Hypertension (including reduction of stroke risk in hypertension with left ventricular hypertrophy); chronic heart failure when ACE inhibitors are unsuitable or contraindicated; diabetic nephropathy in type 2 diabetes mellitus.
For hypertension not adequately controlled with losartan alone, hydrochlorotiazide combingly used.
Losartan Potassium: Hypertension, diabetic nephropathy in type 2 diabetes mellitus, usually 50 mg once daily (intravascular volume depletion, initially 25 mg once daily); if necessary increased after several weeks to 100 mg once daily; elderly over 75 years initially 25 mg daily.
Chronic heart failure, initially 12.5 mg once daily, increased at weekly intervals to max. 150 mg once daily if tolerated.
Hydrochlorothiazide: It is effective in doses of 12.5 to 50 mg once daily and can also be given at doses 12.5 to 25 mg as Precon PlusTM.
This combination is contraindicated in patients who are hypersensitive to any component of this product. Because of the hydrochlorothiazide component, this product is contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.
Side-effects are usually mild. Symptomatic hypotension including dizziness may occur, particularly in patients with intravascular volume depletion (e.g. those taking high-dose diuretics). Hyperkalaemia occurs occasionally; angioedema has also been reported with some angiotensin-II receptor antagonists. Vertigo; less commonly gastro-intestinal disturbances, angina, palpitation, oedema, dyspnoea, headache, sleep disorders, malaise, urticaria, pruritus, rash; rarely hepatitis, atrial fibrillation, cerebrovascular accident, syncope, paraesthesia; also reported pancreatitis, anaphylaxis, cough, depression, erectile dysfunction, anaemia, thrombocytopenia, hyponatraemia, arthralgia, myalgia, renal impairment, rhabdomyolysis, tinnitus, photosensitivity, and vasculitis (including Henoch-Schonlein purpura)
Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohy- dramnios have also been reported.
Information on the use of angiotensin-II receptor antagonists in breast-feeding is limited. They are not recommended in breast-feeding and alternative treatment options, with better established safety information during breast-feeding, are available.
Side-effects see notes above.
Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis. Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Consider dose reduction in mild to moderate impairment.
In case of hydrochlorothiazide, electrolytes should be monitored, particularly with high doses, long term use or in renal impairment.
Store in a cool & dry place, protect from light and moisture.
Keep out of reach of children.