Hypersensitivity Patients with Quinck's edema in the anamnesis (swelling of the face, lips, throat and / or tongue) should be under strict supervision.
Arterial hypotension and disturbances of water-electrolyte balance
Arterial hypotension with clinical manifestations, especially after taking the first dose or after increasing the dose, may occur in patients with hypovolemia and / or hyponatraemia as a result of taking diuretics in high doses, diets with restriction of table salt, diarrhea or vomiting. It is necessary either to correct these conditions before prescribing LOZAP®, or use or prescribe smaller doses of the drug.
Water-electrolyte disturbances
Water-electrolyte disturbances are characteristic for patients with renal dysfunction in combination with or without diabetes mellitus and require correction.In a clinical study conducted with patients with type 2 diabetes mellitus with nephropathy, the incidence of hyperkalemia in the group receiving losartan, was higher than in the placebo group. This indicates the need for regular monitoring of potassium content in blood plasma and creatinine clearance (CC) values - especially in patients with heart failure and QC from 30 to 50 ml / min. The appointment of potassium-sparing diuretics, potassium preparations and potassium-containing substitutes simultaneously with the drug LOZAP® Not recommended.
Impaired liver function
Given the pharmacokinetics data indicating a significant increase in plasma losargan in patients with cirrhosis of the liver, patients with impaired liver function (more than 9 on the Child-Pugh scale) are recommended to prescribe the drug in lower doses. The experience of using the drug in patients with severe hepatic insufficiency is absent. With this in mind, the drug LOZAP® contraindicated in patients with severe hepatic insufficiency.
Double blockade of the renin-angiotensin-aldosterone systemThere is evidence that simultaneous use of ACE inhibitors. ARAII or aliskiren increases the risk of arterial hypotension, hyperkalemia and renal dysfunction (including acute renal failure).
Application of the drug LOZAP® together with alneciren is contraindicated in patients with diabetes mellitus or renal dysfunction (GFR less than 60 ml / min / 1.73 m2 body surface area) and is not recommended for other patients (see section "Contraindications").
Application of the drug LOZAP® in combination with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended to other patients (see the section "Contraindications").
Ischemic heart disease (CHD) and cerebrovascular disease
As with any antihypertensive drug, a too sharp decrease in blood pressure in patients with ischemic heart disease and cerebrovascular disease can lead to myocardial infarction or ischemic stroke.
Heart failure
In patients with heart failure with or without kidney function, as with other drugs acting on RAAS, there is a risk of severe arterial hypotension and acute renal failure.
Practically there is no experience with losartan in the treatment of patients with heart failure and concomitant severe renal insufficiency, in patients with severe chronic heart failure (IV functional class according to the NYHA classification), as well as in patients with heart failure and life-threatening arrhythmias. With this in mind, with the appointment of the drug LOZAP® These categories of patients should be careful.
Co-administration with ACE inhibitors in chronic heart failure (CHF)
When using the drug LOZAP® in combination with ACE inhibitors, the risk of side effects may increase, especially renal dysfunction and hyperkalemia (see "Side effect" section). In these cases, careful monitoring and monitoring of laboratory indicators is necessary.
Hemodialysis
When conducting hemodialysis, the sensitivity of blood pressure to the action of antagonists increases AT1 -receptors as a result of reduction of BCC and activation of RAAS. It is necessary to adjust the dose of the drug LOZAP® to under careful monitoring of blood pressure in patients on hemodialysis.Kidney transplantation Data on the use of the drug LOZAP® patients who have recently undergone kidney transplantation are not present.
General anesthesia
Patients receiving angiotensin II antagonists may develop arterial hypotension as a result of blockade of the renin-angiotensin-aldosterone system during general anesthesia and during surgical interventions. Very rarely, cases of severe arterial hypotension, requiring replenishment of bcc and / or vasopressor preparations, can be noted.
Stenosis of aortic and mitral titanium, hypertrophic obstructive cardiomyopathy
When using the drug LOZAP®, as well as other vasodilators, caution should be exercised in patients with hypertrophic obstructive cardiomyopathy or hemodynamically significant stenosis of the aortic or mitral valve.
Primary hyperaldosteronism
Patients with primary hyperaldosteronism are usually resistant to therapy with antihypertensive drugs that affect RAAS. In connection with this, the drug LOZAP® it is not recommended to appoint such patients.
Patients older than 75 years
As a rule, patients older than 75 years of treatment with the drug LOZAP®it is recommended to start with a dose of 25 mg per day.
Other special instructions and precautions
As the clinical experience of the use of ACE inhibitors, losartan and other antagonists AT1receptors, these drugs less effectively reduce blood pressure in patients of the Negroid race than in representatives of other races, possibly due to low renin activity in patients of this race.