Losartan / Hydrochlorothiazide

Losartan HCTZ

Losartan HCTZ, also known as hydrochlorothiazide, is a medication approved by the FDA for the treatment of high blood pressure. It is often prescribed when a single medication alone is not effective. This medication is also effective in reducing the risk of stroke in individuals who have high blood pressure and left ventricular hypertrophy. The medication combines two active ingredients: Losartan, which is an angiotensin II receptor blocker that works by relaxing blood vessels, and hydrochlorothiazide, which is a diuretic that helps the body remove excess salt and water. Losartan HCTZ is available in various strengths and is usually taken once a day. However, it is essential to follow the prescribed dosage and consult a doctor if there are any concerns.

Product Overview

Losartan HCTZ (hydrochlorothiazide) is a combination medication utilized for the management of high blood pressure (hypertension), particularly in situations where a single medication proves inadequate. Additionally, it aids in reducing the risk of stroke in individuals with hypertension and a specific heart condition known as left ventricular hypertrophy. This medication comprises two active ingredients: Losartan, an angiotensin II receptor blocker (ARB), and hydrochlorothiazide, a thiazide diuretic.

Losartan operates by obstructing the effects of angiotensin II, a chemical that induces blood vessels to constrict. By impeding this action, Losartan facilitates the relaxation and dilation of blood vessels, thereby decreasing blood pressure. Hydrochlorothiazide contributes to blood pressure reduction by eliminating excess salt and water from the body, thereby reducing the workload on the heart. The medication is available in oral tablet form with varying strengths: 50 mg/12.5 mg, 100 mg/12.5 mg, and 100 mg/25 mg. 

The typical starting dose for adults is either 50 mg/12.5 mg or 100 mg/12.5 mg once daily, with a potential increase to a maximum of 100 mg/25 mg if necessary. Common side effects of this medication include upper respiratory infections, dizziness, cough, and back pain. It is crucial to discuss all medications and supplements with a healthcare provider to avoid interactions. Special precautions are necessary for individuals with kidney or liver disease, allergies, diabetes, and pregnant or breastfeeding women. The drug should not be discontinued without medical advice, as abrupt cessation can lead to severe health risks. Proper storage and adherence to the prescribed dosage are essential for safety and efficacy.

Uses of Losartan

• Losartan/hydrochlorothiazide is prescribed to treat high blood pressure, especially when a single medication isn’t enough to lower it effectively.
• This medication is also used to reduce the risk of stroke in people with high blood pressure and a heart condition called left ventricular hypertrophy. 

[Important Warning: The effectiveness of this drug may vary based on your race. While this medication will help manage your blood pressure, it does not cure high blood pressure.]

How to Use Losartan?

Dosage

It comes in the form of an oral tablet and has the following strengths:

• 50 mg /12.5 mg (Losartan / hydrochlorothiazide)
• 100 mg / 12.5 mg (Losartan / hydrochlorothiazide)
• 100 mg / 25 mg (Losartan / hydrochlorothiazide)

Recommended Dosage for Different Patients

Dosage for High Blood Pressure (Hypertension)

• Adult dosage (ages 18-64 years):
  • The initial dose can be either 50 mg Losartan with 12.5 mg hydrochlorothiazide or 100 mg Losartan with 12.5 mg hydrochlorothiazide, to be taken once daily.
  • Your prescribed dose might be influenced by your prior blood pressure medication. If necessary, your doctor might adjust your dose to a maximum of 100 mg Losartan with 25 mg hydrochlorothiazide, taken once daily.
  • The highest recommended dosage is 100 mg Losartan with 25 mg hydrochlorothiazide, taken once daily.
• Child dosage (ages 0-17 years): This medication hasn’t undergone testing in children and is not recommended for individuals under 18 years old.
• Senior dosage (ages 65 years and older): There aren’t any precise guidelines for dosing in seniors. Aging can sometimes slow down how medications are processed in older adults, potentially leading to higher drug levels in the body with standard adult doses. Seniors might require adjustments like a lower dosage or a different dosing regimen.

Special Dosage Considerations

• For people with kidney disease: It’s advised to avoid taking this medication if your creatinine clearance (CrCl) falls below 30 ml/min.
• For people with liver disease:  It’s not recommended to take this medication if you have liver damage. While a lower initial dose of Losartan may be necessary for individuals with liver disease, it’s important to note that this lower dose is not available in this combination medication.

