Losartan-hydrochlorothiazide
Hypersensitivity reactions
Patients with an angioneurotic edema in the anamnesis (edema of the face, lips, pharynx / larynx and / or tongue) need control of the drug (see ADVERSE EFFECTS).
Impaired kidney and liver function
The preparation Gisaar® is contraindicated for use in patients with severe impairment of liver function and severe impairment of kidney function (QC not more than 30 ml / min) (see CONTRAINDICATIONS).
Embryotoxicity
The use of drugs that affect RAAS in the second and third trimester of pregnancy reduces the function of the kidneys of the fetus and increases the incidence and mortality of the fetus and newborns. The development of oligohydramnion can be associated with fetal lung hypoplasia and skeletal deformities. Possible adverse events in newborns include hypoplasia of the skull bones, anuria, arterial hypotension, renal failure and death. When diagnosing pregnancy, the preparation Gisaar® should be immediately canceled (see APPLICATION WITH PREGNANCY AND PERIOD OF BREASTFEEDING).
Losartan
Arterial hypotension and decrease in the volume of circulating blood (BCC)
In patients with reduced BCC or sodium content in the blood, developed due to intensive diuretic therapy, diets with restriction of table salt, diarrhea or vomiting, symptomatic hypotension may develop, especially after the first dose of Gisaar®. Correction of such conditions should be performed prior to the prescription of the preparation Gisaar®.
Violation of the water-electrolyte balance
Violation of the water-electrolyte balance is characteristic of patients with renal insufficiency with diabetes mellitus or without diabetes mellitus, therefore careful monitoring of these patients is necessary. A careful control of the potassium content in the blood or QC is necessary, especially in patients with heart failure and QA 30-50 ml / min.
During treatment with the drug Gisaar® it is not recommended to take potassium-sparing diuretics, potassium preparations or potassium-containing substitutes for edible salt.
Aortic or mitral stenosis, hypertrophic obstructive cardiomyopathy
Like all drugs that have a vasodilating effect,ARA II should be administered with caution to patients with aortic or mitral stenosis or hypertrophic obstructive cardiomyopathy.
Ischemic heart disease and cerebrovascular disease
As with all drugs possessing vasodilating action, ARA II must be administered with caution to patients with coronary artery disease or cerebrovascular disease, because an excessive fall in blood pressure in this group of patients can lead to myocardial infarction or stroke.
Chronic heart failure (CHF)
As with other medicines that have an effect on the RAAS in patients with chronic heart failure and with or without renal impairment are at risk of severe hypotension or acute renal failure.
Primary hyperaldosteronism
Since in patients with primary hyperaldosteronism usually not observed a positive response to the therapy of antihypertensive agents that act by inhibiting the RAAS Gizaar® use of the drug is not recommended in this group of patients.
Impaired liver function
Data from pharmacokinetic studies indicate that the concentration of losartan in the blood plasma in patients with cirrhosis increases significantly, so patients with mild or moderate violations of the liver function in the history of the drug Gisaar® should be administered with caution. There is no experience with losartan in patients with severe impairment of liver function (more than 9 on the Child-Pugh scale), so Gisaar® should not be used in this group of patients (see CONTRAINDICATIONS).
Impaired renal function
Due to inhibition of RAAS in some predisposed patients, renal function changes, including renal failure, were observed. These changes in renal function may return to normal after discontinuation of treatment.
Some drugs that affect RAAS can increase the concentration of urea in the blood and serum creatinine in patients with bilateral stenosis of the renal arteries or stenosis of the renal artery of a single kidney. It has been reported that similar effects occur when taking losartan. Similar violations of kidney function can be reversible after the abolition of therapy. Losartan should be used with caution in patients with bilateral stenosis of the renal arteries or stenosis of the renal artery of a single kidney.
