Losartan Potassium and Hydrochlorothiazide

Clinical summary

Indications and usage Losartan potassium and hydrochlorothiazide tablets are a combination of losartan, an angiotensin II receptor blocker (ARB) and hydrochlorothiazide, a diuretic indicated for: Treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. ( 1.1 ) Reduction of the risk of stroke in patients with hypertension and left ventricular hypertrophy. There is evidence that this benefit does not apply to Black patients. ( 1.2 ) Standard dosing Hypertension Usual starting dose: 50 mg/12.5 mg once daily. ( 2.1 ) Titrate as needed to a maximum dose of 100 mg/25 mg. ( 2.1 ) Hypertensive Patients with Left Ventricular Hypertrophy Not controlled on monotherapy: Initiate with 50 mg/12.5 mg. Titrate as needed to a maximum of 100 mg/25 mg. ( 2.2 ) Contraindications Losartan potassium and hydrochlorothiazide tablets are contraindicated: In patients who are hypersensitive to any component of this product. In patients with anuria For coadministration with aliskiren in patients with diabetes Key warnings Hypotension: Correct volume or salt depletion prior to administration of losartan potassium and hydrochlorothiazide tablets. ( 5.2 ) Monitor renal function and potassium in susceptible patients. ( 5.3 ) Observe for clinical signs of fluid or electrolyte imbalance. ( 5.5 ) Acute angle-closure glaucoma. ( 5.6 ) Exacerbation of systemic lupus erythematosus. ( 5.7 ) Drug interactions Agents increasing serum potassium: Risk of hyperkalemia. ( 7.1 ) Lithium: Risk of lithium toxicity. ( 7.2 ) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): increased risk of renal impairment and reduced diuretic, natriuretic, and antihypertensive effects. ( 7.3 ) Dual inhibition of the renin-angiotensin system: increased risk of renal impairment, hypotension, syncope, and hyperkalemia. ( 7.4 ) Antidiabetic drugs: dosage adjustment of antidiabetic may be required. ( 7.5 ) Cholestyramine and colestipol: Reduced absorption of thiazides. ( 7.5 ) Pregnancy guidance Initiation of losartan potassium and hydrochlorothiazide tablets is not recommended for patients with hepatic impairment because the appropriate starting dose of losartan, 25 mg, is not available.