Lostad HCT 50/12.5 Stella medicine for hypertension, reducing the risk of stroke (3 blisters x 10 tablets)

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

Ingredient

Thành phần cho 1 viên

Composition informationContent
Losartan Potassium50mg
Hydrochlorothiazide12.5mg

Uses

Indications

Lostad HCT 50/12.5 pills are indicated in the following cases:

Treatment hypertension

This fixed dosage combination is not indicated for the initial treatment for hypertension, except for severe hypertension, the benefits of blood pressure control should be achieved quickly far beyond the risk of starting treatment in these patients.

Treatment of hypertension with left ventricular hypertrophy

Lostad HCT 50/12.5 is also indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, but there is evidence that this useful dose is not effective for black skin patients.

Pharmacology

Losartan and main metabolites have the activity that prevents the circuit and the secretion of angiotensin II's aldosteron by inhibiting the cohesion between Angiotensin II and AT1 receptors in many tissues (such as vascular smooth muscles, adrenal glands). The metabolites are more active than Losartan from 10 to 40 times according to weight and is an inhibitor of non -competitive, reversible inhibitors of the AT1 receptor.

Both Losartan and active metabolites are not inhibited ACE (Kininase II, Angiotensin I Pass Angiotensin II and Bradykinin decomposition), they also do not bind or prevent receptors of other hormones or ion channels that play an important role in regulating cardiovascular system.

hydrochlorothiazide is a thiazid diuretic. Thiazid acts on the reabsorption mechanism of electrolytes in the renal tubules, directly increasing the excretion of sodium and chloride in approximately equal.

The diuretic effect of hydrochlorothiazide is to reduce the volume of plasma indirectly through the excretion of aldosteron, increasing potassium in the urine. Angiotensin || Intermediate for the Renin-Lostosteron link, so the simultaneous use of Angiotensin II receptor inhibitors tends to reverse the loss of potassium due to these diuretics.

Hydrochlorothiazide has the effect of lowering blood pressure, first due to decreased plasma volume and extracellular fluid related to sodium -ups. Later, during the use of the drug, the effect of lowering blood pressure depends on the decrease in peripheral resistance, through the gradual adaptation of blood vessels from the reduction of Na+concentration.

Therefore, the hypotension of hydrochlorothiazide is shown slowly after 1-2 weeks, while the diuretic effect occurs quickly and can be seen on the first day of treatment.

pharmacokinetics

losartan

absorption:

Losartan is easily absorbed through the gastrointestinal tract after drinking but significantly metabolized through the liver for the first time, leading to the bioavailability of the whole body only about 33%. After drinking, the peak concentration of Losartan's plasma is reached within 1 hour and of the main metabolites E -3174 is reached in the range of 3-4 hours.

Distribution:

More than 98% Losartan and E-3174 are associated with plasma proteins.

Metabolism:

The drug is metabolized into metabolites that have the activity of carboxylic acid derivatives, E-3174 (EXP-3174), which has a stronger pharmacological activity than Losartan; Some non -active metabolites are also formed. The metabolism is mainly due to the isenzyme of Cytochrom P450 is CYP2C9 and CYP3A4.

Era:

Losartan is excreted in urine and in the stool through the bile duct in the form of air and metabolites. After drinking, about 4% of the dose is excreted in the form of constant and about 6% excreted in the form of metabolites that are active in urine. Losartan waste sale time is about 1.5 - 2.5 hours and of E -3174 about 3 - 9 hours.

hydrochlorothiazide

absorption:

After drinking, hydrochlorothiazide is relatively fast absorption. The absorption rate is about 65 - 75% of the dose, but may be reduced in patients with heart failure.

Distribution:

hydrochlorothiazide accumulated in red blood cells. The drug passes through the placenta, distributed and reaches high concentrations in the fetus.

Metabolism and elimination:

Mainly eliminated drugs through the kidneys, mostly in the form of non -metabolic. The sale time is about 9.5 - 13 hours, but may last in the case of renal failure, so the dose adjustment is needed.

Before taking Lostad HCT 50/12.5 Stella medicine for hypertension, reducing the risk of stroke (3 blisters x 10 tablets)

How to use

use orally, drink with or not with food.

Dosage

Hypertension

Determine the dose based on clinical effects: Patients with blood pressure are not well controlled with single -therapies of Losartan or Hydrochlorothiazide can switch to 1 tablet of Lostad HCT 50/12.5 x 1 time/day.

If the blood pressure is still not controlled after about 3 weeks of treatment, it can increase the dose to 1 tablet of Lostad HCT 100/25 mg x 1 time/day.

Common dose is 1 tablet Lostad HCT 50/12.5 x1 times/day.

It is recommended not to use more than 1 tablet of Lostad HCT 100/25 mg x 1 time/day.

Anti -hypertension effect is maximum after 3 weeks of therapeutic start.

