Composition and form of release of the drug
Film-coated tablets from light yellow to yellow, oval, slightly biconvex, chamfered.
Excipients: cellactose (a mixture of lactose monohydrate and cellulose), pregelatinized starch, corn starch, microcrystalline cellulose, anhydrous colloidal silicon dioxide, magnesium stearate.
Shell composition: hypromellose, talc, propylene glycol, quinoline yellow dye (E104), titanium dioxide (E171).
10 pieces. - cellular contour packings (3) - packs of cardboard.
10 pieces. - cellular contour packings (6) - packs of cardboard.
10 pieces. - cellular contour packings (9) - packs of cardboard.
pharmachologic effect
Antihypertensive agent. It is a non-peptide blocker of angiotensin II receptors. It has high selectivity and affinity for AT 1 type receptors (with the participation of which the main effects of angiotensin II are realized). By blocking these receptors, losartan prevents and eliminates the vasoconstrictive effect of angiotensin II, its stimulating effect on the secretion of aldosterone by the adrenal glands, and some other effects of angiotensin II. It is characterized by a long action (24 hours or more), which is due to the formation of its active metabolite.
Pharmacokinetics
After oral administration, losartan is rapidly absorbed from the gastrointestinal tract. Bioavailability is about 33%. It is metabolized during the "first pass" through the liver with the formation of a carboxyl metabolite, which has a more pronounced pharmacological activity than losartan, and a number of inactive metabolites. C max in the blood of losartan and the active metabolite is achieved after 1 hour and 3-4 hours, respectively. Plasma protein binding of losartan and the active metabolite is high - more than 98%.
T 1/2 of losartan and the active metabolite in the final phase is about 1.5-2.5 hours and 3-9 hours, respectively. Losartan is excreted in the urine and feces (with bile) unchanged and as metabolites. About 35% is excreted in the urine and about 60% in the feces.
Indications
Reducing the risk of associated cardiovascular morbidity and mortality in patients with arterial hypertension and left ventricular hypertrophy, manifested by a reduction in the combined incidence of cardiovascular death, stroke, and myocardial infarction.
Dermatological reactions: itching.
Others: renal dysfunction, myalgia.
drug interaction
With simultaneous use with diuretics in high doses, arterial hypotension is possible.
With simultaneous use with potassium preparations, potassium-sparing diuretics, the risk of developing hyperkalemia increases.
With simultaneous use with indomethacin, a decrease in the effectiveness of losartan is possible.
There is a report on the development of lithium intoxication with simultaneous use with lithium carbonate.
With simultaneous use with decreases the antihypertensive effect of losartan, which can lead to a significant increase in blood pressure, the development of a hypertensive crisis.
With simultaneous use with rifampicin, the clearance of losartan increases and its effectiveness decreases.
special instructions
It should be used with caution in case of arterial hypotension, decrease in BCC, disturbances in water and electrolyte balance, bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney, in renal / hepatic insufficiency
Patients who are deficient in fluid and / or sodium, before starting treatment, it is necessary to correct water and electrolyte disorders or use a lower initial dose.
In patients with dehydration (eg, treated with high dose diuretics), symptomatic hypotension may occur at the start of treatment with losartan.
During the period of treatment, the level of potassium in the blood should be regularly monitored, especially in elderly patients, with impaired renal function.
The simultaneous use of losartan with potassium-sparing diuretics should be avoided.
Pregnancy and lactation
Contraindicated for use during pregnancy and lactation.
Application in childhood
The safety and efficacy of losartan in children have not been established.
For impaired renal function
In case of impaired renal function, a dose reduction of losartan may be required.
For impaired liver function
In patients with a history of liver disease, losartan should be used at low doses. With cirrhosis of the liver, the concentration of losartan in the blood plasma increases significantly.
Use in the elderly
In elderly patients during treatment should regularly monitor the level of potassium in the blood.
The drug is a group of antihypertensive drugs. It is characterized by a combined action.
Lorista N.
ATX
C09DA01 Losartan.
Forms of release and composition
The drug in question is produced in solid form. 1 tablet contains 2 active compounds:
- losartan potassium (50 mg);
- hydrochlorothiazide (12.5 mg).
Minor components that do not show activity:
- starch;
- cellulose microcrystalline;
- lactose monohydrate;
- magnesium stearate.
Tablets differ in an oval form, a yellow-green shade. You can find on sale a package containing 14, 30, 60 and 90 pieces.
pharmachologic effect
The drug provokes a decrease in blood pressure. This possibility is provided due to the diuretic properties of the active substance (hydrochlorothiazide). As a result, the activity of certain components in the blood (for example, renin) increases. At the same time, the intensity of aldosterone secretion and the concentration of potassium in the blood plasma decrease. There is also an increase in the level of angiotensin II.
Under the influence of a diuretic, a loss of potassium ions occurs. The consequences of this effect are leveled by losartan, which is due to the inhibition of the production of angiotensin II. Under the influence of a diuretic substance, the level of uric acid slightly increases. The simultaneous use of hydrochlorothiazide in combination with another active ingredient helps to reduce hyperuricemia.
Under the influence of the drug, the heart rate does not change. The hypotensive effect persists for 1 day. Properties of the losartan component:
- decrease in peripheral vascular resistance;
- the substance stops the development of cardiac muscle hypertrophy;
- increased tolerance to increased stress in patients with cardiovascular pathologies.
Pharmacokinetics
A positive effect is noted within 60-120 minutes after taking the pill. Keeps for 12 hours. The highest level of drug activity occurs after 1-4 hours. The drug is characterized by a cumulative effect. The decrease in the level of pressure occurs for 3-4 days. To ensure the desired result, a long course of treatment is often required.
The process of transformation of the active substance and the release of metabolites occurs during the initial passage through the liver. The bioavailability of losartan is 99%. The second active compound (hydrochlorothiazide) has an absorption rate of 80%. The bioavailability of this component is 64%. Substances are excreted with bile through the intestines or with the participation of the kidneys.
What helps?
The drug is used in the following cases:
- hypertension, and the drug is prescribed along with other drugs in the composition complex therapy;
- reducing the likelihood of developing heart disorders, death in patients with confirmed hypertension, pathologies of the left ventricle, provoking myocardial infarction, stroke;
- if it is necessary to reduce the intensity of the development of renal failure, protect the kidneys when diagnosed diabetes 2 types;
- heart failure with confirmed ineffectiveness of drugs of the ACE inhibitor group, as well as in cases where the patient develops an individual reaction to such drugs.
