Losartan: instructions for use, price, analogues and reviews

pharmachologic effect

Losartan is a selective, competitive antagonist and AT1 receptor blocker in various tissues, including the brain, adrenal cortex, liver, kidneys, heart and vascular smooth muscle, reducing the effect of angiotensin II development.

Administration of the active substance of the drug leads to a decrease in total peripheral resistance (afterload) and cardiac venous return (preload). All physiological effects of angiotensin II, including stimulation of aldosterone , are blocked by the action of Losartan. A decrease in blood pressure occurs regardless of the state of the renin-angiotensin . As a result of the use of this drug, plasma renin activity increases due to the removal of angiotensin II.

The effect of this drug was confirmed during the Life study (Losartan Intervention For Endpoint reduction in hypertension study), which involved 9,193 people suffering from essential arterial hypertension . The age of the subjects was 55-80 years with a blood pressure of 160-200 mm Hg. After taking Losartan, this figure decreased by 13%, and mortality among such patients decreased by 25%.

Pharmacodynamics and pharmacokinetics

This drug has a hypotensive effect immediately after the first oral administration. The effect of the drug is expressed in a decrease in systolic and diastolic blood pressure, which is achieved at most 6 hours after administration. After a day, the effect of the drug decreases. A stable hypotensive effect is observed after 3-6 weeks of taking Losartan.

In people suffering from arterial hypertension, this drug reduces proteinuria albumin and immunoglobulin G excretion . In addition, the active substance helps stabilize the urea content in the blood plasma without affecting the content of norepinephrine in the blood plasma.

Losartan is characterized by excellent absorption from the gastrointestinal tract. Of no less importance is the ability of the active substance to be metabolized during a single passage through the liver by carboxylation with the participation of the CYP2C9 isoenzyme, which produces an active metabolite.

Systemic bioavailability of the active substance is approximately 33%. After approximately 60 minutes, the maximum concentration of the active substance in the blood serum is reached. The bioavailability of Losartan is not affected by food intake.

The degree of penetration of Losartan through the blood-brain barrier is minimal. Almost 99% of the substance binds to albumin and other blood plasma proteins.

Plasma clearance is approximately 600 ml/min and 50 ml/min. Renal clearance is approximately 74 ml/min and 26 ml/min. After taking the drug, approximately 4% of the dose taken is excreted through the kidneys unchanged and approximately 6% is excreted through the kidneys in the form of an active metabolite.

Basically, the active substance of this drug is excreted from the body through the kidneys and intestines.

Release form of the drug Losartan

The drug Losartan is available in the form of tablets with different contents of the active substance. The tablets are white, round in shape. When cut, the contents are also white. A slight color deviation towards a yellow tint is acceptable.

The main active ingredient is losartan potassium. Additional components include:

lactose monohydrate;
pregelatinized starch;
microcrystalline cellulose;
Magnesium stearate.

Tablets are produced with different contents of active substance per unit of drug:

25mg;
50mg;
100 mg.

The difference in the concentration of the substance is needed to accurately select the dosage necessary to achieve a therapeutic effect in each specific case.

Indications for use

Indications for the use of Losartan are as follows:

arterial hypertension (a condition of the body when blood pressure rises above 140 mm Hg);
chronic heart failure (a pathological condition in which the activity of the cardiovascular system does not provide oxygen to the body, first during physical activity and then at rest);
the risk of developing diseases of the cardiovascular system, in particular stroke ;
diabetic nephropathy (a term that combines a complex of lesions of the arteries, arterioles, tubules and glomeruli of the kidneys, which develop as a result of metabolic disorders in the kidney tissues).

Losartan: what is it taken for?

Indications for the use of Losartan are:

Nephropathy of the diabetic type, including damage to the tubules and glomeruli of the kidneys, as well as arterioles and arteries, developing due to disruption of metabolic processes in the renal tissue.
Presence of a tendency to develop disorders of the cardiovascular system, including strokes.
Arterial hypertension, in which the indicator exceeds 140 mm Hg. Art.
Chronic heart failure, in which the circulatory system does not properly supply the body with oxygen either at rest or after exercise.

After entering the gastrointestinal tract, the drug is actively absorbed. As a result of filtration by the liver, a metabolite is formed that is many times more active than Losartan in its original form. The maximum concentration of Losartan in the blood is observed after 1 hour, and the metabolite - after 3-4 hours. About 98% of the drug actively binds to plasma proteins.