Severe hypertension

The starting dose is 1 tablet of Lostad HCT 50/12.5 x 1 time/day.

For patients who do not respond well to 1 tablet of Lostad HCT 50/12.5 after 2-4 weeks of treatment, the dose can be increased to 1 tablet of Lostad HCT 100/25 mg x 1 time/day.

The maximum dose is 1 tablet Lostad HCT 100/25 mg x 1 time/day.

Hypertension with left ventricular hypertrophy

Should be started with Losartan 50 mg 1 time/day.

If the blood pressure has not decreased in commitment, replace it with 1 tablet of Lostad HCT 50/12.5. If the blood pressure is needed further, it can be replaced by Lostad HCT 100/12.5 mg, then use Lostad HCT 100/25 mg.

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 to do when overdose?

losartan

Data overdose in people is limited. The most common manifestation of overdose is hypotension and tachycardia, slow heart rate can also occur due to sympathetic nerve stimulation (vagus nerves).

If symptomic hypotension occurs, supportive treatments should be taken. Can not eliminate Losartan or metabolites that are active by blood absorption.

hydrochlorothiazide

The most common signs and symptoms are due to power outages (hypotension, hypotension, sodium hypoglycemia) and dehydration due to excessive diuretic use. If used with Digitalis, hypokalemia may increase arrhyths. The level of excretion of hydrochlorothiazide by hemorrhage has not been determined.

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

When using HCT 50/12.5, you may experience unwanted effects (ADR).

losartan

  • Neurological: Dizziness, headache , fatigue.
  • Cardiovascular: Hypotension The dosage side, especially in patients with a decrease in fluid volume.

    urinary: renal function. liver: Increase the liver enzyme index.

  • Endocrine - Metabolism: hyperkalemia.
  • Neuropathy - bone: muscle pain, joint pain, back pain, muscle prize (rare).
  • Respiratory: cough (less common than acei), respiratory disorders.
  • digestive: digestive disorders . blood: neutrophils. Body: rash, itching, angioedema.

    hydrochlorothiazide

  • Digestive: pancreatitis , jaundice (jaundice in the liver), salivary gland inflammation, spasticity, stomach irritation.
  • Blood: Anemia, granulocytosis, leukopenia, blood anemia, thrombocytopenia.

    Hypersensitivity: Bleeding, light sensitivity, urticaria, necrotic vasculitis (vasculitis and subcutaneous vasculitis), fever, respiratory failure include pneumonia and pulmonary edema.

  • Metabolic: hyperlem of blood glucose, urinary glucose, hyperuricemia.
  • Muscle muscle: Co.
  • nerve: restlessness.
  • kidney: kidney failure, interstitial nephritis . skin: Diverse roses include Stevens-Johnson syndrome, peeling dermatitis including toxic epidermal necrosis.

    Special senses: fading eyes, they see yellow.

    Instructions on how to handle ADR

    When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

    Warnings

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

    Contraindicated

    Lostad HCT 50/12.5 contraindications in the following cases:

  • Hypersensitivity to Losartan or any ingredient of the drug.
  • Hypersensitivity to thiazids and sulfonamid derivatives, gout, dysentic, Addison disease, hypercalcemia, hyperemia uric acid, liver failure and severe kidney failure.

    Be cautious when using

    Caution to use Losartan in patients with kidney stenosis.

    Losartan is excreted in urine and in the bile duct, so the dose should be reduced in patients with renal impairment and should be considered for patients with liver failure.

    Patients with reduced internal fluid volume (for example, high -dose diuretic users) may occur hypotension; Should adjust the decrease in the volume of internal fluid before taking the drug, or with a low starting dose.

    Due to hyperkalemia, monitoring of special serum levels should be monitored in the elderly, patients with renal impairment and should be avoided simultaneously with potassium diuretics.

    It is recommended not to use Lostad HCT 50/12.5 for patients with liver failure to adjust the losartan dose.

    Should check the electrolytes in the serum periodically at appropriate times to detect possible electrolyte imbalance. All patients who are being treated with thiazid should be monitored with clinical signs of imbalance or electrolytes: hypoglycemia, swordsmanship due to hypotension and hypotension.

    Be careful to use thiazids in patients with liver functional impairment or progressive liver disease due to small changes in fluid balance and electrolyte that can lead to liver coma.

    Hydrochlorothiazide hypersensitivity reactions may occur in patients with or without a history of allergies or bronchial asthma, but more often occurs in patients with a history.

    The thiazid diuretics have been reported to cause an increase in or activated the whole body lupus. Thiazid therapy may reduce glucose tolerance. The dose of diabetes should be adjusted, including insulin.

    can increase blood uric acid or cause gout attacks in some patients who are taking thiazid therapy. Because Losartan reduces uric acid, Losartan in combination with hydrochlorothiazide reduces hyperuricemia caused by diuretics.