At what pressure should I take it?
It is recommended to drink tablets with increasing pressure. The norm is considered to be 120/80 mm Hg. This means that the signs of hypertension appear when the values of this ratio are exceeded. The agent in question performs an antihypertensive function. If you use it at a reduced pressure, the blood pressure indicator may decrease even more, which is a health hazard.
Contraindications
In order to avoid deterioration of the condition of the body, it is forbidden to use the drug in question in the following cases:
- the development of an individual negative reaction to the main components, in addition, the drug is not prescribed for severe side effects while taking sulfanilamide derivatives;
- an increase in the intensity of the outflow of fluid from the body, in particular, against the background of the use of diuretics;
- hyperkalemia;
- hypotension;
- lack of lactase;
- malabsorption syndrome of glucose, galactose.
With caution, therapy is carried out against the background of a violation of water and electrolyte metabolism, a decrease in the level of potassium, magnesium, stenosis of the renal arteries, a tendency to such manifestations of allergies as angioedema, with hypercalcemia, and diabetes mellitus.
How to use?
You can drink tablets before or after meals, this does not affect the bioavailability of the agent in question. The treatment regimen differs depending on the type of disease:
- heart failure: you need to start the course with a minimum amount of the active compound (12.5 mg), weekly it is increased by 2 times until the maximum dose is reached, for this disease it is 150 mg per day;
- in order to reduce the risk of developing CCC pathologies: the amount of the drug at the initial stage is 50 mg / day, if necessary, the dose is increased to 100 mg / day;
- hypertension: a sufficient dosage is 50 mg, during therapy it is initial and gradually increases to 100 mg / day.
With diabetes
In order to protect the kidneys, a course of treatment is started with 50 mg per day. As necessary, the dose is recalculated, for this pathological condition it is 100 mg.
How long to take?
To relieve acute signs of hypertension, it is enough to drink the drug for 3-4 days. In order to stabilize the state of the body, it is recommended to take the tablets for 3-4 weeks (or longer).
Side effects
The main disadvantage of the agent under consideration is a large number of consequences that develop against the background of a negative response of the body to the influence of active compounds. These include pathological conditions of various organs and systems. A cough may occur, hepatitis develops less often (with kidney disorders), pain in the back and joints appears.
If you do not adhere to the treatment regimen, hypotension is often diagnosed against this background. There may be pain in the chest. Other symptoms: swelling, general weakness. Sometimes the concentration of hematocrit, hemoglobin decreases.
Gastrointestinal tract
Common manifestations: pain in the abdomen, nausea and vomiting, loss of appetite.
Hematopoietic organs
Anemia is noted. Henoch-Schonlein disease may develop.
central nervous system
There are headaches, dizziness. The development of insomnia is noted. In case of violations nervous system fatigue sets in faster.
Influence on the ability to control mechanisms
There is no information on the effect of the drug on the level of attentiveness. However, one should take into account the likelihood of developing a large number of side effects, including reactions caused by CNS disorders (dizziness, etc.). So, you need to drive with caution.
allergies
Note the development of urticaria. During therapy with the agent in question, intense itching appears.
special instructions
The drug can affect the biochemical processes in the body. Sometimes it helps to increase the concentration of cholesterol, calcium, triglycerides. Violates glucose tolerance, prevents the excretion of calcium from the body. Before conducting a study of the function of the parathyroid glands, the thiazide diuretic is canceled. This is due to the fact that a substance of this type affects the metabolism of calcium in the body, which means that there is a possibility of obtaining unreliable examination results.
Use during pregnancy and lactation
During the bearing of a child, it is forbidden to use this drug. Active components can provoke the development of pathologies in the fetus and even death.
Appointment of Lorist N to children
Do not use the considered pharmaceutical agent for the treatment of patients who have not reached the age of 18.
Dosage in old age
Therapy is carried out using a fixed amount of the drug. There is no need to start the course of treatment with a minimum dose of the active compound.
Use for impaired renal function
The determining factor is creatinine clearance. If this indicator is below 30 ml / minute, the agent in question is not prescribed for such a pathology.
Use in violation of liver function
In this case, the metabolism of active compounds changes, which can lead to an increase in the level of their content in the blood.
Alcohol compatibility
It is necessary to refuse the use of alcoholic beverages during therapy with Lorista N. This is due to the negative consequences of the combination of such substances. Complications and unpredictable side effects may develop. It is permissible to drink alcohol, but not earlier than 1 day after taking the drug. The course of therapy with Lorista N is continued 14 hours after drinking alcohol.
Overdose
- dehydration;
- hypotension;
- disorders of the cardiovascular system: bradycardia, tachycardia.
To eliminate the negative consequences, symptomatic therapy is carried out, aimed at reducing the intensity of side effects in case of overdose.
Interaction with other drugs
The drug in question is allowed to be used along with analogues (other antihypertensive agents). It is forbidden to use diuretics that increase the level of potassium in the body.
Under the influence of drugs such as Rimfapicin, Fluconazole, there is a slight decrease in the level of active components in the blood. Drugs that affect the levels of potassium in the body contribute to the development of hypo- and hyperkalemia when used simultaneously with Lorista N.
The use of NSAIDs (selective action) may cause a decrease in the effectiveness of treatment with antihypertensive drugs. In addition, this combination contributes to the deterioration of the body in case of kidney dysfunction.
With simultaneous use with cardiac glycosides, the course of arrhythmia is aggravated. The intake of barbiturates, alcohol-containing and narcotic drugs is the cause of a decrease in pressure. If hypoglycemic drugs are used, their dose is recalculated. Corticosteroid drugs provoke the development of hypokalemia. With the simultaneous use of muscle relaxants and Lorista N, an increase in the action of the former is noted.
Analogues
Effective substitutes for the drug in question:
- Lozap Plus;
- Losartan;
- Lorista ND;
- Gizaar, etc.
What is the difference between Lorista and Lorista N?
The difference lies in the composition. So, a variety of Lorista with the designation H, in addition to other components, contains the substance hydrochlorothiazide. In addition, the main intended purpose of this drug is the use as part of complex therapy along with drugs that represent a group of angiotensin receptor blockers.
Manufacturer
JSC "Krka, d.d., Novo Mesto", Slovenia.