[Note: These recommendations can vary from person to person. It’s important to consult with your doctor to tailor the dosage specifically for you.]

How to Take It?

• The dosage of Losartan/hydrochlorothiazide your doctor prescribes will depend on various factors, including:
  • Your age,
  • The condition is being treated with Losartan/hydrochlorothiazide,
  • Any other health conditions you may have, such as kidney damage.
• Generally, your doctor will start you on a lower dosage and gradually adjust it to find the right level for your needs. They will aim to prescribe the lowest dosage that achieves the desired effect.
• The dosages mentioned below are commonly used or recommended. However, always follow the specific dosage your doctor prescribes for you, as they will determine the most appropriate dosage for your situation.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Losartan Work?

Losartan/hydrochlorothiazide combines two medications from distinct drug classes, which are groups of medicines that function in a similar manner and are often used to treat comparable conditions.

Losartan belongs to the class known as angiotensin II receptor blockers. It inhibits the effects of angiotensin II, a chemical in your body that tightens and narrows blood vessels. By blocking this action, Losartan helps to relax and expand your blood vessels, thereby reducing your blood pressure.

Hydrochlorothiazide falls into the category of thiazide diuretics. It is believed to help eliminate excess salt and water from your body, which reduces the workload on your heart and lowers blood pressure.

Important Safety Information

Side Effects

Common side effects of Losartan/hydrochlorothiazide may include:

• Dizziness
• Cough
• Back pain
• Upper respiratory infections, such as the common cold

Serious side effects of Losartan/hydrochlorothiazide may include:

• Serious allergic reaction: Symptoms can include:
  • Trouble breathing
  • Swelling of your face, throat, lips, or tongue
• Low blood pressure (hypotension): Symptoms can include:
  • Feeling like you’re going to faint
  • Dizziness
• Lupus: Symptoms can include:
  • Fatigue
  • Skin rash
  • Weight loss
  • Joint pain
  • Stiffness
• Kidney problems. Symptoms can include:
  • Swelling of your ankles, feet, or hands
  • Weight gain
• Eye problems: Symptoms can include:
  • Trouble seeing
  • Eye pain
• High or low potassium blood levels: Symptoms can include:
  • Heart rhythm problems
  • Slow heart rate
  • Muscle weakness

[Note: This list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

• Discontinuing the Medication: It is crucial not to halt the intake of Losartan/hydrochlorothiazide without consulting your healthcare provider. Abrupt cessation of this medication may lead to a rapid escalation in blood pressure, significantly enhancing the likelihood of experiencing a heart attack or stroke. If you are considering discontinuing Losartan/hydrochlorothiazide, it is important to discuss this with your doctor. They can devise a plan to gradually reduce your dosage over time, allowing you to safely discontinue the use of the medication.
• Low Blood Pressure (Hypotension): Taking Losartan/hydrochlorothiazide might result in a drop in blood pressure levels, a condition known as hypotension. This risk is particularly elevated if you also use diuretics, adhere to a low-salt diet, have existing heart conditions, or suffer from episodes of vomiting or diarrhea. In these situations, medical practitioners typically monitor patients closely during the initial dosing period to manage any potential complications effectively.
• Sensitivity Reactions: Individuals with a history of allergies or asthma might experience sensitivity reactions upon beginning treatment with Losartan/hydrochlorothiazide. Common symptoms of such reactions include skin rashes, hives, difficulty breathing or wheezing, itching, and fever. If you start to exhibit these symptoms, it’s important to notify your doctor immediately.
• Eye Issues: Losartan/hydrochlorothiazide has been associated with certain eye problems, such as myopia (nearsightedness) and glaucoma. If you notice any vision changes or experience eye pain, you are advised to contact your healthcare provider promptly and cease taking the medication until further guidance is provided.
• Allergy Warning: This medication can trigger severe allergic reactions in some individuals. Signs of a severe allergic reaction include difficulty breathing, swelling of the throat or tongue, and hives. If you experience any of these symptoms, seek emergency medical attention by calling 911 or visiting the nearest emergency room. Additionally, if you have previously had an allergic reaction to Losartan/hydrochlorothiazide, you should not take it again, as a subsequent reaction could be life-threatening.
• Alcohol Interaction Warning: Consuming alcoholic beverages while taking Losartan/hydrochlorothiazide can heighten the risk of experiencing dizziness or lightheadedness. If you consume alcohol, discuss with your doctor to determine if it is safe to drink while on this medication.

