losartan potassium 50 mg;
hydrochlorothiazide 12.5 mg;
dye Opaspray Yellow M-1-22801 (which includes: purified water, titanium dioxide, methyl alcohol BP, hypromellose, Quinolin Yellow (E104), Ponceau 4R (E124))
Lozap plus - hypotensive, diuretic.
Losartan is rapidly absorbed from the gastrointestinal tract. Bioavailability is about 33%. Has the effect of "first pass" through the liver, is metabolized by carboxylation to form an active metabolite.
Plasma protein binding - 99%. Time to reach Cmaxlosartan - 1 hour, active metabolite - 3-4 hours after oral administration. T1 / 2 - 1.5-2 hours, and its main metabolite - 3-4 hours, respectively. About 35% of the dose is excreted in the urine, about 60% through the intestines. Hydrochlorothiazide is rapidly absorbed from the gastrointestinal tract. T1 / 2 - 5.8-14.8 hours
Not metabolized by the liver. About 61% is excreted by the kidneys unchanged. Pharmacodynamics The combined drug has a hypotensive effect.
Contains losartan potassium - an angiotensin II receptor antagonist (AT1 subtype) - and hydrochlorothiazide - a diuretic. Losartan is a specific angiotensin II receptor antagonist (AT1 subtype).
Does not inhibit kinase II, an enzyme that degrades bradykinin. Reduces OPSS, blood concentration of adrenaline and aldosterone, blood pressure, pressure in the pulmonary circulation; reduces afterload, has a diuretic effect.
Prevents the development of myocardial hypertrophy, increases exercise tolerance in patients with chronic heart failure. Hydrochlorothiazide is a thiazide diuretic. Reduces reabsorption of Na +, enhances urinary excretion of K +, bicarbonate and phosphates. Lowers blood pressure by reducing the BCC, changing the reactivity of the vascular wall, reducing the pressor effect of vasoconstrictor substances.
Arterial hypertension (in patients for whom combination therapy is optimal).
Application during pregnancy and lactation
Taking drugs that directly affect the renin-angiotensin system during the II and III trimesters of pregnancy can lead to fetal death. When pregnancy occurs, drug withdrawal is indicated.
The use of diuretics is usually not recommended for pregnant women due to the risk of jaundice in the fetus and newborn, thrombocytopenia in the mother. Diuretic therapy does not prevent the development of pregnancy toxicosis.
severe arterial hypotension; hypersensitivity to drug components; anuria; severe impaired liver and kidney function (Cl creatinine hypovolemia (including against the background of high doses of diuretics); pregnancy and lactation; age up to 18 years (efficacy and safety have not been established).
With caution: patients with diabetes mellitus, hypercalcemia, hyperuricemia and / or gout; patients with bilateral renal stenosis / stenosis of a solitary artery; patients with a history of allergy and bronchial asthma, as well as with systemic diseases of the connective tissue (including systemic lupus erythematosus).
On the part of the skin: urticaria.
From the side of the cardiovascular system: lowering blood pressure.
From the side of the digestive tract: rare have been reported with losartan.
From the respiratory system: when taking losartan - cough.
Allergic reactions: angioedema, including edema of the larynx and / or tongue, leading to airway obstruction, and / or edema of the face, lips, pharynx and / or tongue, occasionally noted with losartan.
Some of the patients with the aforementioned allergic reactions have previously experienced angioedema when using other drugs, incl. and ACE inhibitors.
It is extremely rare when taking losartan manifestations of vasculitis, including Shenlein-Henoch disease, were noted.
Laboratory indicators: rarely (5.5 mmol / l), increased activity of hepatic transaminases.
Losartan enhances the effect of other antihypertensive drugs. There was no clinically significant interaction with digoxin, indirect anticoagulants, cimetidine, phenobarbital, ketoconazole, erythromycin.
As with other drugs that block angiotensin II or its action, the simultaneous administration of potassium-sparing diuretics (eg spironolactone, triamterene, amiloride), potassium preparations or salt substitutes containing potassium can lead to hyperkalemia.
Hydrochlorothiazide. The following drugs can interact with thiazide diuretics while prescribing the following drugs:
barbiturates, narcotic pain relievers, ethanol - potentiation of orthostatic hypotension may occur;
hypoglycemic agents (oral agents and insulin) - dose adjustment of hypoglycemic agents may be required;
other antihypertensive drugs - an additive effect is possible;
cholestyramine - reduced absorption of hydrochlorothiazide;
corticosteroids, ACTH - increased loss of electrolytes, especially potassium;
non-depolarizing muscle relaxants (for example tubocurarine) - it is possible to enhance the action of muscle relaxants;
lithium preparations - diuretics reduce the renal clearance of Li + and increase the risk of lithium intoxication, therefore, simultaneous use is not recommended;
NSAIDs - in some patients, the use of NSAIDs can reduce the diuretic, natriuretic and hypotensive effects of diuretics.
Due to their effect on calcium excretion, thiazides can influence the results of the analysis of the function of the parathyroid glands.
How to take, course of administration and dosage
Inside, regardless of food intake.
The usual starting and maintenance dose is 1 tablet daily. For those patients in whom, at this dosage, it is not possible to achieve adequate blood pressure, the dose of the drug can be increased to 2 tablets once a day.
The maximum dose is 2 tablets once a day. In general, the maximum antihypertensive effect is achieved within 3 weeks after starting treatment.
There is no need for a special selection of the initial dose in elderly patients.
Symptoms: losartan - tachycardia, marked decrease in blood pressure, bradycardia (as a result of vagal stimulation); hydrochlorothiazide - loss of electrolytes (hyperchloremia, hypokalemia, hyponatremia), as well as dehydration resulting from excessive diuresis.
Treatment: symptomatic and supportive therapy.
If the drug has been recently taken, the stomach should be flushed; if necessary, correction of water-electrolyte disturbances is carried out. The drug Losartan and its active metabolites are not removed by hemodialysis.
Lozap plus can be prescribed together with other antihypertensive drugs.
The drug can increase the concentration of urea and creatinine in the blood plasma in patients with bilateral renal artery stenosis or renal artery stenosis of a single kidney.
Hydrochlorothiazide can increase disturbances in the water-electrolyte balance (decrease in BCC, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), impair glucose tolerance, reduce urinary Ca2 + excretion and cause a transient slight increase in the concentration of Ca2 + in the blood plasma of cholesterol, and increase the occurrence of hyperuricemia and / or gout.