Conditions for dispensing from a pharmacy
A prescription drug is offered.
Price for Lorista N
The cost varies from 260 to 770 rubles, which is affected by the dose of the active compound, the number of tablets in the package.
Storage conditions of the drug
Acceptable ambient temperature is within +25°С.
Best before date
Quickly about medicines. Lorista and Losartan
Composition and form of release of the drug
Film-coated tablets from yellow to yellow with a greenish tint, oval, slightly biconvex, with a risk on one side; cross-sectional view of the tablet - the core of the tablet is white.
Excipients: pregelatinized starch - 34.92 mg, microcrystalline cellulose - 87.7 mg, lactose monohydrate - 63.13 mg, magnesium stearate - 1.75 mg.
Compound film shell: hypromellose - 5 mg, macrogol 4000 - 0.5 mg, quinoline yellow dye (E104) - 0.11 mg, titanium dioxide (E171) - 1.39 mg, talc - 0.5 mg.
10 pieces. - blisters (3) - packs of cardboard.
10 pieces. - blisters (6) - packs of cardboard.
10 pieces. - blisters (9) - packs of cardboard.
pharmachologic effect
Combined antihypertensive agent. Losartan and hydrochlorothiazide have an additive antihypertensive effect, lowering blood pressure to a greater extent than either of the components separately.
Losartan is a selective angiotensin II receptor antagonist (type AT 1) for oral administration. In vivo and in vitro, losartan and its pharmacologically active metabolite E-3174 block all physiologically significant effects of angiotensin II on AT 1 receptors, regardless of the route of its synthesis: it leads to an increase in blood renin activity, reduces the concentration of aldosterone in blood plasma. Losartan indirectly causes the activation of AT 2 receptors by increasing the concentration of angiotensin II. Does not inhibit the activity of kininase II, an enzyme that is involved in the metabolism of bradykinin. Reduces peripheral vascular resistance, pressure in the pulmonary circulation, reduces afterload on the myocardium, has a diuretic effect. Prevents the development of myocardial hypertrophy, increases tolerance to physical activity in patients with chronic heart failure (CHF). Taking losartan 1 time / day leads to a statistically significant decrease in systolic and diastolic blood pressure.
Losartan evenly controls blood pressure throughout the day, while the antihypertensive effect corresponds to the natural circadian rhythm. The decrease in blood pressure at the end of the dose of the drug was approximately 70-80% of the maximum effect of losartan, 5-6 hours after ingestion. There is no withdrawal syndrome.
Losartan has no clinically significant effect on heart rate, has a moderate and transient uricosuric effect.
Hydrochlorothiazide- thiazide diuretic, the diuretic effect of which is associated with a violation of the reabsorption of sodium, chlorine, potassium, magnesium, water ions in the distal nephron; delays the excretion of calcium ions, uric acid. It has an antihypertensive effect, the action of which develops due to the expansion of arterioles. Virtually no effect on normal blood pressure. The diuretic effect occurs after 1-2 hours, reaches a maximum after 4 hours and lasts 6-12 hours. The maximum antihypertensive effect occurs after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect.
Due to the diuretic effect, hydrochlorothiazide increases plasma renin activity, stimulates the secretion of aldosterone, increases the concentration of angiotensin II and reduces the concentration of potassium in the blood plasma. Taking losartan blocks all physiological effects of angiotensin II and, due to the suppression of the effects of aldosterone, may help reduce the loss of potassium associated with taking a diuretic. Hydrochlorothiazide causes a slight increase in the concentration of uric acid in the blood; the combination of losartan and hydrochlorothiazide helps to reduce the severity of diuretic-induced hyperuricemia.
Pharmacokinetics
The pharmacokinetics of losartan and hydrochlorothiazide with simultaneous use does not differ from that when they are used in monotherapy.
Losartan
After oral administration, losartan is well absorbed from the gastrointestinal tract. It undergoes significant metabolism during the "first pass" through the liver, forming a pharmacologically active carboxylated metabolite (E-3174) and inactive metabolites. Bioavailability is approximately 33%. The average C max of losartan and its active metabolite are reached after 1 hour and after 3-4 hours, respectively. Losartan and its active metabolite bind to plasma proteins (mainly c) by more than 99%. V d of losartan is 34 liters. It penetrates very poorly through the BBB.
Losartan is metabolized with the formation of an active (E-3174) metabolite (14%) and inactive, including two main metabolites formed by hydroxylation of the butyl group of the chain and a less significant metabolite, N-2-tetrazolglucuronide. The plasma clearance of losartan and its active metabolite is approximately 10 ml/sec (600 ml/min) and 0.83 ml/sec (50 ml/min), respectively. The renal clearance of losartan and its active metabolite is about 1.23 ml/sec (74 ml/min) and 0.43 ml/sec (26 ml/min). T 1/2 of losartan and the active metabolite is 2 hours and 6-9 hours , respectively. Excreted mainly with bile through the intestines - 58% , kidneys - 35% . Does not accumulate.
When administered in doses up to 200 mg, losartan and its active metabolite have linear pharmacokinetics.
Hydrochlorothiazide
After oral administration, the absorption of hydrochlorothiazide is 60-80%. Cmax in blood plasma is achieved 1-5 hours after ingestion. Plasma protein binding - 64%. Penetrates through the placental barrier. It is allocated with breast milk. Hydrochlorothiazide is not metabolized and is rapidly excreted by the kidneys. T1 / 2 is 5-15 hours. At least 61% of the ingested dose is excreted unchanged within 24 hours.
Indications
Arterial hypertension (for patients who are indicated for combination therapy); reducing the risk of cardiovascular morbidity and mortality in patients with arterial hypertension and left ventricular hypertrophy.
Contraindications
Anuria; severe renal failure (CK<30 мл/мин); тяжелые нарушения функции печени; беременность; период лактации (грудного вскармливания); детский и подростковый возраст до 18 лет (эффективность и безопасность не установлены); повышенная чувствительность к компонентам препарата; повышенная чувствительность к производным сульфонамида.
Carefully
Violations of the water and electrolyte balance of the blood (hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), bilateral renal artery stenosis, stenosis of the artery of the only functioning kidney, condition after kidney transplantation, hypercalcemia, hyperuricemia and / or gout, aggravated allergic history, bronchial asthma, systemic diseases connective tissue (including systemic lupus erythematosus), simultaneous use of NSAIDs, including COX-2 inhibitors, diabetes mellitus, impaired liver function, impaired renal function (CC from 30-50 ml / min), hypovolemia (including against the background of taking diuretics in high doses), an acute attack of angle-closure glaucoma.