The half-life of Losartan is 2-2.5 hours, and the active metabolite is up to 9 hours, depending on the speed of metabolic processes in the body. The drug and its derivatives are excreted unchanged in feces, urine and bile. Most of the medicine comes out through the rectum.

Side effects

When taking this drug, side effects may occur, which can be classified into “common” and “rare”.

Common side effects include:

pain in the abdominal area or stomach;
state of anxiety;
bladder pain;
bloody spots in the urine;
blurred vision;
chills;
cold sweat;
coma;
confusion of thoughts;
pale skin;
depression;
difficulty breathing;
painful urination;
dizziness;
cardiopalmus;
frequent urge to urinate;
headache;
increased feeling of hunger;
irregular heartbeat;
pain in various parts of the body;
nausea or vomiting ;
numbness or tingling in the arms, legs, lips;
convulsions;
slurred speech;
unstable breathing during exercise;
sudden and causeless hematomas;
state of fatigue or weakness ;
heaviness in the legs.

The following side effects occur much less frequently when taking Losartan:

chest pain or discomfort;
chest tightness or heaviness;
malaise;
increased heart rate;
inability to speak;
pain or discomfort in the neck;
sweating;
swelling of the face;
temporary blindness;
instability or awkwardness.

Losartan, instructions for use

Losartan tablets must be taken orally without reference to meals. The drug is available in the form of tablets that should be swallowed without chewing once a day.

Instructions for the use of Losartan for various diseases:

Patients with arterial hypertension are prescribed a daily dose of 50 mg once a day. At the discretion of the attending physician, the daily dose can be increased to 100 mg per day.
For chronic heart failure, Losartan is prescribed initially at 12.5 mg per day, after which the dose is doubled at weekly intervals.
If it is necessary to reduce the risk of developing diseases of the cardiovascular system, the drug is prescribed at a dose of 50 mg per day.
In case of liver failure, taking this drug is recommended at a minimum dose of 25 mg per day. The same dosage is prescribed to patients over 75 years of age.

During treatment of any disease with the use of Losartan, strict monitoring of blood pressure is necessary.

To increase the therapeutic effect, this drug must be taken at the same time, which is usually determined by a specialist. If one dose is missed, the next one should be taken at the time closest to the scheduled one, followed by adjustment of the time of taking the next dose. It is not recommended to take a double dose of this medicine.

Losartan-NAN tablets p/o 50 mg No. 15x2

Name

Losartan-NAS.

Release forms

Pills.

INN

Losartan.

FTG

Angiotensin II receptor antagonist.

Compound

Each tablet contains: 50 mg tablets contain the active substance: losartan potassium 50 mg; excipients: microcrystalline cellulose, calcium hydrogen phosphate dihydrate, colloidal anhydrous silicon dioxide, croscarmellose sodium, talc, magnesium stearate; shell composition: polyvinyl alcohol, macrogol 3350, talc, titanium dioxide. tablets with a dosage of 100 mg contain the active substance: losartan potassium 100 mg; excipients: lactose monohydrate, pregelatinized corn starch, magnesium stearate, microcrystalline cellulose. shell composition: polyvinyl alcohol, macrogol 3350, talc, titanium dioxide.

Description

Dosage 50 mg: round, biconvex tablets with a score, white coated. The tablet can be divided into equal halves. Dosage 100 mg: round, biconvex, white coated tablets.

Pharmacotherapeutic group

Drugs affecting the renin-angiotensin system. Angiotensin II antagonists. ATX code: C09CA01

Pharmacological properties

Losartan is an antihypertensive drug that is a specific antagonist of angiotensin II receptors (type AT1). Reduces total peripheral vascular resistance (vascular resistance to blood flow), reduces afterload (blood pressure in the aorta by reducing peripheral vascular resistance to blood flow), and reduces blood pressure (BP). Reduces pressure in the pulmonary circulation, prevents sodium and water retention in the body. Increases exercise tolerance in patients with heart failure. After a single dose, the hypotensive effect reaches a maximum after 6 hours and gradually decreases over 24 hours. A stable decrease in blood pressure in most patients is observed by the 3rd – 6th week of course use.

