What is losartan and hydrochlorothiazide, and how does it work (mechanism of action)?
Hyzaar is a combination of losartan (Cozaar)
and
hydrochlorothiazide and is used for treating high blood pressure. Losartan
is an oral medication that belongs to a class of drugs called
angiotensin
receptor blockers (ARBs). Other ARBs include irbesartan (Avapro), valsartan (Diovan),
and candesartan (Atacand). Angiotensin, formed in the blood by the action of
angiotensin converting enzyme (ACE), is a powerful chemical that attaches to
angiotensin receptors found in many tissues but primarily on smooth muscle cells
surrounding blood vessels. Angiotensin's attachment to the receptors causes the
muscles to contract and the blood vessels to narrow (vasoconstrict) which leads
to an increase in blood pressure (hypertension). Losartan (more specifically,
the chemical formed when the liver converts the inactive losartan into an active
chemical) blocks the angiotensin receptor. By blocking the action of angiotensin,
losartan relaxes the muscles, dilates blood vessels and thereby reduces blood
pressure.
Hydrochlorothiazide (HCTZ) is a diuretic (water pill) used for
treating high blood pressure (hypertension) and accumulation of fluid. It works
by blocking salt and fluid reabsorption in the kidneys, causing an increased
amount of urine containing salt (diuresis). The mechanism of its action in
lowering high blood pressure is not well understood. The combination of losartan
and HCTZ reduces blood pressure better than either drug alone. Losartan
increases potassium levels while HCTZ reduces potassium levels; the combination
of both drugs has less effect on potassium levels. The FDA approved Hyzaar in
April 1995.
What brand names are available for losartan and hydrochlorothiazide?
Hyzaar
Is losartan and hydrochlorothiazide available as a generic drug?
GENERIC AVAILABLE: Yes
Do I need a prescription for losartan and hydrochlorothiazide?
Yes
What are the side effects of losartan and hydrochlorothiazide?
Common side effects of Hyzaar are:
- nausea,
- vomiting,
- back pain,
- stomach upset,
- dizziness, and
- upper respiratory infection.
Other important side effects that may be caused by Hyzaar include:
- persistent cough,
- severe hypotension,
- changes in electrolyte concentrations,
- impotence, and
- angioedema.
Hyzaar may reduce kidney function in some patients
and should not be used by patients who have bilateral renal artery stenosis
(narrowing of both arteries going to the kidneys). Rare cases of rhabdomyolysis
(muscle breakdown), hepatitis, ,reduced number of platelets, and pancreatitis
have been reported.
QUESTION
Salt and sodium are the same.
See Answer
What is the dosage for losartan and hydrochlorothiazide?
The usual starting dose is 12.5/50 mg of Hyzaar once daily for
patients not controlled on losartan or HCTZ treatment alone. The dose may be
increased after 3 weeks to 2 tablets of 12.5/50 mg or one tablet of 25/100 mg
daily. Patients who have not been controlled on losartan 100 mg alone should be
switched to Hyzaar 12.5/100 mg.
Which drugs or supplements interact with losartan and hydrochlorothiazide?
Losartan may increase levels of blood potassium
which can lead to serious
heart problems (arrhythmias). Therefore, concomitant
use of other substances that increase blood potassium-such as potassium-sparing
diuretics (for example, spironolactone (Aldactone), triamterene, and amiloride),
potassium supplements, or salt substitutes containing potassium may lead to
dangerous increases in serum potassium.
Combining losartan or other ARBs with
nonsteroidal anti-Inflammatory drugs (NSAIDs) in patients who are
elderly,
volume-depleted (including those on diuretic therapy), or with poor kidney
function may result in reduced kidney function, including kidney failure. These
effects usually are reversible. The antihypertensive effect of losartan may be
reduced by aspirin and other NSAIDs such as ibuprofen (Advil, Children's
Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin,
Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve). HCTZ reduces the
elimination of lithium (Lithobid,
Eskalith) by the kidneys and can lead to lithium
toxicity. NSAIDs, for example, ibuprofen, may reduce the blood pressure effects
of hydrochlorothiazide.
Blood sugar levels can be elevated by HCTZ,
necessitating adjustment in the doses of medications that are used for treating
diabetes.
Combining HCTZ with corticosteroids may increase the risk for low
levels of blood potassium and other electrolytes. Low blood potassium
(hypokalemia) can
increase the toxicity of digoxin (Lanoxin). Cholestyramine (Questran, Questran
Light) and colestipol (Colestid) bind to hydrochlorothiazide and reduce its
absorption from the gastrointestinal tract by 43%-85%.
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Is losartan and hydrochlorothiazide safe to take if I’m pregnant or breastfeeding?
When used in the second or third trimester of pregnancy
ACE
inhibitors and ARBs can cause injury and even death to the fetus. Hyzaar should not be
used during pregnancy.
It is not known whether losartan is excreted in breast milk , but losartan and its active metabolite are excreted in rat milk.
Due to the possibility of harm to the nursing infant, if possible, losartan
should be discontinued by women who are
breastfeeding. HCTZ is excreted in breast milk.
What else should I know about losartan and hydrochlorothiazide?
What preparations of losartan and hydrochlorothiazide are available?
Tablets (HCTZ/losartan): 12.5/50 mg, 12.5/100 mg, and
25/100 mg
How should I keep losartan and hydrochlorothiazide stored?
Tablets should be stored at room temperature, between 15 C – 30 C
(59 F – 86 F) and protected from excessive light and humidity. They should be kept
in a tightly-closed, light-resistant container.