Dosage
Side effects
From the immune system: rarely - anaphylactic reactions, angioedema (including edema of the larynx and tongue, causing airway obstruction and / or swelling of the face, lips, pharynx), urticarial rash.
From the hematopoietic system: infrequently - anemia, Shenlein-Genoch purpura, ecchymosis, hemolysis, agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, thrombocytopenia.
From the nervous system: often - headache, dizziness, insomnia, increased fatigue; infrequently - migraine, anxiety, confusion, depression, sleep disturbances, memory impairment, drowsiness, nervousness, paresthesia, tremor, fainting.
From the side of the cardiovascular system: often - orthostatic hypotension (dose-dependent), palpitations, tachycardia; infrequently - AV block II degree, chest pain, myocardial infarction, arrhythmias; rarely - vasculitis.
From the respiratory system: often - cough, infections of the upper respiratory tract, sinusitis, swelling of the nasal mucosa, nasal congestion; infrequently - pharyngitis, laryngitis, rhinitis, dyspnea, bronchitis, epistaxis.
From the digestive system: often - diarrhea, dyspepsia, nausea, vomiting, abdominal pain; rarely - hepatitis, liver dysfunction.
From the urinary system: infrequently - urinary tract infections, frequent urination, nocturia, glucosuria.
From the reproductive system: infrequently - weakening of libido, decreased potency.
From the sense organs: infrequently - blurred vision, burning sensation in the eyes, conjunctivitis.
From the side of the skin: often - alopecia, dry skin, erythema, photosensitivity, increased sweating; infrequently - urticaria, pruritus.
From the musculoskeletal system: often - myalgia, back pain; infrequently - arthralgia.
Others: often - asthenia, weakness, peripheral edema; infrequently - anorexia, exacerbation of the course of gout.
From the side of laboratory indicators: often - hyperkalemia, a slight decrease in the concentration of hemoglobin and hematocrit; infrequently - a moderate increase in the concentration of urea and creatinine in the blood plasma, hyperglycemia, hyperuricemia, disturbances in the water and electrolyte balance; rarely - increased activity of ALT; very rarely - an increase in ACT activity and bilirubin concentration.
drug interaction
Simultaneous use with potassium-sparing diuretics (eplerenone, triamterene, amiloride), potassium preparations or potassium-containing table salt substitutes, as well as the use of other drugs that increase the concentration of potassium in the blood plasma, increase the risk of developing hyperkalemia.
NSAIDs, incl. selective COX-2 inhibitors may reduce the effect of diuretics and other antihypertensive drugs, including losartan.
The antihypertensive effect of losartan, like other antihypertensive drugs, may be reduced when using indomethacin.
Double blockade of the RAAS, i.e. adding an ACE inhibitor to an angiotensin II receptor antagonist therapy is possible only in selected cases under close monitoring of renal function.
In patients with atherosclerosis, heart failure, or diabetes mellitus with target organ damage, dual blockade of the RAAS (with concomitant use of angiotensin II receptor antagonists, ACE inhibitors, or aliskiren) is accompanied by an increased incidence of arterial hypotension, syncope, hyperkalemia, and renal dysfunction (including acute renal insufficiency) in comparison with the use of the drug of one of the listed groups.
Possible decrease in the excretion of lithium ions. Therefore, with the simultaneous use of angiotensin II receptor antagonists with lithium salts, serum lithium concentrations should be carefully monitored.
When used simultaneously with thiazide diuretics, drugs such as ethanol, barbiturates and opioids may potentiate the risk of developing orthostatic hypotension.
With simultaneous use, it is possible to increase the hypoglycemic effect of oral hypoglycemic agents (sulfonylurea derivatives) and / or insulin in patients with diabetes mellitus; with such combinations, it is possible to increase tolerance to, which may require dose adjustment of hypoglycemic agents for oral administration and / or insulin.
With simultaneous use with other antihypertensive drugs - an additive effect.
The absorption of hydrochlorothiazide is impaired in the presence of cholestyramine and colestipol.
With simultaneous use with GCS, ACTH, there is a pronounced decrease in the content of electrolytes, in particular hypokalemia.
There is a decrease in the severity of the therapeutic effect of hydrochlorothiazide against the background of the use of pressor amines (for example, epinephrine (adrenaline), norepinephrine (norepinephrine)).
Hydrochlorothiazide enhances the effect of muscle relaxants of a non-depolarizing type of action (for example, tubocurarine chloride).
Diuretics reduce the renal clearance of lithium and increase the risk of lithium toxicity. Simultaneous use is not recommended.
With simultaneous use with barbiturates, narcotic analgesics, antidepressants, ethanol, the risk of developing orthostatic hypotension increases.
Drugs used to treat gout (probenecid, sulfinpyrazone and allopurinol): hydrochlorothiazide can increase the serum concentration of uric acid, so dose adjustment of uricosuric drugs may be required - an increase in the dose of probenecid or sulfinpyrazone. The simultaneous use of thiazide diuretics may increase the frequency of hypersensitivity reactions to allopurinol.
Simultaneous use with cyclosporine may increase the risk of developing hyperuricemia and exacerbate the course of gout.
Anticholinergics (eg, atropine, biperiden) increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility and gastric emptying rate.
Thiazide diuretics can reduce the renal excretion of cytotoxic drugs (cyclophosphamide, methotrexate) and increase their myelosuppressive effect.
In the case of the use of salicylates in high doses, hydrochlorothiazide may increase their toxic effects on the central nervous system.
There are limited data on the development of hemolytic anemia with the simultaneous use of hydrochlorothiazide and methyldopa.
Caused by thiazide diuretics, hypokalemia or hypomagnesemia can lead to the development of arrhythmias against the background of the use of cardiac glycosides.
special instructions
Against the background of the use of losartan, reversible renal dysfunction, including renal failure, is possible, which disappear after discontinuation of losartan. Drugs that act on the RAAS can lead to an increase in the concentration of urea and creatinine in the blood plasma in patients with bilateral renal artery stenosis or stenosis of the artery to a single kidney. These changes in renal function may be reversible and disappear after discontinuation of therapy.