Indications for use

- treatment of essential hypertension in adults and children (adolescents) aged 6-18 years; - treatment of renal failure in adult patients with hypertension and type 2 diabetes mellitus with proteinuria ≥ 0.5 g / day as part of antihypertensive therapy; - treatment of chronic heart failure in adult patients, when treatment with angiotensin-converting enzyme inhibitors (ACEIs) is unacceptable due to drug intolerance, especially due to cough or contraindications. If a patient with heart failure has been stabilized by an ACE inhibitor, he should not be switched to losartan. Patients must have a left ventricular ejection fraction ≤ 40% and be clinically stable on an established chronic heart failure treatment regimen; - reducing the risk of stroke in patients with arterial hypertension and left ventricular hypertrophy, documented by ECG results.

Contraindications

- hypersensitivity to losartan or to any of the excipients; — 2nd and 3rd trimesters of pregnancy (see sections “Precautions”, “Use during pregnancy and breastfeeding”); - severe liver failure; - simultaneous use of losartan with drugs containing aliskiren in patients with diabetes mellitus or moderate/severe renal failure (glomerular filtration rate (GFR)

Precautionary measures

Hypersensitivity Symptoms of hypersensitivity such as angioedema may occur. Patients with a history of angioedema (swelling of the face, lips, throat, and/or tongue) should be closely monitored. Hypotension and electrolyte imbalance Symptomatic hypotension, especially after the first dose or after dose increases, may occur in patients with reduced intravascular volume and/or sodium deficiency due to high-dose diuretic therapy, a salt-restricted diet, diarrhea, or vomiting. These conditions should be corrected before losartan is prescribed or a lower initial dose of the drug should be used. The same recommendations apply to the use of the drug in children from 6 to 18 years of age. Electrolyte imbalance Electrolyte imbalance is common in patients with renal failure with or without diabetes mellitus, and special attention should be paid to such patients. In clinical trials involving patients with type 2 diabetes mellitus with nephropathy, the incidence of hyperkalemia was higher in the losartan-treated group than in the placebo-treated group. Therefore, it is necessary to carefully monitor plasma potassium concentrations, as well as creatinine clearance values, especially in patients with heart failure and a creatinine clearance of 30-50 ml/min. Concomitant use of potassium-sparing diuretics, potassium supplements, and potassium-containing salt substitutes with losartan is not recommended. Liver dysfunction Based on pharmacokinetic data that indicate a significant increase in plasma concentrations of losartan in patients with liver cirrhosis, a lower dose of the drug should be used in case of liver dysfunction. There is no therapeutic experience with the use of losartan in patients with severe hepatic impairment, therefore losartan should not be used in patients with severe hepatic impairment. Losartan is not recommended for the treatment of children with impaired liver function. Impaired renal function Due to inhibition of the renin-angiotensin system, changes in renal function, including renal failure, have been reported in some patients (particularly in patients whose renal function is dependent on the renin-angiotensin-aldosterone system, such as patients with severe heart failure or patients with existing renal impairment). As with other drugs that affect the renin-angiotensin-aldosterone system, increased blood urea and serum creatinine concentrations have been reported in patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney; these changes in renal function may be reversible after discontinuation of therapy. Losartan should be used with caution in the treatment of patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney. Use in children with impaired renal function It is not recommended to use the drug for the treatment of children with glomerular filtration rate

Pregnancy and breastfeeding period

Pregnancy Drugs that act directly on the renin-angiotensin system may cause fetal malformations or death. If pregnancy is diagnosed, Losartan-NAN should be discontinued immediately. The use of losartan is not recommended during the first trimester of pregnancy and is contraindicated during the second and third trimesters of pregnancy. Epidemiological data regarding the risk of teratogenicity after use of ACE inhibitors during the first trimester of pregnancy are inconclusive, but a slight increase in risk cannot be excluded. Since there are no controlled epidemiological data regarding the risk of angiotensin II receptor antagonists (APAII), similar risks may exist for this class of drugs. Unless continued APAII therapy is considered necessary, patients planning pregnancy should be given an alternative hypertensive therapy with an established safety profile for use during pregnancy. If pregnancy is diagnosed, treatment with losartan should be stopped immediately and, if necessary, alternative treatment should be initiated. The use of APAII during the second and third trimesters of pregnancy is known to induce fetotoxicity (weakened renal function, oligohydramnios, delayed ossification of the skull) and neonatal toxicity (renal failure, hypotension, hyperkalemia). If losartan was used during the second trimester of pregnancy, an ultrasound examination is recommended to check kidney function and the condition of the skull bones. The condition of newborns whose mothers have used losartan should be frequently monitored for the occurrence of arterial hypotension. Breastfeeding Since there is no information regarding the use of losartan during breastfeeding, it is not recommended to use this drug during lactation. It is preferable to alternative treatment with drugs with a better studied safety profile for use during breastfeeding, especially when feeding newborns and premature infants.

