial hypertension, the average daily dose is 50 mg once a day. To achieve a greater therapeutic effect, the dose is increased to 100 mg per day.
Chronic heart failure
The initial dose for patients with chronic heart failure is 12.5 mg once a day. Typically, the dose increases with a weekly interval (i.e., 12.5 mg / day, 25 mg / day and 50 mg / day) to an average maintenance dose of 50 mg once a day, depending on the patient's tolerability.
No dose adjustment is required in elderly patients.
Reducing the risk of developing cardiovascular diseases (including stroke) and mortality in patients with hypertension and left ventricular hypertrophy
The initial dose of the drug is 50 mg once a day. In the future, hydrochlorothiazide can be added in low doses or the dose of Lozartan can be increased to 100 mg in 1 or 2 doses, taking into account the decrease in blood pressure.
Patients with concomitant type 2 diabetes mellitus with proteinuria
The drug is given in an initial dose of 50 mg once a day with a further increase in the dose to 100 mg per day (taking into account the degree of BP reduction) in one or two doses.
In patients with reduced BCC (for example, when taking diuretics in high doses) the recommended initial dose of the drug Lozartan is 25 mg once a day.
Patients with hepatic insufficiency (less than 9 on the Child-Pugh scale), hemodialysis procedure, and patients older than 75 years are recommended a lower initial dose of the drug - 25 mg once a day.
Insufficient experience in the use of the drug in patients with severe hepatic insufficiency, so the drug is not recommended for this category of patients.
The drug does not have the features of the action at the first admission or when it is withdrawn, but it is necessary to control the blood pressure as when taking any antihypertensive drug.
Admission of antihypertensive drugs should be carried out at the same time as prescribed by the doctor to increase the therapeutic effect. If you miss a dose-one dose, you need to take the next dose of the drug at the time closest to the time of the usual drug intake or while remembering that you missed the appointment by moving the time of taking the next dose. Do not take twice the dose of the drug.
Side effect
- dizziness;
- asthenia / fatigue;
- headache;
- insomnia;
- anxiety;
- sleep disturbance;
- drowsiness;
- memory disorders;
- peripheral neuropathies;
- paresthesia;
- migraine;
- tremor;
- depression;
- tinnitus;
- a taste disorder;
- change of vision;
- conjunctivitis;
- nasal congestion;
- cough;
- infections of the upper respiratory tract (fever, sore throat);
- sinusitis;
- pharyngitis;
- rhinitis;
- nausea, vomiting;
- diarrhea;
- dyspeptic phenomena;
- abdominal pain;
- dryness of the oral mucosa;
- anorexia;
- convulsions;
- myalgia;
- pain in the back, chest, legs;
- arthralgia;
- tachy- or bradycardia;
- arrhythmias;
- angina pectoris;
- anemia;
- myocardial infarction;
- imperative urge to urinate;
- weakening of libido;
- impotence;
- dry skin;
- a rush of blood;
- photosensitization;
- increased sweating;
- alopecia;
- hives;
- skin rash;
- itching;
- angioedema, incl. face, lips, throat and / or tongue;
- fever;
- gout;
- vasculitis;
- eosinophilia;
- purple Shenlaine-Genocha.
Contraindications
- pregnancy;
- lactation period;
- age to 18 years;
- severe hepatic insufficiency (more than 9 on the Child-Pugh scale);
- hereditary intolerance to galactose, lactase deficiency or glucose-galactose malabsorption syndrome;
- hypersensitivity to the components of the drug.
Application in pregnancy and lactation
The use of the drug Losartan during pregnancy is contraindicated. It is known that drugs acting directly on the renin-angiotensin-aldosterone system (RAAS), when used in the 2nd and 3rd trimesters of pregnancy, can cause developmental defects or even death of the developing fetus. Therefore, when diagnosing a pregnancy, taking Loszartan should be stopped immediately.
It is not known whether losartan is excreted in breast milk. It is not recommended to take Lozartan during lactation. If the drug Lozartan is needed during lactation, then breastfeeding should be discontinued.
Application in elderly patients
No dose adjustment is required in elderly patients.
Patients older than 75 years are recommended a lower initial dose of the drug - 25 mg once a day.
Use in children
Contraindicated in children and adolescents under the age of 18 years.
special instructions
For patients with chronic heart failure, in whom a stable effect was achieved as a result of the use of ACE inhibitors, it is not recommended to switch to the use of angiotensin 2 receptor antagonists, incl. drug Lozartan.
Patients with liver disease (less than 9 points on the Scale-Pugh scale, and especially with cirrhosis), incl. in the anamnesis, it is necessary to prescribe smaller doses.
In patients with dehydration (for example, receiving treatment with high doses of diuretics), at the beginning of treatment with losartan, symptomatic arterial hypotension may occur (it is necessary to correct dehydration before losartan is administered or to begin treatment at a lower dose).
In patients with renal dysfunction, with or without diabetes, electrolyte disorders (hyperkalemia) often develop, to which attention should be paid. In the presence of acute or chronic renal failure, losartan may lead to impaired renal function with or without hyperkalemia.
During treatment with losartan should regularly monitor the potassium content in the blood, especially in elderly patients and with violations of kidney function. It should avoid simultaneous use of losartan with potassium-sparing diuretics.
In elderly patients who use non-steroidal anti-inflammatory drugs, with simultaneous administration of diuretics, or with impaired renal function, the use of losartan can lead to impaired renal function,including the possibility of acute renal failure. These effects are usually reversible. Periodically monitor renal function in patients taking losartan and non-steroidal anti-inflammatory drugs.
Data on the safety and efficacy of the drug in children are not sufficient.
Impact on the ability to drive vehicles and manage mechanisms
The ability of the drug to influence the speed of psychomotor reactions and the ability to control transport or other technical means has not been studied. Care should be taken when dealing with potentially hazardous activities requiring increased attention and rapid psychomotor reactions.
Drug Interactions
The drug Losartan can be used simultaneously with other antihypertensive drugs.
Mutually enhances the effect of beta-blockers and sympatholytics.
The combined use of losartan with diuretics causes an additive effect.
There were no pharmacokinetic interactions of losartan with hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, Ketoconazole and erythromycin.
Reportedly, rifampicin and Fluconazole reduce the concentration of the active metabolite in the blood plasma. The clinical significance of these interactions is still unknown.
As with other agents that inhibit angiotensin or its effect, combined use of losartan potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium preparations, salts containing potassium, increases the risk of hyperkalemia.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including selective inhibitors of cyclooxygenase-2 (COX-2), can reduce the effect of diuretics or other antihypertensives.
With the combined use of antagonists of angiotensin 2 and lithium receptors, an increase in the concentration of lithium in the blood plasma is possible. Given this, it is necessary to weigh the benefit and risk of joint use, losartan with lithium salts. In case of necessity of joint application of preparations, it is necessary to regularly monitor the concentration of lithium in blood plasma.
Analogues of the drug Losartan
Structural analogs for the active substance:
- Bloktran;
- Brozaar;
- Vasotensis;
- Vero Losartan;
- Zisakar;
- Cardomin Sanovel;
- Karzartan;
- Cosaar;
- Lacka;
- Lozap;
- Lozarel;
- Losartan McLeodz;
- Losartan Richter;
- Losartan Teva;
- Lorist;
- Losakor;
- Lothor;
- Prezartan;
- Renikard.
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