In patients with impaired renal function treated with NSAIDs (including COX-2 inhibitors), therapy with angiotensin II receptor antagonists may lead to further worsening of renal dysfunction, including acute renal failure, which is usually reversible, as well as increase the concentration of potassium in the blood plasma in patients with pre-existing renal impairment. This combination is recommended to be used with caution, especially in elderly patients. Patients should receive adequate fluids and monitor renal function before and after starting treatment with this combination.
Patients should be monitored for early detection of clinical signs of fluid and electrolyte disturbances, such as dehydration, hyponatremia, hypochloremic alkalosis, hypomagnesemia, or hypokalemia, which may develop in the presence of concomitant diarrhea or vomiting. In such patients, it is necessary to control the content of electrolytes in the blood plasma.
Therapy with thiazide diuretics may impair glucose tolerance. In some cases, it may be necessary to adjust the doses of hypoglycemic agents for oral administration and / or insulin.
Thiazides can reduce the excretion of calcium by the kidneys and cause a short-term and slight increase in the concentration of calcium in the blood plasma. Severe hypercalcemia may indicate latent hyperparathyroidism.
Due to the effect of thiazides on calcium metabolism, their use can distort the results of the study of parathyroid function, therefore, before examining the function of the parathyroid glands, the thiazide diuretic should be canceled.
An increase in the concentration of cholesterol and blood triglycerides can also be associated with thiazide diuretic therapy.
In some patients, the use of thiazide diuretics can lead to hyperuricemia and / or the development of gout. Since losartan reduces the concentration of uric acid, its combination with hydrochlorothiazide reduces the severity of diuretic-induced hyperuricemia.
Hydrochlorothiazide is a sulfonamide that can cause an idiosyncratic reaction leading to the development of an acute attack of angle-closure glaucoma.
In patients receiving thiazide diuretics, hypersensitivity reactions may occur even in the absence of a history of indications of allergic reactions or bronchial asthma. There are reports of the development of exacerbation or progression of systemic lupus erythematosus against the background of the use of thiazide diuretics.
For impaired liver function
Contraindicated in severe hepatic impairment.
Carefully at mild and moderate hepatic dysfunction.
In this article, you can read the instructions for using the drug Lorista. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Lorista in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Analogues of Lorista in the presence of existing structural analogues. Use to treat high blood pressure in adults, children, and during pregnancy and lactation.
Lorista- selective angiotensin 2 type AT1 receptor antagonist of non-protein nature.
Losartan (the active ingredient of Lorista) and its biologically active carboxyl metabolite (EXP-3174) block all physiologically significant effects of angiotensin 2 on AT1 receptors, regardless of the route of its synthesis: it leads to an increase in plasma renin activity, reduces the concentration of aldosterone in blood plasma.
Losartan indirectly causes the activation of AT2 receptors by increasing the level of angiotensin 2. Losartan does not inhibit the activity of kininase 2, an enzyme that is involved in the metabolism of bradykinin.
Reduces OPSS, 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.
Taking Lorista once a day leads to a statistically significant decrease in systolic and diastolic blood pressure. During the day, losartan evenly controls blood pressure, while the antihypertensive effect corresponds to the natural circadian rhythm. The decrease in blood pressure at the end of the dose of the drug was approximately 70-80% of the effect at the peak of the drug, 5-6 hours after administration. There is no withdrawal syndrome; also, losartan does not have a clinically significant effect on heart rate.
Losartan is effective in men and women, as well as in older (≥ 65 years) and younger patients (≤ 65 years).
Hydrochlorothiazide is a thiazide diuretic, the diuretic effect of which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, and water ions in the distal nephron; delays the excretion of calcium ions, uric acid. Has antihypertensive properties; hypotensive effect develops due to the expansion of arterioles. Virtually no effect on normal blood pressure. The diuretic effect occurs after 1-2 hours, reaches a maximum after 4 hours and lasts 6-12 hours.
The antihypertensive effect occurs after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect.
Compound
Losartan potassium + excipients.
Losartan potassium + Hydrochlorothiazide + excipients (Lorista H and ND).
Pharmacokinetics
The pharmacokinetics of losartan and hydrochlorothiazide with simultaneous use does not differ from that with their separate use.
Losartan
Well absorbed from the gastrointestinal tract. Taking the drug with food does not have a clinically significant effect on its serum concentrations. Practically does not penetrate through the blood-brain (BBB). About 58% of the drug is excreted in the bile, 35% in the urine.
Hydrochlorothiazide
After oral administration, the absorption of hydrochlorothiazide is 60-80%. Hydrochlorothiazide is not metabolized and is rapidly excreted by the kidneys.
Indications
- arterial hypertension;
- reduced risk of stroke in patients with arterial hypertension and left ventricular hypertrophy;
- chronic heart failure (as part of combination therapy, with intolerance or ineffectiveness of therapy with ACE inhibitors);
- protection of kidney function in patients with type 2 diabetes mellitus with proteinuria to reduce proteinuria, reduce the progression of kidney damage, reduce the risk of end-stage development (preventing the need for dialysis, the likelihood of an increase in serum creatinine), or death.
Release form
Tablets 12.5 mg, 25 mg, 50 mg and 100 mg.
Lorista N (additionally contains 12.5 mg of hydrochlorothiazide).
Lorista ND (additionally contains 25 mg of hydrochlorothiazide).
Instructions for use and dosage
The drug is taken orally, regardless of food intake, the frequency of administration is 1 time per day.
With arterial hypertension, the average daily dose is 50 mg. The maximum antihypertensive effect is achieved within 3-6 weeks of therapy. It is possible to achieve a more pronounced effect by increasing the dose of the drug to 100 mg per day in two doses or in one dose.
Against the background of taking diuretics in high doses, it is recommended to start therapy with Lorista with 25 mg per day in one dose.
Elderly patients, patients with impaired renal function (including patients on hemodialysis) do not require adjustment of the initial dose of the drug.
In patients with impaired liver function, the drug should be prescribed at a lower dose.
In chronic heart failure, the initial dose of the drug is 12.5 mg per day in one dose. In order to reach the usual maintenance dose of 50 mg per day, the dose must be increased gradually at intervals of 1 week (eg, 12.5 mg, 25 mg, 50 mg per day). Lorista is usually given in combination with diuretics and cardiac glycosides.
