Generic Name and Formulations:
Losartan potassium, hydrochlorothiazide; 50mg/12.5mg, 100mg/12.5mg, 100mg/25mg; tabs.
Merck & Co., Inc.
Hypertension (not for initial therapy unless HTN is severe). To reduce stroke in hypertensive patients with left ventricular hypertrophy (LVH); this benefit may not apply to black patients.
≥18yrs: One 50/12.5mg tab once daily; may increase after about 3 weeks (2–4 weeks for severe HTN) to two 50/12.5mg tabs once daily or one 100/25mg tab once daily. Titrate components: see full labeling. HTN with LVH: switch from losartan monotherapy (see full labeling). Severe renal impairment (CrCl<30mL/min): not recommended.
<18yrs: not established.
Angiotensin II receptor blocker + thiazide diuretic.
Anuria. Sulfonamide allergy. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Correct salt/volume depletion before starting therapy, or reduce initial dose. Renal impairment: monitor for worsening renal function. Hepatic impairment requiring titration with losartan: not recommended. Severe CHF. Renal artery stenosis. Asthma. SLE. Gout. Diabetes. Postsympathectomy. Acute myopia. Secondary angle-closure glaucoma. Pregnancy (Cat.D). Nursing mothers: not recommended.
See Contraindications. Hyperkalemia with K+ supplements, K+ sparing diuretics, K+ containing salt substitutes. Potentiated by fluconazole. Antagonized by rifampin. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors (monitor renal function periodically in elderly and/or volume-depleted). Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Orthostatic hypotension with alcohol, other CNS depressants. Potentiates other antihypertensives, tubocurarine. Hypokalemia with corticosteroids, ACTH. May antagonize pressor amines (eg, norepinephrine), cholestyramine, colestipol resins. Adjust antihyperglycemics. May increase digitalis, lithium toxicity (monitor). May interfere with parathyroid tests.
Dizziness, abdominal pain, palpitations, back pain, sinusitis, cough, upper respiratory infection, rash, hyperkalemia; angioedema, syncope (discontinue if occurs), rhabdomyolysis (rare).
Hepatic (CYP2C9, 3A4).
Tabs—30, 90, 1000