Use in children

It is not recommended to use losartan for the treatment of children under 6 years of age, as data on experience in this age group are limited. It is not recommended to use the drug to treat children with glomerular filtration rate

Side effect

In general, losartan is well tolerated; side effects are mild and transient and do not require discontinuation of the drug. During treatment with losartan potassium, undesirable effects may develop, which are divided according to the frequency of occurrence into: very common (> 1/10); frequent (> 1/100 and 1/1000 and 1/10000 and 5.5 mmol/l). Experience with post-registration use Disorders of the blood and lymphatic system: frequency unknown - anemia, thrombocytopenia, Disorders of the immune system: rarely - hypersensitivity reactions, anaphylactic reactions, angioedema (including swelling of the larynx, glottis, tongue, face, lips, pharynx and /or tongue, causing airway obstruction) and vasculitis (Henoch-Schönlein purpura). Respiratory, thoracic and mediastinal disorders: frequency unknown – cough. Gastrointestinal disorders: frequency unknown – diarrhea. Disorders of the liver and biliary tract: rarely - hepatitis; frequency unknown - pancreatitis, liver dysfunction. Skin and subcutaneous tissue disorders: frequency unknown - urticaria, itching, rash, photosensitivity. Musculoskeletal and connective tissue disorders: frequency unknown - myalgia, arthralgia, rhabdomyolysis. Genital and breast disorders: frequency unknown – erectile dysfunction/impotence. General disorders and disorders at the injection site: frequency unknown - malaise. Mental disorders: frequency unknown - depression. Nervous system disorders: frequency unknown – migraine, dysgeusia. Hearing and labyrinthine disorders: frequency unknown - tinnitus. Impact on the results of laboratory and instrumental studies: frequency unknown - hyponatremia. The following adverse reactions occurred more frequently in patients receiving losartan than in patients receiving placebo (frequency unknown): back pain, urinary tract infection, flu-like symptoms. Renal and urinary tract disorders: Due to inhibition of the renin-angiotensin-aldosterone system, changes in renal function, including renal failure, have been reported in patients at risk; these changes in renal function may be reversible after discontinuation of therapy. Children The profile of adverse reactions in children is similar to that in adult patients. Data regarding adverse reactions in children are limited. Important information about some components of the drug Losartan-NAN, film-coated tablets, 100 mg contains lactose. If your doctor has told you that you have an intolerance to certain sugars, you should consult your doctor before using this medicine.

