Combizar United medicine for high blood pressure (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Losartan, hydrochlorothiazide
Ingredient United

Ingredient

Composition informationContent
Losartan50mg
Hydrochlorothiazide12.5mg

Uses

indications

Combizar drugs are indicated for treating high blood pressure for patients suitable for combined treatment.

Pharmacokology

Losartan Potassium

angiotensin II (made up of angiotensin I), is a vasoconstrictor, which is the first hormone hormone of the Renin - Angiotensin system and is an important component in the pathological physiology of hypertension. This substance (angiotensin II) also stimulates the secretion of aldosterone from the adrenal shell. Losartan and the main metabolites have a clogging and aldosterone secretion of angiotensin II by preventing the cohesion of Angiotensine II into the AT1 receptor in many tissues. The AT2 receptor is also found in many tissues but it is unclear whether this receptor is related to the cardiovascular air conditioner.

Studies in combining in vitro shows that Losartan is a reversible competitive inhibitor of the AT1 receptor. The metabolic substance has the activity of drugs 10 to 40 times stronger than Losartan, calculated by weight and is a non -competitive, reversible inhibitor of the AT1 receptor. Both Losartan and its active metabolites do not inhibit ACE; As well as not combining or inhibiting other hormone receptors or ion channels known as important in the cardiovascular regulation.

hydrochlorothiazide (HCTZ)

Hydrochlorothiazide is a thiazide diuretic. Thiazide increases water secretion by inhibiting the reabsorption of sodium and chloride ions in the distance. The effect of excreting of sodium in the urine occurs along with secondary loss of potassium and bicarbonate that can cause mild hematuria, blood chlorine, alkaline metabolism. Thiazide also reduces calcium and uric acid excretion.

Thiazide diuretics usually do not affect normal blood pressure. When taken for a long time, thiazide diuretics reduce the resistance of peripheral blood vessels. The exact mechanism that reduces peripheral resistance is unknown, but the excretion of sodium through the kidney is necessary to reduce blood pressure.

Initially, diuretics reduce blood pressure by reducing cardiac weight, plasma volume and extracellular volume. The cardiac supply will gradually return to normal, plasma and extracellular values ​​are slightly lower than normal, but the peripheral vascular resistance decreases, leading to lowering blood pressure.

Dynamic pharmacokinetics

Losartan Potassium

After drinking, Losartan is well absorbed but the system precursor in the liver, forming an active metabolite (E - 3174) and other non -active metabolites. The bioavailability of Losartan tablets is about 33%. The average peak concentration of Losartan and metabolites has the corresponding activity after 1 hour and 3 - 4 hours. There is no clinical difference on losartan concentration in plasma when the drug is used with food.

both Losartan and its metabolites combine with plasma proteins more than 99%, mainly with albumin. Losartan's distribution volume is relatively low of 34 liters. The plasma concentration of metabolites is more active than Losartan at all doses. CMAX and AUC of E - 3174 are about 2 and 5 - 8 times higher than the corresponding value of Losartan. After drinking, Losartan's plasma concentrations and metabolites have a rapid decrease in activity, with a half -life of about 2 hours (1.5 - 2.5 hours) and 6 - 9 hours. Due to short selling time, both Losartan and metabolites have significant accumulation in plasma when using 100 mg at a day a day.

Losartan's plasma clearance and metabolites have the corresponding activity of about 600 ml/min and 50 ml/min. Losartan is metabolized mainly in the liver. About 35% of oral dose is excreted in urine in constant form and metabolic form. Only 4% of the dose is excreted in the form of unchanged by the kidney. The kidney clearance of Losartan is 74 ml/min. About 6% of the dose is excreted in urine in the form of metabolic activity with renal clearance of 26 ml/min. Losartan and metabolic substances are also excreted through the bile, with 58% of oral doses found in the feces.

hydrochlorothiazide (HCTZ)

Hydrochlorothiazide is absorbed from the digestive system depending on the formula and dosage. Birth is about 50 - 60%. After taking HCTZ, diuretic impact occurs within 2 hours, the peak concentration is reached after about 4 hours and lasts about 6 to 12 hours. The impact time ranges from 6 - 12 hours.

The drug can pass the placenta, but cannot pass the bloody barrier and are distributed in breast milk. HCTZ is not metabolized but is eliminated in a constant form for 24 hours. Starting HCTZ's disposal time was recorded in the range of 5.6 - 14.8 hours when plasma concentrations were monitored for at least 24 hours. A recent study recorded an average selling time of 2.5 hours in patients with normal kidney function. The sale time is expected to increase by 12-20 hours in patients with severe renal disease (such as kidney clearance

Before taking Combizar United medicine for high blood pressure (3 blisters x 10 tablets)

Dosage and usage
  • Starting and maintaining dose in adults: 1 tablet of Losartan combination 50 mg + HCTZ 12.5 mg once daily.

    • For patients who do not fully respond, adjust to the maximum dose: 2 Losartan combination tablets 50 mg + HCTZ 12.5 mg daily.

    or as instructed by a physician.

    In general, the hypotension effect achieved 3 weeks after the beginning of treatment.

    Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What do

    do when using overdose?