Hydrochlorothiazide
Arterial hypotension and disturbance of water-electrolyte balance
When using antihypertensive drugs in some patients may develop symptomatic hypotension. Patients should be observed to detect clinical signs of water-electrolyte balance disturbance, for example, dehydration, hyponatremia, hypochloraemic alkalosis, hypomagnesemia or hypokalemia, which may develop against the background of concomitant diarrhea or vomiting. Such patients need regular monitoring of the content of serum electrolytes. Patients with edema may experience dilutional hyponatremia in hot weather.
Metabolic and endocrine effects
Thiazide therapy may impair glucose tolerance. In some cases, it may be necessary to correct the dose of hypoglycemic agents, including insulin (see INTERACTION WITH OTHER MEDICINES).Thiazides can reduce the excretion of calcium by the kidneys and cause a short-term and insignificant increase in serum calcium. Expressed hypercalcemia may indicate latent hyperparathyroidism. Due to the influence of thiazides on calcium metabolism, their administration can distort the results of the study of parathyroid gland function, therefore, before the study of parathyroid function, the thiazide diuretic should be canceled.
The increase in the concentration of cholesterol and triglycerides in the blood can also be associated with therapy with thiazide diuretics.
In some patients, the use of thiazide diuretics can lead to hyperuricemia and / or gout development. Because the losartan reduces the concentration of uric acid, its simultaneous use with hydrochlorothiazide reduces the severity of hyperuricemia caused by a diuretic.
Impaired liver function
Thiazides should be used with caution in patients with impaired hepatic function or progressive liver disease, as this can lead to the development of intrahepatic cholestasis, and minor changes in the water-electrolyte balance can trigger the development of hepatic coma.The drug Gisaar® is contraindicated in patients with severe impairment of liver function.
Acute myopia and secondary closed angle glaucoma
Hydrochlorothiazide, being a sulfonamide derivative, can cause an idiosyncratic reaction in the form of acute transient myopia and acute closed-angle glaucoma. Symptoms of these disorders are an unexpected reduction in visual acuity or eye pain, which typically occurs within a few hours to several weeks after starting the drug. If therapy is not available, acute angle-closure glaucoma can lead to loss of vision. The main treatment consists in the fastest possible removal of hydrochlorothiazide. It should be borne in mind that if intraocular pressure remains uncontrolled, urgent surgical or surgical treatment may be required. The risk factors for the development of acute closed-angle glaucoma include information about allergies to sulfonamides or penicillin in the anamnesis.
Other effects
In patients taking thiazide diuretics, hypersensitivity reactions can occur even in the absence of an anamnesis of allergic reactions or bronchial asthma.Reported relapses or worsening of the severity of systemic lupus erythematosus in patients taking thiazide diuretics.
Special patient groups
Race
Analysis of the data of the entire population of patients included in the study LIFE on the study of the effect of losartan on the reduction in the frequency of development of the main composite criterion for evaluating the study in patients with hypertrophy and left ventricular hypertrophyn = 9193), showed that the ability of losartan in comparison with atenolol to reduce the risk of stroke and myocardial infarction, as well as to reduce the rate of cardiovascular mortality in patients with AH and left ventricular hypertrophy (by 13.0%, p = 0.021) does not apply to patients Negroid race, although both regimens effectively reduced blood pressure in these patients. In this study, the drug losartan in comparison with atenolol reduced the rate of cardiovascular morbidity and mortality in patients with AH and left ventricular hypertrophy of all races, except Negroid (n = 8660, p = 0.003). However, in this study, patients of the Negroid race who received atenolol, had a lower risk of developing a basic composite criterion for evaluating the study (ie, a lower combined rate of cardiovascular mortality,stroke and myocardial infarction) compared with patients of the same race who took losartan (p = 0.03).
Children and teens
The effectiveness and safety of Gisaar® in children and adolescents under 18 years of age have not been established.
If newborns whose mothers take Gisaar during pregnancy develop oliguria or arterial hypotension, symptomatic therapy is required to maintain blood pressure and renal perfusion, blood transfusion or dialysis may be required to prevent the development of arterial hypotension and / or maintenance kidney function.
Elderly patients
Clinical studies have not revealed any specific features regarding the safety and efficacy of Gisaar® in elderly patients (over 65 years of age).