Interaction with other drugs and other forms of interaction

Other antihypertensive drugs may enhance the hypotensive effect of losartan. Concomitant use with other drugs that can induce arterial hypotension as an adverse reaction (tricyclic antidepressants, antipsychotics, baclofen and amifostine) may increase the risk of hypotension. Losartan is metabolized primarily through the cytochrome P450 (CYP) 2C9 system to an active carboxylic acid metabolite. In a clinical study, fluconazole (a CYP2C9 inhibitor) was found to reduce exposure to the active metabolite by approximately 50%. It has been established that simultaneous treatment with losartan and rifampicin (an inducer of metabolic enzymes) leads to a 40% decrease in the concentration of the active metabolite in the blood plasma. The clinical significance of this effect is unknown. There is no difference in exposure when losartan is co-administered with fluvastatin (a weak CYP2C9 inhibitor). As with other drugs that block angiotensin II or its effects, concomitant use of drugs that retain potassium in the body (eg, potassium-sparing diuretics: spironolactone, triamterene, amiloride) or may increase potassium levels (eg, heparin), and Also, potassium supplements or potassium-containing salt substitutes may lead to increased serum potassium levels. The simultaneous use of such drugs is not recommended. A reversible increase in serum lithium concentrations, as well as toxicity, has been reported during concomitant use of lithium with ACE inhibitors. This adverse reaction has also been very rarely reported with angiotensin II receptor antagonists (APAII). Concomitant treatment with lithium and losartan should be carried out with caution. If use of such a combination is considered necessary, it is recommended that serum lithium levels be monitored during coadministration. With the simultaneous use of APAII and non-steroidal anti-inflammatory drugs (for example, selective cyclooxygenase-2 (COX-2) inhibitors, acetylsalicylic acid in doses that have an anti-inflammatory effect, non-selective NSAIDs), the antihypertensive effect may be weakened. Concomitant use of angiotensin II antagonists or diuretics with NSAIDs may lead to an increased risk of deterioration of renal function, including the possibility of acute renal failure, as well as an increase in serum potassium levels, especially in patients with existing renal impairment. This combination should be prescribed with caution, especially in elderly patients. Patients should be adequately hydrated and consideration should be given to monitoring renal function once appropriate therapy is initiated and periodically thereafter. Double blockade of the renin-angiotensin-aldosterone system. Clinical trial data have shown that dual blockade of the renin-angiotensin-aldosterone system (RAAS) due to concomitant use of ACE inhibitors, angiotensin II receptor blockers or aliskiren is associated with an increased incidence of hypotension, hyperkalemia and decreased renal function (including acute renal failure), including comparison with monotherapy with a drug acting on the RAAS. Your doctor should be informed about all the medications you take. Before taking any medicine while being treated with Losartan-NAN, consult your doctor.

Directions for use and doses

Arterial hypertension The standard initial and maintenance dose for most patients is 50 mg once daily. The maximum hypotensive effect is achieved 3-6 weeks from the start of therapy. In some patients, to achieve greater effect, the dose can be increased to 100 mg once a day (in the morning). Losartan can be taken with other antihypertensive drugs, including diuretics (hydrochlorothiazide). Hypertensive patients with type II diabetes with proteinuria ≥ 0.5 g / day The standard initial dose of the drug is 50 mg 1 time per day. The dose may be increased to 100 mg once daily based on blood pressure control results after the first month of therapy. Losartan may be used in combination with other antihypertensive drugs (eg, diuretics, calcium channel blockers, alpha- or beta-blockers, and centrally acting drugs), as well as with insulin and other commonly used antihypertensive drugs (eg, sulfonylureas, glitazones, and glucosidase inhibitors). ). Heart failure The starting dose of losartan for patients with heart failure is 12.5 mg once daily. The dose may be increased at weekly intervals (i.e., 12.5 mg once daily in the first week, 25 mg once daily in the second week, 50 mg once daily in the third week, 100 mg once daily in the fourth weeks until the maximum dose of 150 mg once daily is reached) according to the patient’s tolerability. Reducing the risk of stroke in patients with left ventricular hypertrophy documented by ECG results. The starting dose of losartan is 50 mg once daily. In the future, hydrochlorothiazide may be added in low doses and/or the dose of losartan may be increased to 100 mg per day in one dose based on the results of blood pressure control. Special groups of patients Use in patients with a deficiency of circulating blood volume In patients with a deficiency of circulating blood volume (including patients taking diuretics in high doses), the initial dose of losartan is 25 mg 1 time per day. Use in patients with renal failure and patients on hemodialysis No initial dosage adjustment is required in patients with renal failure and patients on hemodialysis. Use in Patients with Hepatic Impairment A lower dose should be given to patients with a history of hepatic impairment. There is no therapeutic experience in patients with severe liver dysfunction, therefore losartan is contraindicated for this group of patients.

Use in children and adolescents

Children 6 months to 6 years Safety and effectiveness in children 6 months to 6 years have not been established. Limited data exist but use cannot be recommended. Children from 6 years to 18 years For patients weighing 20 to 50 kg who are able to swallow tablets, the recommended dose is 25 mg once daily. In exceptional cases, the dose may be increased to a maximum dose of 50 mg once daily. The dosage should be adjusted according to changes in blood pressure. In patients weighing more than 50 kg, the daily dose is 50 mg once a day. In exceptional cases, the dose may be adjusted to a maximum dose of 100 mg once daily. Doses higher than 1.4 mg/kg (or more than 100 mg) per day have not been studied in this patient population. Losartan is not recommended for use in children under 6 years of age and only limited data are available in these patient groups. Losartan is not recommended for use in children with glomerular filtration rate

Application

Losartan tablets should be swallowed with a glass of water. Losartan tablets are taken regardless of meals at the same time every day. Skipping the next dose of the drug If you forget to take the drug Losartan-NAN, then you should not compensate for the missed dose by taking a double dose, just take the usual dose of the drug.

