losartan/hydrochlorothiazide (Rx)

Brand and Other Names:Hyzaar
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

losartan/hydrochlorothiazide

tablet

  • 50mg/12.5mg
  • 100mg/12.5mg
  • 100mg/25mg
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Hypertension

Initial: 50 mg/12.5 mg PO qDay

If dose titrated upward, do not to exceed final titration of 100 mg/25 mg PO qDay or 50 mg/12.5 mg PO q12hr

Decrease losartan to 25 mg PO qDay initially if volume depleted

Dosing considerations

  • Replacement therapy: Combination may be substituted for the individually titrated components

Dosing Modifications

Renal impairment

  • CrCl ≤30 mL/min: Do not use thiazide-containing products; loop diuretic preferred
  • CrCl >30 mL/min: No dosage adjustment required

Safety and efficacy not established

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Interactions

Interaction Checker

and losartan/hydrochlorothiazide

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Adverse Effects

            >10%

            Losartan

            • Fatigue (14%)
            • Hypoglycemia (14%)
            • Chest pain (12%)
            • Cough, incidence higher in previous cough related to ACE therapy (3-11%)

            1-10%

            Losartan

            • Diarrhea (2-10%)
            • URI (8%)
            • Hypotension (7%)
            • Dizziness (4%)
            • Nausea (2%)

            Hydrochlorothiazide

            • Hypotension
            • Anorexia
            • Epigastric distress
            • Hypokalemia
            • Phototoxicity
            • Thrombocytopenia
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            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death (see Pregnancy & Lactation)

            Contraindications

            Hypersensitivity to losartan, hydrochlorothiazides, or sulfonamides

            Renal impairment (CrCl <30 mL/min)

            Hepatic impairment

            Anuria

            Do not coadminister with aliskiren in patients with diabetes

            Cautions

            Stroke risk reduction may be less effective in African-Americans

            Intravascular volume or salt depletion should be corrected prior to use

            Monitor serum lithium levels in patients receiving lithium and hydrochlorothiazide

            Inform female patients of childbearing age about consequences of exposure to losartan during pregnancy and importance of informing their physician about a pregnancy while on therapy; discontinue if pregnancy detected

            Monitor for signs of fluid or electrolyte imbalance, including hyponatremia, hypochloremic alkalosis, and hypokalemia

            If oliguria or hypotension occurs in neonate with history of in utero exposure, direct attention toward support of blood pressure and renal perfusion; exchange transfusions or dialysis may be required as a means of reversing hypotension and/or substituting for disordered renal function

            Acute transient myopia and acute angle-closure glaucoma have been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

            Coadministration with corticosteroids, ACTH, or glycyrrhizin (found in liquorice) may intensify electrolyte depletion, particularly hypokalemia

            Monitor renal function and potassium in susceptible patients

            Exacerbation of systemic lupus erythematosus reported

            Dual blockade of the renin-angiotensin-aldosterone system (ie, ARB plus an ACE inhibitor) in patients with established atherosclerotic disease, heart failure, or with diabetes with end organ damage is associated with a higher frequency of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) as compared with use of a single renin-angiotensin-aldosterone system agent; closely monitor blood pressure, renal function and electrolytes in patients on losartan and other agents that affect the renin-angiotensin system (RAS)

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            Pregnancy & Lactation

            Pregnancy category: D

            Use of drugs that act on the renin-angiotensin system during the 2nd and 3rd trimesters of pregnancy reduces renal function and increases fetal and neonatal morbidity and death

            Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations

            Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death

            When pregnancy is detected, discontinue as soon as possible

            Lactation: Discontinue drug or do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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