To reduce the risk of stroke in patients with arterial hypertension and left ventricular hypertrophy, the standard initial dose is 50 mg per day. In the future, low-dose hydrochlorothiazide may be added and / or the dose of Lorista may be increased to 100 mg per day.
For kidney protection in type 2 diabetic patients with proteinuria, the standard starting dose of Lorista is 50 mg daily. The dose of the drug can be increased to 100 mg per day, taking into account the decrease in blood pressure.
side
- dizziness;
- asthenia;
- headache;
- fatigue;
- insomnia;
- anxiety;
- sleep disturbance;
- drowsiness;
- memory disorders;
- peripheral neuropathy;
- paresthesia;
- hypoesthesia;
- migraine;
- tremor;
- depression;
- orthostatic hypotension (dose-dependent);
- heartbeat;
- tachycardia;
- bradycardia;
- arrhythmias;
- angina;
- nasal congestion;
- cough;
- bronchitis;
- swelling of the nasal mucosa;
- nausea, vomiting;
- diarrhea;
- abdominal pain;
- anorexia;
- dry mouth;
- toothache;
- flatulence;
- constipation;
- imperative urge to urinate;
- impaired renal function;
- decreased libido;
- impotence;
- convulsions;
- pain in the back, chest, legs;
- tinnitus;
- taste disorder;
- visual impairment;
- conjunctivitis;
- anemia;
- purpura of Shenlein-Henoch;
- dry skin;
- increased sweating;
- alopecia;
- gout;
- hives;
- skin rash;
- angioedema (including swelling of the larynx and tongue, causing airway obstruction and / or swelling of the face, lips, pharynx).
Contraindications
- arterial hypotension;
- hyperkalemia;
- dehydration;
- lactose intolerance;
- galactosemia or glucose/galactose malabsorption syndrome;
- pregnancy;
- lactation period;
- age up to 18 years (efficacy and safety in children have not been established);
- hypersensitivity to losartan and / or other components of the drug.
Use during pregnancy and lactation
There are no data on the use of Lorist during pregnancy. Renal perfusion of the fetus, which depends on the development of the renin-angiotensin system, begins to function in the 3rd trimester of pregnancy. The risk to the fetus increases when taking losartan in the 2nd and 3rd trimesters. When pregnancy is established, losartan therapy should be discontinued immediately.
There are no data on the allocation of losartan with breast milk. Therefore, the issue of stopping breastfeeding or discontinuing losartan therapy should be considered, taking into account its importance to the mother.
special instructions
Patients with a reduced volume of circulating blood (for example, during therapy with large doses of diuretics) may develop symptomatic arterial hypotension. Before taking losartan, it is necessary to eliminate existing disorders, or start therapy with small doses.
In patients with mild to moderate liver cirrhosis, the concentration of losartan and its active metabolite in the blood plasma after oral administration is higher than in healthy people. Therefore, in patients with a history of liver disease, therapy at lower doses is recommended.
Patients with impaired renal function, both with and without diabetes mellitus, often develop hyperkalemia, which should be borne in mind, but only in rare cases do they stop treatment as a result. During the period of treatment, the concentration of potassium in the blood should be regularly monitored, especially in elderly patients, with impaired renal function.
Drugs that act on the renin-angiotensin system may increase serum urea and creatinine in patients with bilateral renal artery stenosis or unilateral stenosis of the artery to a solitary kidney. Changes in renal function may be reversible after discontinuation of therapy. During treatment, it is necessary to regularly monitor the concentration of creatinine in the blood serum at regular intervals.
Influence on the ability to drive vehicles and control mechanisms
There are no data on the effect of Lorist on the ability to drive vehicles or other technical means.
drug interaction
There were no clinically significant drug interactions with hydrochlorothiazide, digoxin, indirect anticoagulants, cimetidine, phenobarbital, ketoconazole and erythromycin.
During simultaneous administration with rifampicin and fluconazole, a decrease in the level of the active metabolite of losartan potassium was noted. The clinical consequences of this phenomenon are unknown.
Simultaneous use with potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride) and potassium preparations increases the risk of hyperkalemia.
The simultaneous use of non-steroidal anti-inflammatory drugs, including selective COX-2 inhibitors, may reduce the effect of diuretics and other antihypertensive drugs.
When Lorista is administered concomitantly with thiazide diuretics, the reduction in blood pressure is approximately additive. Enhances (mutually) the effect of other antihypertensive drugs (diuretics, beta-blockers, sympatholytics).
Analogues of the drug Lorista
Structural analogues for the active substance:
- Blocktran;
- Brozaar;
- Vasotens;
- Vero Losartan;
- Zisacar;
- Cardomine Sanovel;
- Carsartan;
- Cozaar;
- Lakea;
- Lozap;
- Losarel;
- Losartan;
- Losartan potassium;
- Losacor;
- Lotor;
- Presartan;
- Renicard.
In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.
Latin name: Lorista H
ATX code: C09DA01
Active substance: losartan + hydrochlorothiazide (losartan + hydrochlorothiazide)
Manufacturer: KRKA (Slovenia), KRKA-RUS (Russia)
Description and photo update: 25.10.2018
Lorista N is a combined antihypertensive drug.
Release form and composition
Lorista N is produced in the form of film-coated tablets: oval, slightly biconvex, on one side of the risk, the color is from yellowish-green to yellow, a white core stands out at the break (7 pcs in blisters, in a pack of cardboard 2 , 4, 8, 12 or 14 blisters, 10 pieces in blisters, in a carton pack of 3, 6 or 9 blisters, 14 pieces in blisters, in a carton pack of 1, 2, 4, 6 or 7 blisters) .
1 tablet contains:
- active ingredients: losartan (in the form of losartan potassium) - 50 mg; hydrochlorothiazide - 12.5 mg;
- auxiliary components: microcrystalline cellulose, pregelatinized starch, magnesium stearate, lactose monohydrate;
- film shell: macrogol 4000, hypromellose, titanium dioxide (E171), quinoline yellow dye (E104), talc.
Pharmacological properties
Pharmacodynamics
Lorista N is a combined antihypertensive drug, the effectiveness of which is due to the properties of its active components.