Overdose

If you take a larger dose of medication than prescribed by your doctor, you should immediately contact a specialist to provide timely medical assistance! Symptoms: there is insufficient data on cases of drug overdose. The most likely manifestations of an overdose may be arterial hypotension and tachycardia. Bradycardia may occur due to parasympathetic (vagal) stimulation. Treatment: If hypotension occurs, supportive treatment should be given. Treatment depends on the length of time after taking the drug and the nature and severity of symptoms. The priority measure should be to stabilize the cardiovascular system. After oral administration of the drug, the use of activated carbon in an appropriate dose is indicated. Later, vital signs should be monitored and adjusted if necessary. Losartan and the active metabolite are not excreted from the body by hemodialysis. Effects on the ability to drive vehicles and potentially dangerous machinery No studies have been conducted on the effect of the drug on the ability to drive a car or operate machinery. However, when driving or operating machinery, it is necessary to take into account that when taking antihypertensive drugs, sudden onset of dizziness or drowsiness is possible, especially at the beginning of treatment or when the dose is increased.

Package

Dosage 50 mg: 10, 15 or 25 tablets per blister pack. 1 blister pack of 10 or 25 tablets, or 2 blister packs of 15 tablets with instructions for use are placed in a cardboard pack. Dosage 100 mg: 10 or 15 tablets per blister pack. 3 blister packs of 10 tablets each, or 2 blister packs of 15 tablets each with instructions for use are placed in a cardboard pack.

Storage conditions

In a place protected from light and moisture at a temperature not exceeding 25 ºС. Keep out of the reach of children.

Best before date

2 years. Do not use after expiration date.

Conditions for dispensing from pharmacies

On prescription.

Buy Losartan-NAN tablet p/o 50 mg in container pack No. 15x2 in the pharmacy

Price for Losartan-NAN tablet p/o 50 mg in container pack No. 15x2

Instructions for use for Losartan-NAN tablet p/o 50 mg in container pack No. 15x2

Interaction with other drugs

When certain drugs are used concomitantly with Losartan, this may lead to negative drug interactions. An interaction may occur if the drug is taken with medications such as potassium supplements, potassium-sparing diuretics, or nonsteroidal anti-inflammatory drugs. In addition, the body metabolizes drugs differently, so taking them together with this drug may cause an extreme increase in the content of active substances.

Losartan potassium may potentially interact with a number of other medicines. Some of them are:

Drug interactions with ACE inhibitors

Losartan works similarly to ACE inhibitors, although it is not one. Therefore, combining these drugs may increase the risk of high potassium levels ( hyperkalemia ), the development of kidney failure, and dangerously low blood pressure.

Drug interactions with diuretics

The combination of this drug with diuretics can cause a severe decrease in blood pressure. To reduce the risk of such a manifestation, the attending physician should adjust the dose of Losartan.

Potassium supplements or potassium salt substitutes

If you take this drug with products that contain potassium or a potassium salt substitute, your blood potassium levels may become too high. This can cause serious problems, including those with the cardiovascular system.

Potassium-sparing diuretics

When taking Losartan and potassium-sparing diuretics at the same time, the body may absorb them differently than intended, which will ultimately lead to an increase in potassium levels in the blood.

Rifampicin

In this case, the absorption of Losartan will occur differently than expected, which may lead to a decrease in the level of the active substance of the drug in the body.

Lithium

The simultaneous use of Losartan and lithium-containing drugs can lead to changes in metabolism and an increase in the level of lithium in the blood.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

If the patient has kidney disease or renal failure, simultaneous use of this drug and NSAIDs may worsen the health condition and worsen the course of the disease.

Losartan N, 12.5 mg+50 mg, film-coated tablets, 30 pcs.

Losartan

In clinical pharmacokinetic studies, no clinically significant interactions were identified with hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole and erythromycin. Rifampicin reduces the concentration of the active metabolite. The clinical significance of this interaction has not been established.