Boxed Warning

FDA Warning: Use During Pregnancy

• This medication carries the FDA’s most serious warning, known as a black box warning. It is issued to inform both doctors and patients of potential severe risks associated with the drug.
• Do not use this medication if you are pregnant, as it could harm or terminate the pregnancy. If you discover you are pregnant while taking this drug, contact your doctor immediately and discontinue its use.”

Precautions

• Sulfonamide Allergy Warning: Individuals who are allergic to sulfonamides should avoid using this medication. It’s crucial to disclose all allergies to your healthcare provider to prevent adverse reactions.
• Kidney Disease: Patients with kidney disease are at an increased risk of experiencing severe side effects from this medication. Particularly, those who no longer produce urine should abstain from using this drug. Regular monitoring of kidney function by a healthcare professional is essential, and adjustments to the medication dosage may be necessary based on kidney health.
• Liver Disease: This medication is contraindicated for individuals with liver disease. Patients with this condition should consult their doctor for alternative treatments.
• Lupus: There is a potential for this drug to trigger or exacerbate symptoms of lupus. If you notice new symptoms or a worsening of existing symptoms, it is imperative to contact your healthcare provider immediately.
• Diabetes: For diabetic patients, there may be a need to adjust the dosage of diabetes medications when taking this drug. Your doctor will guide you on how frequently you should check your blood sugar levels to ensure they remain stable.
• Glaucoma: Those with glaucoma should be aware that this medication might worsen their condition. It’s important to discuss this with your doctor, who might suggest monitoring or alternative treatments to mitigate the risk.

Other Important Precautions

• For Breastfeeding Women: The excretion of this drug into breast milk remains unclear. If the drug is present in breast milk, it could potentially lead to adverse effects in a breastfeeding infant. If you are breastfeeding, consult your doctor to weigh the necessity of continuing breastfeeding against the continued use of this medication. A decision may be required to either discontinue breastfeeding or cease the medication based on the best interest of the child’s health.
• For Seniors: Elderly patients may metabolize drugs at a slower rate, leading to elevated levels of the drug in their system when administered at normal adult dosages. Therefore, if you are an older adult, you might need a reduced dosage or an adjusted administration schedule to safely use this drug.
• For Children: This medication has not been sufficiently studied in pediatric populations and is not recommended for individuals under the age of 18. Due to the lack of comprehensive data on its safety and efficacy within this group, its use should be avoided in children.

Missed Dose

• If you forget to take your Losartan HCTZ dose, take it as soon as you remember. If it is only a few hours until your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Never attempt to catch up by taking two doses of Losartan HCTZ at the same time. Doing so can lead to dangerous side effects.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Overdose

Taking an excessive amount of this medication can alter your blood electrolyte levels. You might experience symptoms such as a pounding heartbeat, weakness, and dizziness. If you believe you have overdosed, contact your doctor or get advice from the American Association of Poison Control Centers via their online tool. In cases of severe symptoms, immediately call 911 or visit the nearest emergency room.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

• Keep this medication stored at room temperature, ideally around 77°F (25°C), though brief storage between 59°F and 86°F (15°C and 30°C) is permissible. 
• Avoid freezing the drug and exposure to high temperatures. 
• Protect it from light, and do not store it in humid areas such as bathrooms. Always carry your medication with you, particularly when flying, and ensure it remains in your carry-on bag rather than a checked bag.

[Note: Discuss with your healthcare professional the proper disposal of unused medicine and any questions you may have regarding its storage.]

Losartan Interactions

Losartan/hydrochlorothiazide oral tablets have the potential to interact with a variety of other medications, which can lead to various outcomes. Some interactions might hinder the effectiveness of the drug, while others may escalate the likelihood of experiencing adverse effects. The following is a compilation of medications known to interact with Losartan/hydrochlorothiazide; however, this enumeration is not exhaustive and does not cover all possible drug interactions.