Losartan is a selective angiotensin II receptor antagonist (AT 1 subtype) of a non-protein nature. The substance, together with its biologically active carboxyl metabolite EXP-3174, according to in vivo and in vitro studies, blocks all physiologically significant effects of angiotensin II on AT 1 receptors, regardless of the method of its synthesis, thereby increasing the activity of blood plasma renin and reducing plasma aldosterone concentration. Due to the increase in the level of angiotensin II, AT 2 receptors are indirectly activated. The activity of the enzyme involved in the metabolism of bradykinin - kininase II, it does not inhibit.
Losartan reduces TPVR (total peripheral vascular resistance), lowering pressure in the pulmonary circulation and afterload, and also has a diuretic effect. By preventing myocardial hypertrophy, losartan increases susceptibility to physical activity in CHF (chronic heart failure).
As a result of taking losartan once a day, systolic and diastolic blood pressure (blood pressure) is statistically significantly reduced. During the day, losartan normalizes blood pressure, while the antihypertensive effect is consistent with the natural circadian rhythm. At the end of the action of a single dose of the drug, the decrease in blood pressure was ~ 70-80% of its maximum effect, which occurs 5-6 hours after administration. Losartan does not cause withdrawal symptoms upon discontinuation of therapy and has no clinically significant effect on heart rate (heart rate). The effectiveness of the substance does not depend on gender (it is the same for men and women), as well as on the age of patients.
Hydrochlorothiazide is a thiazide diuretic, the diuretic effect of which is based on impaired reabsorption of chloride, sodium, magnesium, potassium, and water ions in the distal nephron. It delays the elimination of calcium and uric acid ions. It has a hypotensive effect, which develops due to vasodilation of arterioles. Hydrochlorothiazide has practically no effect on normal blood pressure. Its diuretic effect occurs 1–2 hours after ingestion, reaches a maximum after 4 hours and lasts 6–12 hours. .
Pharmacokinetics
The pharmacokinetics of losartan and hydrochlorothiazide in their combined administration does not differ from that in separate treatment.
Pharmacokinetic characteristics of losartan:
- absorption: it is well absorbed from the gastrointestinal tract (gastrointestinal tract), the serum concentrations of the substance do not clinically significantly depend on the diet and food quality. The bioavailability index is ~ 33%. Cmax (maximum concentration) in plasma is determined 1 hour after oral administration, and Cmax of its biologically active carboxyl metabolite EXP-3174 is reached after 3-4 hours;
- distribution: losartan and EXP-3174 are 99% or more bound to plasma proteins, mostly to albumin. V d (volume of distribution) is 34 liters. Permeability through the BBB (blood-brain barrier) is extremely low;
- metabolism: undergoes a significant first pass metabolism, the so-called. the effect of the first passage through the liver, with the formation of the active metabolite EXP-3174 (14%) and a number of inactive metabolites;
- excretion: plasma clearance of losartan and its active metabolite EXP-3174 is ~ 600 ml / min (10 ml / s) and 50 ml / min (0.83 ml / s), respectively; renal clearance rates are ~ 74 ml / min (1.23 ml / s) and 26 ml / min (0.43 ml / s), respectively. T1 / 2 (half-life) of losartan is 2 hours, the EXP-3174 metabolite is 6-9 hours. About 58% of the drug is excreted in the bile, up to 35% - by the kidneys.
Pharmacokinetic characteristics of hydrochlorothiazide:
- absorption and distribution: absorption after oral administration ranges from 60 to 80%. C max in blood plasma is reached after 1-5 hours. Up to 64% of the substance binds to plasma proteins;
- metabolism and excretion: not metabolized, excreted by the kidneys quickly; T 1/2 is from 5 to 15 hours.
Indications for use
The drug is also prescribed to reduce the risk of cardiovascular disease and mortality in patients with arterial hypertension and left ventricular hypertrophy.
Contraindications
Absolute:
- severe renal failure with creatinine clearance (CC)< 30 мл/мин;
- anuria;
- dehydration (including during high-dose diuretic therapy);
- hyperkalemia;
- severe liver failure;
- arterial hypotension;
- refractory hypokalemia;
- lactase deficiency, glucose-galactose malabsorption syndrome, galactosemia;
- the period of pregnancy and lactation (breastfeeding);
- children and adolescents under 18 years of age;
- hypersensitivity to sulfonamide derivatives, losartan and / or any other ingredients of the drug.
Relative contraindications for taking Lorista H, in which the drug should be taken with caution, are: violations of the water and electrolyte balance of the blood (hypochloremic alkalosis, hyponatremia, hypokalemia, hypomagnesemia), bilateral renal artery stenosis or stenosis of the artery of a single kidney, diabetes mellitus, hypercalcemia, hyperuricemia and / or gout, aggravated allergic history [angioneurotic edema in some patients developed earlier when taking other drugs, including ACE inhibitors (angiotensin-converting enzyme)], bronchial asthma, systemic blood diseases (including systemic lupus erythematosus), simultaneous use with NSAIDs (non-steroidal anti-inflammatory drugs), including with inhibitors of COX (cyclooxygenase)-2.
Instructions for use Lorista N: method and dosage
Lorista N is for oral use. The choice of the time of taking the tablets does not depend on the diet. The drug can be combined with other antihypertensive drugs.
For the treatment of arterial hypertension, it is recommended to take Lorista N in the initial and maintenance dose - 1 tablet (50 + 12.5 mg) 1 time per day. The maximum antihypertensive effect occurs by the end of the third week of treatment. In order to achieve a more pronounced therapeutic effect, you can increase the dose of the drug to the maximum allowable - 2 tablets per day for 1 dose.
In the case of reduced BCC (volume of circulating blood), for example, while taking high doses of diuretics, patients with hypovolemia are recommended to start treatment with a dose of losartan - 25 mg 1 time per day. In this regard, Lorista H should be started after discontinuation of diuretic treatment and correction of hypovolemia.
Elderly patients, patients with an average degree of renal insufficiency (with a CC of 30-50 ml / min), including those on dialysis, do not need to adjust the initial dose.
In arterial hypertension and left ventricular hypertrophy, in order to reduce the risk of cardiovascular pathologies and mortality, losartan is prescribed at an initial dose of 50 mg 1 time per day. If the target value of blood pressure cannot be achieved while taking losartan at a daily dose of 50 mg, it is necessary to select the dose by combining it with small doses of hydrochlorothiazide (12.5 mg per day). If necessary, the daily dose of losartan should be increased to 100 mg in combination with hydrochlorothiazide at a dose of 12.5 mg, and then the daily dose of Lorista H should be increased to 2 tablets.