Concomitant use with aliskiren and drugs containing aliskiren in patients with diabetes mellitus and/or moderate or severe renal impairment (GFR less than 60 ml/min/1.73 m2 body surface area) is contraindicated.

Fluconazole and rifampicin decreased plasma concentrations of the active metabolite of losartan.

The clinical significance of this interaction has not been studied.

The simultaneous use of losartan, as well as other drugs that affect the RAAS, with potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone), potassium-containing supplements or potassium salts may lead to an increase in potassium levels in the blood serum. Simultaneous use is not recommended.

As with the use of other drugs that affect the excretion of lithium, treatment with losartan may be accompanied by a decrease in excretion and an increase in the serum concentration of lithium, therefore, during simultaneous treatment with lithium preparations, its serum concentration should be monitored.

With simultaneous use of angiotensin II receptor antagonists (ARA II) with NSAIDs, including selective COX-2 inhibitors and acetylsalicylic acid in doses of more than 3 g per day, the effect of antihypertensive drugs may be reduced. Therefore, the antihypertensive effect of ARA II may be weakened by NSAIDs, including COX-2 inhibitors and acetylsalicylic acid in doses of more than 3 g per day.

In some patients with impaired renal function who have been treated with NSAIDs, including COX-2 inhibitors, treatment with ARB II may cause further deterioration of renal function, including the development of acute renal failure, and an increase in potassium levels (especially in patients with a history of renal dysfunction ). Concomitant use with NSAIDs should be done with caution, especially in elderly patients. In this case, it is necessary to adequately replenish the volume of blood volume and periodically monitor renal function from the moment of initiation of therapy and subsequently.

In some patients with impaired renal function who have used NSAIDs, including selective COX-2 inhibitors, concomitant use of ARB II may cause further deterioration of renal function.

Double blockade of the RAAS: double blockade of the RAAS, i.e. the addition of an ACE inhibitor to APAII therapy is only possible in selected cases under careful monitoring of renal function. In patients with atherosclerosis, heart failure or diabetes mellitus with target organ damage, double blockade of the RAAS (with simultaneous use of ARB II, ACE inhibitors or aliskiren) is accompanied by an increased incidence of arterial hypotension, syncope, hyperkalemia and renal dysfunction (including acute renal failure) in comparison with the use of a drug from one of the listed groups. The simultaneous use of losartan with ACE inhibitors in patients with diabetic nephropathy is contraindicated.

Other drugs that cause arterial hypotension, including tricyclic antidepressants, antipsychotics, baclofen, amifostine: simultaneous use of drugs that lower blood pressure (main or side effect) may increase the risk of developing arterial hypotension.

Hydrochlorothiazide

With thiazide diuretics, drugs such as ethanol, barbiturates and narcotics may potentiate the risk of orthostatic hypotension.

Hypoglycemic agents (for oral administration and insulin) - dose adjustment of hypoglycemic agents may be required, because hydrochlorothiazide affects glucose tolerance.

Metformin should be used with caution due to the risk of lactic acidosis due to renal impairment caused by hydrochlorothiazide.

Other antihypertensive drugs have an additive effect.

Cholestyramine and colestipol - in the presence of anion exchange resins, the absorption of hydrochlorothiazide is impaired. Cholestyramine and colestipol in a single dose bind hydrochlorothiazide and reduce its absorption in the gastrointestinal tract by 85% and 43%, respectively.

Corticosteroids, ACTH (adrenocorticotropic hormone) or glycyrrhizic acid (found in licorice root) - marked reduction in electrolytes, in particular the risk of hypokalemia.

Pressor amines (eg, epinephrine, norepinephrine) - decreased response to pressor amines.

Muscle relaxants of a non-depolarizing type of action (for example, tubocurarine) - enhance the effect of muscle relaxants.

Lithium - diuretics reduce the renal clearance of lithium and increase the risk of lithium toxicity; simultaneous use is not recommended.

NSAIDs (including COX-2 inhibitors) may reduce the diuretic, natriuretic and antihypertensive effects of diuretics.

Medicines used to treat gout (probenecid, sulfinpyrazone and allopurinol): Dosage adjustment of uricosuric drugs may be required as hydrochlorothiazide may cause an increase in serum uric acid concentrations. Thiazide diuretics may increase the incidence of hypersensitivity reactions to allopurinol.