Before you start taking Losartan/hydrochlorothiazide, it is crucial to inform your healthcare provider and pharmacist about all medications you are currently using, including prescription drugs, over-the-counter medicines, and any other substances. Additionally, make sure to mention any vitamins, herbs, and supplements you are taking. Sharing this comprehensive list with your healthcare professionals is essential for managing and preventing potential drug interactions. If you have any concerns or questions about how drug interactions might affect your treatment, do not hesitate to discuss them with your doctor or pharmacist.

Drugs or supplements that contain potassium: 

Losartan/hydrochlorothiazide may raise the potassium levels in your blood. Using Losartan alongside medications containing potassium, potassium supplements, or potassium-enriched salt substitutes can heighten your risk of hyperkalemia (elevated potassium levels). Some examples of potassium-containing medications are:

• Potassium chloride (Klor-Con, Klor-Con M, K-Tab, Micro-K)
• Potassium bicarbonate (Klor-Con EF)
• Potassium gluconate

Lithium: When taken with Losartan/hydrochlorothiazide, lithium—a medication used for treating bipolar disorder—might see increased levels in your body. This could raise the likelihood of experiencing severe side effects. If you are prescribed both medications, your doctor might adjust your lithium dose.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Combining NSAIDs with losartan/hydrochlorothiazide can increase your risk of kidney damage. This risk is particularly heightened if you have diminished kidney function, are elderly, use diuretics, or are experiencing dehydration. Furthermore, NSAIDs can lessen the effectiveness of losartan/hydrochlorothiazide in lowering blood pressure, potentially compromising Losartan’s effectiveness. Common NSAIDs include:

• Ibuprofen
• Naproxen

Blood pressure drugs: Combining Losartan/hydrochlorothiazide with other medications that have similar mechanisms can elevate your risks of low blood pressure, elevated potassium levels in your blood, and kidney damage. These medications include:

• Angiotensin Receptor Blockers (ARBs), such as:
  • Irbesartan
  • Candesartan
  • Valsartan
• Angiotensin-converting enzyme (ACE) Inhibitors, such as:
  • Lisinopril
  • Fosinopril
  • Enalapril
  • Aliskiren

Diabetes drugs: Losartan/hydrochlorothiazide may cause an increase in your blood sugar levels. If you are using diabetes medications in conjunction with Losartan/hydrochlorothiazide, your doctor might need to modify the dosages of your diabetes treatments. Examples of diabetes medications include:

• Miglitol
• Rosiglitazone
• Glyburide
• Insulin
• Pioglitazone
• Glipizide
• Acarbose

Cholesterol-lowering drugs: Using Losartan/hydrochlorothiazide alongside specific cholesterol-lowering medications may reduce the levels of Losartan/hydrochlorothiazide in your body, potentially diminishing its effectiveness. To manage this, your doctor might advise taking Losartan/hydrochlorothiazide at least four hours before or four to six hours after taking these cholesterol-lowering drugs. Examples of these medications include:

• Cholestyramine
• Colestipol

[Note: This isn’t a complete list, and there could be other drugs that interact with Losartan. Tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Losartan Alternatives

• Cozaar (Losartan)
• Diovan (valsartan)
• Zestril (lisinopril)
• Vasotec (enalapril)
• Norvasc (amlodipine)
• Dilt-XR (diltiazem)
• Chlorthalidone (chlorthalidone)
• Hydrochlorothiazide (hydrochlorothiazide)
• Toprol XL (metoprolol succinate)
• Hyzaar (Losartan and hydrochlorothiazide)
• Exforge (valsartan and amlodipine)
• Edarbi (azilsartan)
• Atacand (candesartan)

• Teveten (eprosartan)
• Avapro (irbesartan)
• Benicar (olmesartan)
• Micardis (telmisartan)

• Lotensin (benazepril) 
• Capoten (captopril) 
• Monopril (fosinopril) 
• Univasc (moexipril) 
• Aceon (perindopril) 
• Accupril (quinapril)
• Altace (ramipril)
• Mavik (trandolapril)

• Cardene (nicardipine)
• Procardia (nifedipine)
• Sular (nisoldipine)
• Verelan (verapamil)

• Bumex (bumetanide)
• Diuril (chlorothiazide)
• Lasix (furosemide)
• Lozol (indapamide)
• Zaroxolyn (metolazone)
• Demadex (torsemide)