    Losartan Potassium: Data overdose in humans is limited. The most overdose manifestation is probably lower blood pressure and tachycardia; It is also possible to experience a slow heartbeat due to sympathetic stimulation (vagus nerve). If symptomic hypotension occurs, supportive treatment must be treated. Both Losartan and metabolites are active, they cannot be removed by hemolysis.

    hydrochlorothiazide: The main manifestation is water and electrolyte disorders due to a lot of urinary tract. If using digitalis, hypoglycemia increases arrhythmia.

    Management: Symptom support treatment. Launch of stomach if new to medication. Can use activated carbon after vomiting. Should evaluate and adjust the water and electrolyte disorders quickly.

    What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

    Side Effects

    In general, the treatment with Losartan Potassium - Hydrochlorothiazide is well tolerated. Most of the mild, transient side effects and no need to stop treatment. In controlled clinical trials, the discontinuation of treatment due to clinical side effects in the patient group is treated with a combination form compared to the placebo group, respectively 2.8% and 2.3%.

    The following side effects are recorded with Losartan - Hydrochlorothiazide:

  • Body: abdominal pain, edema, weakness, headache.
    • Cardiovascular: Heart beat fast.

    Digestive system: diarrhea, nausea.

  • Muscle muscle: back pain.
    • nervous/mental: dizziness.
  • Respiratory system: dry mouth, sinusitis, bronchitis, pharyngitis, upper respiratory infections.
    • skin: rash.

    Instructions on how to handle ADR

    Need to notify the doctor unwanted effects when taking the drug.

    Warnings

    Before using the drug you need to read the instructions carefully and refer to the information below.

    contraindicated

    Combizar medicine contraindicated in the following cases:

  • Too hypersensitivity to any ingredients of the drug (excipients: microcrystalline cellulose, lactose, hydroxypropyl cellulose, starch, magnesium stearate, Opadry, yellow).

    • Hypersensitivity to sulfonamide derivatives.

    pregnancy.

  • Patients with anuria.

    • Be cautious when using

    Do not use the form of combination of Losartan - HCTZ in patients who may have intravascular dehydration (for example, patients treated with high -dose diuretic pills).

    Losartan combination - HCTZ combination should not be used for patients with severe renal failure (creatinine clearance Losartan's plasma data concentration increases significantly in patients with cirrhosis, which should consider using low doses for patients with a history of liver failure. Therefore, the form of Losartan - HCTZ combination should not be used for patients who need the standard of Losartan dosage.

    Losartan can increase blood urea and serum creatinine in patients with narrowed kidney stenosis on both sides or human artery stenosis only one kidney. These changes in kidney function can recover when stopped treatment.

    The ability to drive and operate machinery

    There is no research on affecting the ability to drive and operate machinery has been done.

    However, it may occasionally encounter dizziness or drowsiness when taking the drug, especially at the beginning of treatment or newly increased dose. Should be cautious when driving or operating machinery.

    Pregnancy

    When used for pregnant women in the second and third 3 months of pregnancy, drugs acting on the Renin - Angiotensin system (such as Losartan) can cause damage and even death in the developing fetus. Stop using Losartan as soon as you detect pregnancy.

    The period of breastfeeding

    It is unclear whether Losartan will excrete through breast milk or not. HCTZ appears in breast milk. Due to the ability to cause side effects in breastfed babies, it is advisable to consider the stop breastfeeding and stop using the drug, taking into account the importance of the drug for the mother.

    Drug interaction

    Losartan Potassium

    When used at the same time, the following drugs may interact with Losartan:

  • cimetidine: Increasing about 18% of Losartan's AUC can occur but no effect on pharmacokinetics of active metabolites.

    • Phenobarbital: Discount about 20% AUC of Losartan and AUC of active metabolites.

  • Rifampicin and Fluconazole: Reduce the concentration of metabolites with activity of losartan.
  • Potassium diuretics (such as spironolactone, triamterene, amiloride), potassium supplements, or salt -containing substances containing potassium: increased potassium in serum.

    • hydrochlorothiazide (HCTZ)

    When used at the same time, the following drugs can interact with HCTZ:

  • Alcohol, barbiturate, or addictive analgesic: may occur with a vertical posture.
  • Diabetes medications (oral and insulin drugs): may need to adjust the dose of diabetes treatment.
  • Cholestyramine and Colestipol bile acids: HCTZ absorbing reduced in the presence of negative bile acid -mounted drugs. Single doses of cholestyramine or colestipol combined with HCTZ reduces the absorption of the drug from the digestive system, respectively 85 and 43%.
  • Corticosteroids, ACTH: causing strong power outages, especially hypokalemia.
  • Amines that increase blood pressure (such as adrenaline): responding to amines that cause hypertension may decrease but not enough to prevent the use of these drugs.

    • Muscle relaxants, non -reducing (such as tubocurarine): may increase in response to muscle relaxants. lithium: Diuretics reduce lithium clearance and increase the risk of lithium poisoning.

    Non -steroid anti -inflammatory drugs (NSAIDs): NSAIDs can reduce the impact of diuretic, eliminate sodium in urine and treat high blood pressure of HCTZ.

    Storage

    Store at a temperature not exceeding 30 ° C.

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