    In patients with diabetes, insulin's dose can be adjusted or oral hypoglycemic drugs. Thiazid diuretics can cause hyperglycemia. Therefore, potential diabetes can be clearly revealed during treatment with thiazid.

    The hypotension effect of the drug can increase in patients after removal of sympathetic nerves.

    thiazid diuretics increases the secretion of magnesium through the sub -road; This leads to lowering blood.

    Using thiazid diuretics can cause increased cholesterol and triglyceride levels.

    kidney failure:

    Renal failure people with CLCR ≤ 30 ml/minute do not recommend this combination, because diuretics if selected is diuretic.

    Hepatic failure:

    This form of combination should not be used in dosage for liver failure, because it must be started with the dose of Losartan Potassium 25 mg x 1 time/day.

    Lostad HCT 50/12.5 contains lactose. This drug should not be used for patients with rare genetic problems galactose intolerance, total lactase enzyme deficiency or poorly absorbed glucose-galactose.

    The ability to drive and operate machinery

    There has been no research on reactions on the ability to drive and operate machinery. However, when driving or operating machinery must pay attention to dizziness and drowsiness can sometimes occur when treating hypertension, especially when starting treatment or when increasing the dose.

    Pregnancy

    When used in the second and third quarter of pregnancy, drugs that work directly on the Renin - Angiotensin system may cause damage, even death for the developing fetus. Stop using Losartan as soon as possible when detecting pregnancy.

    The period of breastfeeding

    It is unknown whether Losartan is excreted in breast milk or not, but the significant amount of Losartan and metabolites whether the activity of the drug is found in mouse milk. Thiazid diuretics appear in breast milk. Due to the ability to be harmful to breastfeeding, it is necessary to decide to stop breastfeeding or stop the drug, taking into account the importance of the drug for the mother.

    Interactive, taboo

    Interaction of drugs

    losartan

  • In studies on drug interaction, there is no significant pharmacokinetic interaction between Losartan and Hydrochlorothiazide, Digoxin, Warfarin.
  • cimetidine increases the AUC of Losartan in the blood, but does not affect metabolites.

    Phenobarbital reduces Losartan's AUC.

  • lithium: Interactive reduces lithium elimination, so lithium concentration must be monitored.
  • rifampin , a drug metabolic induction agent, reduces the level of Losartan and active chemicals.
  • fluconazole, a P450 2C9 inhibitor, reduces the concentration of active metabolites and increases Losartan concentration.

    Like angiotensin II blockers, if used simultaneously with potassium diuretics (such as spironolacton, triamteren, amilorid), with potassium supplements, or salt -containing substances containing potassium, it can lead to hyperiemia.

  • As well as other hypertension drugs, Losartan's anti -hypertension effect may be reduced when using indomethacin, an non -steroid anti -inflammatory drug.
  • NSAID groups: Interactive impaired renal function.

    hydrochlorothiazide

  • Alcohol, barbiturates or addictive sleeping pills: The ability to lower blood pressure can occur.
  • Diabetes treatment (oral and insulin): need to adjust the dose of diabetes.
  • Other antihypertensive drugs: the effect of synergies or increased the likelihood of hypotension.

  • Cholestyramin and Colestipol: The absorption of hydrochlorothiazide decreases when the presence of anion exchange resin. The single dose of cholestyramin or colestipol plastic associated with hydrochlorothiazide reduces the absorption of plastic through the gastrointestinal tract to 85% and 43% respectively.
  • corticosteroids, ACTH: increase power outages, especially hypokalemia.
  • amino hypertension (such as norepinephrin ): may reduce response to hypertension but not enough to prevent use.
  • Muscle relaxants, non -reducing (such as tubocurarin): may increase response to muscle relaxants.
  • lithium: should not be used with diuretics. Diuretics reduce lithium clearance in the kidneys and increase the toxicity of lithium.
  • Steroid anti-inflammatory drugs include COX-2 selective inhibitors: In some patients, the use of nonsteroidal anti-inflammatory drugs includes COX-2 selective inhibitors can reduce diuretics, sodium ureter and lower blood pressure effects of diuretics, potassium diuretics, thiazid diuretics.

  • NSAID groups: Interactive impaired renal function, reducing kidney perfusion current.
  • quinidine can cause torsion, vibration that is life -threatening.

    Thiazid diuretics reduce the effects of anticoagulants, gout treatments.

    Thiazid diuretics increase the effects of anesthesia, vitamin D. Digoxin: Interaction with digoxin increases Digoxin poisoning (due to hypotension).

    Tyeum of drugs

    Due to the absence of studies on the correlation of the drug, not mixing this drug with other drugs.

    Storage

    Store in closed packaging, dry place, avoid light. The temperature does not exceed 30 ° C.

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