• Sectral (acebutolol)
• Tenormin (atenolol)
• Kerlone (betaxolol)
• Zebeta (bisoprolol fumarate)
• Coreg (carvedilol)
• Trandate (labetalol)
• Lopressor (metoprolol tartrate)
• Corgard (nadolol)
• Bystolic (nebivolol)
• Visken (pindolol)
• Inderal (propranolol)
• Betapace (sotacor)

• Cardura (doxazosin mesylate)
• Minipress (prazosin)
• Hytrin (terazosin)

• Catapres (clonidine)
• Tenex (guanfacine)
• Aldomet (methyldopa)

• Inspra (eplerenone)
• Aldactone (spironolactone)

• Avalide (irbesartan and hydrochlorothiazide)            
• Azor (olmesartan and amlodipine)
• Benicar HCT (olmesartan and hydrochlorothiazide)
• Diovan HCT (valsartan and hydrochlorothiazide)
• Micardis HCT (telmisartan and hydrochlorothiazide)
• Twynsta (telmisartan and amlodipine)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

When is the best time to take Losartan?

Losartan tablets should be taken once daily, and it is recommended that a consistent routine for taking the medication at the same time each day is established to maintain optimal effectiveness. Initially, your healthcare provider may advise taking the first dose of Losartan at bedtime. This recommendation is based on the fact that Losartan can sometimes cause dizziness, especially after the first dose. Taking it before bedtime may help minimize the impact of dizziness during waking hours. After the initial dose, you may choose any time of day that suits your schedule for taking Losartan, as long as you consistently take it at that same time daily.

What foods should be avoided when taking Losartan?

When taking Losartan, a medication commonly used to manage high blood pressure and protect the kidneys in people with diabetes, it’s important to monitor and manage your potassium intake carefully. Losartan can increase potassium levels in your blood, a condition known as hyperkalemia, which can be dangerous if not controlled.

To avoid this risk, you should avoid potassium supplements and products like potassium-containing salt substitutes. Additionally, it is advisable to limit or avoid high-potassium foods. Some common high-potassium foods include Noni juice, bananas, oranges, potatoes, spinach, and tomatoes.

Always consult with your healthcare provider before making any changes to your diet or taking new supplements, especially when managing a condition with medications like Losartan. Your doctor can provide specific guidance tailored to your health needs, ensuring that your potassium levels remain safe and well-managed while on this medication.

What organ does Losartan affect?

Losartan primarily impacts the kidneys, heart, and brain by influencing the blood vessels associated with these organs. When blood pressure is excessively high, it can lead to gradual and severe damage to these vital blood vessels. In the brain, this damage increases the risk of stroke, a condition where the blood supply to part of the brain is interrupted, leading to potentially fatal or disabling outcomes. 

Regarding the heart, the damage can contribute to heart failure, a condition where the heart is unable to pump blood effectively, which can be life-threatening. In the kidneys, high blood pressure can cause kidney failure, impairing the kidneys’ ability to filter waste and excess fluids from the body, which can necessitate dialysis or kidney transplantation. 

Is it better to take blood pressure medication at night or in the morning?

Taking blood pressure medication at night might be more advantageous than taking it in the morning, according to findings from a significant study conducted in Spain. This robust research included over 19,000 participants and demonstrated that administering blood pressure medication to coincide with nighttime can substantially reduce the risk of cardiovascular-related deaths and diseases. 

Specifically, the study found that this timing strategy could decrease the likelihood of such events by nearly 50%. This suggests that the body’s response to blood pressure medication during the night could potentially lead to more pronounced health benefits compared to morning administration.

Should you drink lots of water with Losartan?

If you are taking Losartan, it’s important to manage your diet and hydration levels carefully. Opt for simple, bland meals rather than consuming rich or spicy foods, as these can exacerbate potential side effects. It is advisable to take your dose of Losartan after a meal, which can help reduce stomach upset or discomfort.

Staying hydrated is crucial while on Losartan. Drinking water in small, frequent sips throughout the day is recommended. This approach helps prevent dehydration. You should be aware of the signs of dehydration, which include urinating less frequently than normal and urine that appears darker and has a stronger odor than usual. Ensuring adequate hydration will support your body’s ability to manage and process Losartan effectively.

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