Lorista: instructions for use

Indications and contraindications for therapy with Lorista

Both forms of medication are prescribed to patients:

to reduce the likelihood of developing cardiovascular pathologies;
to prevent death in patients with high blood pressure and hypertrophic changes in the left ventricle;
as a component of combination treatment of hypertension.

The instructions indicate the following contraindications to Lorista:

in the absence of urine entering the bladder;
insufficient amount of lactase, increased or decreased amounts of potassium;
hepatic, renal dysfunction, disorders of the conversion of galactose into glucose;
dehydration, low blood pressure;
intolerance to the component composition;
pregnancy, breastfeeding, under age.

Particular care during therapy with Lorista is required for patients:

with diabetes mellitus, bilateral narrowing of arterial vessels in the kidneys;
water-electrolyte imbalance - with insufficient amounts of magnesium, potassium, sodium;
systemic blood pathologies, allergic reactions;
a large amount of calcium, uric acid in the blood;
bronchial asthma, gout.

Lorista is not used in conjunction with NSAIDs; in some cases it causes the development of adverse reactions. During drug therapy, the following may occur:

attack of dizziness, sleep disturbance with insomnia, cephalgia;
accelerated heart rate, decreased blood pressure (dose-dependent), vasculitis;
swelling of the nasal passages, pharyngitis, infection of the upper respiratory tract;
cough, pain in the abdominal area, nausea with vomiting, dyspeptic disorders;
hepatitis, increased activity of liver enzymes, liver dysfunction;
muscle and joint pain, anemic conditions, capillary toxicosis;
swelling in the peripheral areas, chest pain, asthenic syndrome, general weakness;
nettle fever, anaphylaxis, obsessive itching, Quincke's edema.

Treatment may change the levels of urea, creatinine, potassium, hemoglobin, and hematocrit.

Side effects of the drug Lorista h/hd

dizziness, sometimes tachycardia, dry cough, upper respiratory tract infections, diarrhea, edema, abdominal pain, back pain, angioedema, rash, hepatitis, pancreatitis, neutropenia, thrombocytopenia, hypercalcemia and hyperkalemia. Rarely - an increase in the activity of liver enzymes and the level of bilirubin in the blood serum, a decrease in hematocrit and hemoglobin levels is possible; in patients with bilateral renal artery stenosis or with stenosis of the artery of a single kidney, there may be a slight increase in the level of urea and creatinine in the blood serum, but these symptoms do not require cancellation drug.

Dosages and methods of therapy from the instructions for Lorista

Oral medication can be combined with other drugs responsible for lowering blood pressure. Taking the product is not associated with food.

The instructions indicate the following methods of treatment with Lorista N:

Arterial hypertension - 1 tablet for three days. During this period, the maximum effect in reducing blood pressure is achieved. To obtain greater results, use 2 units of medication daily - this is the highest permitted dose of the medication.
Reduced blood volume - allows the use of 25 mg of losartan per day. If the deviation occurs due to large dosages of diuretics, then the diuretics are discontinued before therapy.
Initial doses do not imply a change in the standard regimen for the treatment of patients with moderate renal failure, over 65 years of age, on dialysis.

A daily dose of 50 mg of the drug is recommended to reduce the likelihood of developing cardiovascular pathologies and the risk of death in patients with a hypertrophied left ventricle of the heart and arterial hypertension.

In the absence of the expected effect, 12.5 mg of Hydrochlorothiazide is added to 50 mg of Lorista N. If necessary, the amount of the main medication is increased to 100 mg, and the volume of the second drug remains in its original position. The maximum permissible dosage is 2 tablets.

Lorista ND is prescribed in the absence of the expected results from Lorista N. Daily doses are similar for both forms of the drug.

Accidentally exceeding the recommended amount of medication provokes a slow or rapid heartbeat and a drop in blood pressure. In case of overdose, symptomatic therapy is carried out with forced diuresis, without hemodialysis.

An excess of hydrochlorothiazide also leads to the appearance of side symptoms with a sharp decrease in the volume of sodium, potassium, and chlorine in the bloodstream. Treatment of the condition consists of suppressing the emerging clinical manifestations of intoxication.