Anticholinergic drugs (eg, atropine, biperiden): increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility and the rate of gastric emptying.

Cytostatic drugs, for example, cyclophosphamide, methotrexate: the myelosuppressive effect increases by slowing elimination from the body.

Salicylates - when taking high doses of salicylates, hydrochlorothiazide can enhance their toxic effect on the central nervous system.

Methyldopa: Isolated cases of hemolytic anemia have been described with the simultaneous use of hydrochlorothiazide and methyldopa.

Concomitant use of cyclosporine increases the risk of developing hyperuricemia and exacerbation of gout.

Cardiac glycosides: Hypokalemia and hypomagnesemia caused by the use of thiazide diuretics increases the risk of developing arrhythmias during treatment with cardiac glycosides.

Calcium salts - thiazide diuretics can increase the calcium level in the blood serum due to a decrease in its excretion. If it is necessary to use calcium supplements, the dose is selected under the control of calcium levels in the blood serum.

Vitamin D - increases the risk of hypercalcemia.

Interference with Laboratory Tests - Due to their effects on calcium excretion, thiazides may interfere with tests of parathyroid function.

Carbamazepine - increases the risk of symptomatic hyponatremia. Serum sodium levels must be monitored.

Iodine-containing contrast agents - with dehydration caused by taking diuretics, the risk of developing acute renal failure increases, especially when high doses of iodine-containing drugs are administered. Before administering such drugs, the patient must be rehydrated.

Amphotericin B (intravenous), stimulant laxatives, or ammonium glycyrrhizinate (found in licorice)—hydrochlorothiazide may increase electrolyte disturbances, especially hypokalemia.

Drugs that bind intensively to proteins enhance the diuretic effect. Dosage adjustments of oral anticoagulants probenecid and sulfinpyrazone may be necessary as hydrochlorothiazide may inhibit their effect.

Concomitant use of thiazide diuretics with antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide), some antipsychotic drugs (neuroleptics) (thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, sultopride, amisulpride, tiapride, pi mosid, haloperidol, droperidol) and other drugs (bepridil, cisapride, difemanil, erythromycin, halofantrine, mizolastine, pentamidine, terfenadine, vincamine, pentamidine) may be accompanied by the development of hypokalemia, which in turn can cause the development of ar.

Losartan's analogs

Level 4 ATC code matches:
Telmisartan

Irbesartan

Presartan

Nortivan

Candesartan

Kozaar

Aprovel

Teveten

Blocktran

Cardosal

Valsartan

Atakand

Diovan

Valsacor

Mikardis

Vazar

Valz

Lorista

Lozap

There are quite a large number of analogues of Losartan. Analogues, or synonyms of a given drug, are medicines containing the same active substance and intended to treat the same diseases. Analogues of the drug include:

Lorista
Lozap
Kozaar
Blocktran
Vasotens
Presartan
Renicard
Losarel
Karzartan
Zisakar
Cardomine
Losakor

Losartan price

The price of Losartan, relative to its quality and truly effective effect on the body, is very low. In pharmacies, this drug can be purchased at a price of 120 to 300 rubles, depending on the number of tablets in the package.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine

ZdravCity

Losartan tablets p.p.o.
12.5 mg 30 pcs. Pranapharm LLC 48 rub. order
Losartan tablets p.p.o. 50 mg 30 pcs. OzonOzon LLC
124 RUR order
Losartan N tablets p.p.o. 12.5mg+50mg 30 pcs. Ozone LLC
184 RUR order
Losartan tablets p.p.o. 100 mg 30 pcs. Ozone LLC
136 RUR order
Losartan tab. p/o captivity. 12.5 mg No. 30Ozon LLC
56 RUR order

Pharmacy Dialogue

Losartan (tab.p.pl.vol. 12.5 mg No. 30) Ozone LLC
57 RUR order
Losartan-Richter (tab.p.pl/vol. 50mg No. 30)Gedeon-Richter-RUS ZAO
RUB 181 order
Losartan (tab.p/pl/vol. 50 mg No. 30) Ozone LLC
RUB 158 order
Losartan (tablet p/o 25 mg No. 30)Vertex
123 RUR order
Losartan-N (tablet p/o 50 mg + 12.5 mg No. 30) Ozon LLC
RUB 194 order