Losartan and Hydrochlorothiazide (Systemic)
Losartan and Hydrochlorothiazide (Systemic)
US Brand Names
Losartan (lo-SAR-tan) and hydrochlorothiazide (hye-droe-klor-oh-THYE-a-zide) is a combination medicine that belongs to the class of medicines called high blood pressure medicines (antihypertensives). It is used to treat high blood pressure (hypertension).
High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
Losartan works by blocking a substance in the body that causes blood vessels to tighten. As a result, losartan relaxes blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart. Hydrochlorothiazide helps reduce the amount of salt and water in the body by acting on the kidneys to increase the flow of urine; this also helps to lower blood pressure.
This combination also may be used for other conditions as determined by your doctor.
This medicine is available only with your doctor's prescription, in the following dosage form(s):
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For losartan and hydrochlorothiazide, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to losartan, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, or methazolamide or to hydrochlorothiazide or any of the other thiazide diuretics (water pills). Also tell your health care professional if you are allergic to any other substances, such as foods, sulfites or other preservatives, or dyes.
Use of losartan during pregnancy, especially after the first 3 months, can cause low blood pressure, kidney failure, too much potassium, or death in newborns. Additionally, when hydrochlorothiazide is used during pregnancy, it may cause jaundice, blood problems, and other side effects in the newborn baby. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant .
It is not known whether losartan passes into breast milk. However, it does pass into the milk of lactating rats. Hydrochlorothiazide does pass into breast milk. Be sure that you discuss this with your doctor if you decide to breast-feed while taking these medicines.
Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of losartan and hydrochlorothiazide combination in children with use in other age groups.
Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way as they do in younger adults. Although there is no specific information comparing the use of losartan and hydrochlorothiazide combination in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine. When you are taking losartan and hydrochlorothiazide, it is especially important that your health care professional know if you are taking the following:
• Lithium (e.g., Lithane, Lithobid)-Hydrochlorothiazide may increase blood levels of lithium, which may increase the risk of adverse reactions
Other medical problems
The presence of other medical problems may affect the use of losartan and hydrochlorothiazide. Make sure you tell your doctor if you have any other medical problems, especially:
• Allergy or
• Asthma, bronchial-May have an increased risk of allergic reaction to hydrochlorothiazide
• Fluid or electrolyte (e.g., potassium, chloride, sodium) imbalance (due to excessive perspiration, vomiting, diarrhea, etc.)-The side effects of losartan and hydrochlorothiazide may be increased
• Heart failure, severe-Lowering of blood pressure by these medicines may make this condition worse
• Kidney disease or
• Liver disease-These conditions may be aggravated by losartan and hydrochlorothiazide
• Sympathectomy-Blood pressure-lowering effects may be increased
• Systemic lupus erythematosus (SLE)-Symptoms of this condition may be made worse with use of hydrochlorothiazide
This medicine works best if there is a constant amount in the blood. To help keep this amount constant, do not miss any doses and take the medicine at the same time each day.
In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these is most important for you. You should check with your doctor before changing your diet.
Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
This medicine may be taken with or without food.
The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking losartan and hydrochlorothiazide .
• For oral dosage form (tablets):
o For high blood pressure:
§ Adults-1 tablet once a day. Your doctor may increase your dose if needed.
§ Children-Use and dose must be determined by your doctor.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
To store this medicine:
• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
Check with your doctor immediately if you think that you may be pregnant . Losartan and hydrochlorothiazide may cause birth defects or other problems in the baby if taken during pregnancy.
It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.
Do not take other medicines unless they have been discussed with your doctor . This especially includes potassium supplements or salt substitutes that contain potassium, since they may change your blood potassium levels, or over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.
Dizziness, lightheadedness, or fainting may occur with this medicine. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you experience these effects.
Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea and vomiting or diarrhea. These conditions may cause you to lose too much water and lead to low blood pressure.
Dizziness, lightheadedness, or fainting may also occur if you exercise or if the weather is hot. Heavy sweating can cause loss of too much water and result in low blood pressure. Use extra care during exercise or hot weather.
Avoid alcoholic beverages until you have discussed their use with your doctor. Alcohol may make the low blood pressure effect worse and/or increase the possibility of dizziness or fainting.
For diabetic patients :
• Hydrochlorothiazide may raise blood sugar levels. Check with your doctor if any changes in your blood sugar levels occur.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Cough or hoarseness accompanied by chills or fever, lower back or side pain, painful or difficult urination.
Symptoms of fluid and electrolyte imbalance
Dry mouth; increased thirst; weak and/or irregular heartbeat; muscle cramps or pain; nausea or vomiting; unusual tiredness or weakness.
Check with your doctor as soon as possible if any of the following side effects occur:
Cold or flu-like symptoms; dizziness; sore throat.
Black tarry stools; blood in urine or stools; fainting; pinpoint red spots on skin; pounding heartbeat; skin rash; severe stomach pain, nausea, and vomiting; swelling of feet or lower legs; unusual bleeding or bruising.
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
Headache; increased sensitivity of skin to sunlight; stomach pain.
Cough; sinus problems.
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
August 12, 1998