Pharmacological properties of the drug Lorista h/hd

Pharmacodynamics. Losartan is an antihypertensive agent, a selective antagonist of angiotensin II receptors (AT1 type). It binds to AT1 type receptors located in various tissues, including the myocardium, vascular smooth muscle, adrenal cortex and kidneys, blocks the development of the effects of angiotensin II, in particular, reduces arterial vasoconstriction and aldosterone release, wedge pressure in the pulmonary vessels, reduces peripheral vascular resistance, which leads to to a decrease in systemic blood pressure. Losartan does not inhibit the activity of kinase II, an enzyme that catalyzes the breakdown of bradykinin. The maximum effect of losartan is observed 6 hours after taking the drug. This effect lasts for 24 hours, so it is enough to take the drug once a day. The hypotensive effect stabilizes during the first week of treatment, and the maximum hypotensive effect is achieved 3–6 weeks from the start of therapy. Hydrochlorothiazide is a diuretic. Thiazide diuretics inhibit the reabsorption of Na+ and Cl– ions in the distal tubules of the nephrons, increasing the excretion of sodium, potassium, chlorine and water. At the beginning of treatment with hydrochlorothiazide, a decrease in the volume of circulating blood plasma occurs, followed by a decrease in cardiac output and a significant decrease in blood pressure. In response to a decrease in blood pressure and cardiac output, fluid is redistributed from the interstitial space into the intravascular bed, and after 3–4 months there is a gradual normalization of blood plasma volume. With prolonged use of the drug, cardiac output returns to the initial value, and peripheral vascular resistance decreases to a lower level compared to the initial value. Diuresis is usually observed within 2 hours after taking hydrochlorothiazide, reaches a maximum after 3-4 hours and lasts for 6-12 hours. The hypotensive effect appears after 3-4 days of treatment and reaches a maximum after 3-4 weeks. The duration of the hypotensive effect is 12–18 hours. When losartan is combined with hydrochlorothiazide, an additive hypotensive effect is observed, which lasts 24 hours and persists over a long period of treatment. Pharmacokinetics of Losartan. After oral administration, losartan is rapidly absorbed into the gastrointestinal tract. It undergoes significant primary metabolism to form active carboxylic acid metabolites and a number of inactive metabolites. Systemic bioavailability is approximately 33%. The maximum concentration of losartan in the blood serum is achieved within 1 hour, and its active metabolite - within 3-4 hours after administration. 99% of losartan and its active metabolite are bound to plasma proteins, mainly albumin. The clearance of losartan and its active metabolite from blood plasma is about 600 and 50 ml/min, respectively. The renal clearance of losartan and its active metabolite from the kidneys is approximately 75 and 26 ml/min, respectively. When taken orally, about 5% of the dose of losartan taken is excreted in the urine unchanged and 6% in the form of an active metabolite. The half-life is 1.5–2 hours and 6–9 hours, respectively. Approximately 35% is excreted in urine, and approximately 65% in feces. Hydrochlorothiazide. Absorption of hydrochlorothiazide when taken orally is rapid. Its bioavailability is 70%. The maximum concentration in blood plasma is achieved 1.5–5 hours after administration. Approximately 40% of the drug is bound to plasma proteins. About 95% of hydrochlorothiazide is excreted unchanged by the kidneys. Elimination occurs as a result of tubular excretion. The half-life from the body is 5.6–14.8 hours.

Drug interactions Lorista h/hd

The drug can be used in combination with other antihypertensive drugs. There were no clinically significant interactions between losartan and digoxin, warfarin, cimetidine, phenobarbital, ketoconazole and erythromycin. With simultaneous use of losartan and rifampicin, the metabolism of losartan and the breakdown of its active metabolites may be accelerated, which leads to a decrease in the effectiveness of losartan. The combined use of losartan and spironolactone, amiloride, triamterene and/or potassium supplements may lead to the development of hyperkalemia. As is the case with other antihypertensive drugs, the severity of the hypotensive effect of losartan may be reduced with simultaneous use of NSAIDs (for example, indomethacin), as well as sympathomimetics. Hydrochlorothiazide reduces lithium excretion. The combined use of losartan with lithium preparations may lead to increased side effects of lithium due to increased reabsorption of lithium in the proximal tubules of nephrons. Therefore, it is recommended to monitor the concentration of lithium in the blood serum and, if possible, avoid the simultaneous use of hydrochlorothiazide and lithium preparations. The combined use of barbiturates, narcotic analgesics (morphine) or consumption of alcoholic beverages may enhance the hypotensive effect of hydrochlorothiazide. In addition, the hypotensive effect of hydrochlorothiazide may also be enhanced by concomitant use of other antihypertensive agents. Hydrochlorothiazide, by weakening the effect of antidiabetic agents, can cause the development of hyperglycemia, therefore, when treating patients with diabetes mellitus, blood glucose levels should be regularly monitored and, if necessary, the dose of the antidiabetic agent should be adjusted. The combined use of hydrochlorothiazide and colestipol or cholestyramine leads to a decrease in the absorption of hydrochlorothiazide by 43 and 85%, respectively. The simultaneous use of hydrochlorothiazide and corticosteroids (including ACTH) may cause the development of hypokalemia. With the combined use of hydrochlorothiazide and pressor amines, the corresponding response to the administration of the latter may be reduced, but this effect is usually insignificant. When performing general anesthesia or administering non-depolarizing muscle relaxants (for example, tubocurarine), the risk of hypotension increases. When taking amiodarone concomitantly with hydrochlorothiazide, the risk of developing arrhythmia due to hypokalemia increases. NSAIDs may reduce the diuretic and hypotensive effects of hydrochlorothiazide. Diflunisal increases the concentration of hydrochlorothiazide in the blood plasma and reduces the severity of its hyperuricemic effect. When the drug is used in combination with digitalis glycosides, the likelihood of toxic effects of cardiac glycosides increases.

Overdose of Lorista h/hd, symptoms and treatment

Data on drug overdose are limited. The most likely consequences of an overdose of losartan may be arterial hypotension and tachycardia; It is also possible to develop bradycardia due to parasympathetic (vagal) stimulation. The main symptoms of hydrochlorothiazide overdose are excessive diuresis, significant hypotension with bradycardia, other cardiac arrhythmias, decreased serum electrolyte levels and impaired core function. In case of overdose, the drug should be discontinued immediately. In case of recent overdose, gastric lavage is recommended. It is necessary to monitor the vital functions of the body and, if necessary, carry out symptomatic treatment. Losartan and its active metabolite are not excreted from the body during hemodialysis.