Side effects
- central nervous system: often - headaches, dizziness (systemic and non-systemic), fatigue, insomnia; sometimes - migraine;
- digestive system: often - nausea / vomiting, diarrhea, dyspepsia, abdominal pain; rarely - liver dysfunction, hepatitis; extremely rarely - increased activity of hepatic transaminases and bilirubin;
- cardiovascular system: often - tachycardia, palpitations, dose-dependent orthostatic hypotension; rarely - vasculitis;
- respiratory system: often - infections of the upper respiratory tract, cough, pharyngitis, swelling of the mucous membrane of the nasal cavity;
- hematopoietic system: infrequently - hemorrhagic vasculitis (Schonlein-Genoch purpura), anemia;
- musculoskeletal system: often - back pain, myalgia; sometimes - arthralgia;
- hypersensitivity reactions: sometimes - pruritus, urticaria; rarely - anaphylaxis, angioedema (including swelling of the tongue and larynx, causing airway obstruction, and / or swelling of the lips, face, pharynx);
- laboratory data: often - a clinically insignificant increase in the concentration of hematocrit and hemoglobin, hyperkalemia; sometimes - a moderate increase in serum concentrations of creatinine and urea;
- other reactions: often - weakness, asthenia, chest pain, peripheral edema.
Overdose
Symptoms of an overdose of losartan are tachycardia, a pronounced decrease in blood pressure and bradycardia due to vagal (parasympathetic) stimulation.
Symptoms of an overdose of hydrochlorothiazide most often (as a result of electrolyte deficiency) are hypokalemia, hypochloremia, hyponatremia, as a result of excessive diuresis - dehydration. With the combined use of cardiac glycosides, hypokalemia can aggravate the course of arrhythmias.
special instructions
Lorista N can be taken concomitantly with other antihypertensive drugs.
Due to the use of Lorista N, an increase in plasma concentrations of urea and creatinine is possible with bilateral stenosis of the renal arteries or stenosis of the renal artery of a single kidney.
Under the action of hydrochlorothiazide, it is possible to increase arterial hypotension and disturb the water and electrolyte balance, manifested by a decrease in BCC, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia, impaired glucose tolerance, decreased calcium elimination in the urine and a transient, slight increase in plasma calcium concentration in the blood, increased concentration cholesterol and TG (thyroglobulin), provoking the appearance of hyperuricemia and / or gout.
Influence on the ability to drive vehicles and complex mechanisms
At the beginning of taking Lorista N, some patients may experience side effects such as arterial hypotension and dizziness, which indirectly affect their psychophysical state. These situations require increased attention when performing potentially hazardous types of work, including when driving. It is necessary to conduct an objective assessment of the body's response to the treatment.
Use during pregnancy and lactation
There are insufficient data from studies on the use of losartan during pregnancy. It is known that the function of fetal renal perfusion, which depends on the development of the renin-angiotensin system, is activated in the III trimester of pregnancy, therefore, the risk for fetal development when taking losartan increases in the II-III trimesters, since substances acting directly on the renin-angiotensin system taken during this period can lead to fetal death.
Diuretics are not recommended during pregnancy due to the risk of jaundice in the fetus/newborn and thrombocytopenia in the mother. Taking diuretics does not help with the development of toxicosis during pregnancy.
If pregnancy is confirmed, Lorista H should be discontinued immediately.
If, according to indications, the drug must be used during lactation, it is necessary to resolve the issue of stopping breastfeeding.
Application in childhood
There is insufficient data on the safety and efficacy of Lorista N in pediatrics, and therefore the drug is contraindicated for the treatment of children and adolescents under the age of 18 years.
For impaired renal function
Lorist H 50 mg + 12.5 mg is contraindicated in severe renal impairment, as well as in patients on hemodialysis.
For impaired liver function
Lorista N is contraindicated for use in severe liver damage.
Use in the elderly
Elderly patients do not need to adjust the initial dose.
drug interaction
Losartan
- hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole, erythromycin: no clinically significant pharmacokinetic interaction with losartan has been identified according to studies;
- rifampicin, fluconazole: reduce the level of the active metabolite of losartan (the clinical significance of this interaction has not been studied);
- potassium-sparing diuretics (triamterene, spironolactone, amiloride), potassium supplements or potassium salts: hyperkalemia may develop;
- NSAIDs (including selective COX-2 inhibitors): may reduce the effectiveness of diuretics, as well as other antihypertensive drugs, including losartan. In case of impaired renal function in patients treated with NSAIDs (including COX-2 inhibitors) in combination with angiotensin II receptor antagonists, a further deterioration in renal function may develop, up to acute renal failure (usually reversible);
- indomethacin: may reduce the antihypertensive effect of losartan, as well as other antihypertensive drugs.
Hydrochlorothiazide
- thiazide diuretics, barbiturates, ethanol, narcotic substances: may increase the likelihood of developing orthostatic hypotension;
- hypoglycemic drugs for oral administration and insulin: their dose adjustment may be necessary;
- other antihypertensive drugs: exhibit additive synergism;
- cholestyramine, colestipol: inhibit the absorption of hydrochlorothiazide;
- glucocorticosteroids, adrenocorticotropic hormone: have a pronounced decrease in the level of electrolytes, in particular cause hypokalemia;
- epinephrine, norepinephrine, other pressor amines: hydrochlorothiazide reduces their effectiveness;
- non-depolarizing muscle relaxants, for example, tubocurarine: hydrochlorothiazide enhances their effectiveness;
- lithium: diuretics reduce its renal clearance and increase the likelihood of developing a toxic effect (simultaneous use is not recommended);
- NSAIDs (including selective COX-2 inhibitors): possible inhibition of the diuretic, natriuretic and hypotensive effects of diuretics.
Due to the influence of thiazide diuretics on calcium metabolism, their administration may distort the results of the study of the function of the parathyroid glands.
Analogues
The analogues of Lorista N are: Hydrochlorothiazide + Losartan TAD, Blocktran GT, GIZAAR Forte, Gizaar, Losarel Plus, Lozap plus, Losartan-N Canon, Losartan N, Losartan / Hydrochlorothiazide-Teva, Lorista ND, Simartan-N, Presartan N.
Terms and conditions of storage
Store at temperatures up to 30 °C. Keep away from children.
Shelf life - 3 years.