Lozarel Plus

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Lozarel Plus: instructions for use and reviews

1. Release form and composition
2. Pharmacological properties
3. Indications for use
4. Contraindications
5. Method of application and dosage
6. Side effects
7. Overdose
8. Special instructions
9. Application during pregnancy and lactation
10. Use in childhood
11. In case of impaired renal function
12. For violations of liver function
13. Use in the elderly
14. Drug interactions
15. Analogs
16. Terms and conditions of storage
17. Terms of dispensing from pharmacies
18. Reviews
19. Price in pharmacies

Latin name: Losarel Plus

ATX code: C09DA01

Active ingredient: hydrochlorothiazide (Hydrochlorothiazide) + losartan (Losartanum)

Manufacturer: LEK d.d. (LEK dd) (Slovenia)

Description and photo update: 28.11.2018

Lozarel Plus is a combined antihypertensive drug.

Release form and composition

Dosage form - tablets, film-coated: round, biconvex, in a light yellow shell, with a core from white with a yellowish tinge to white (in a cardboard box 3-6, 8, 10 or 14 blisters containing 7 or 10 tablets, and instructions for the use of Lozarela Plus).

The composition of 1 tablet (12.5 mg + 50 mg) / (25 mg + 100 mg) includes:

active substances: hydrochlorothiazide - 12.5 / 25 mg; losartan potassium - 50/100 mg (including losartan - 45.8 / 91.6 mg and potassium - 4.24 / 8.48 mg);
auxiliary components (core): microcrystalline cellulose - 60/120 mg; lactose monohydrate - 26.9 / 53.8 mg; pregelatinized starch - 23.6 / 47.2 mg; colloidal silicon dioxide - 0.5 / 1 mg; magnesium stearate - 1.5 / 3 mg;
film shell: hyprolosis - 1.925 / 3.85 mg; hypromellose - 1.925 / 3.85 mg; titanium dioxide - 1.13 / 2.26 mg; dye iron oxide yellow - 0.02 / 0.04 mg.

Pharmacological properties

Lozarel Plus is a combination of losartan (angiotensin II receptor antagonist) and hydrochlorothiazide (thiazide diuretic). The combination of these substances has an additive antihypertensive effect and lowers blood pressure (blood pressure) to a greater extent in comparison with the use of these components as monotherapy.

The antihypertensive effect of Lozarela Plus lasts for 24 hours, the maximum therapeutic effect is usually achieved within four weeks of administration.

Pharmacodynamics

Losartan

Losartan is a specific angiotensin II receptor antagonist (type AT1). After taking it, angiotensin II selectively binds to AT1 receptors, which are located in different tissues (in the adrenal glands, vascular smooth muscle cells, heart and kidneys), while several important biological functions are performed, including the release of aldosterone and vasoconstriction. Also, angiotensin II stimulates the proliferation of smooth muscle cells.

According to the results of the studies, losartan and its metabolite E-3174, which exhibits pharmacological activity, block all physiological effects of angiotensin II, regardless of the source or the path of its biosynthesis.

Losartan ACE (angiotensin-converting enzyme), which does not inhibit kininase II, and, accordingly, does not interfere with the destruction of bradykinin. Therefore, negative reactions that are indirectly associated with bradykinin (in particular, angioedema) are quite rare. Losartan and its active metabolite have a greater affinity for angiotensin I receptors than for angiotensin II receptors. The active metabolite of losartan is more active than the substance, approximately 10-40 times. Plasma concentrations of losartan and its active metabolite in the blood, as well as the antihypertensive effect of the substance, increase depending on the dose of Lozarela Plus. Since losartan and its active metabolite are among the angiotensin II receptor antagonists, they both contribute to the hypotensive effect.

The main effects of losartan and its metabolite E-3174:

decrease in blood pressure and pressure in the pulmonary circulation, decrease in total peripheral vascular resistance and blood concentration of aldosterone;
reduced afterload;
providing a diuretic effect;
preventing the development of myocardial hypertrophy;
increased exercise tolerance in patients with CHF (chronic heart failure);
stabilization of the plasma concentration of urea in the blood.

Both losartan and its active metabolite do not affect autonomic reflexes; they do not have a long-term effect on the plasma concentration of norepinephrine in the blood.

The hypotensive effect (in the form of a decrease in systolic and diastolic blood pressure) after a single oral administration reaches its maximum values in 6 hours, then over 24 hours the effect gradually decreases. The maximum antihypertensive effect develops within 3–6 weeks of therapy.

As established in controlled clinical studies involving patients with mild to moderate severity of primary arterial hypertension, as a result of taking losartan once a day, there is a statistically significant decrease in systolic and diastolic blood pressure. When comparing blood pressure measured 5-6 and 24 hours after ingestion of a single dose of Lozarela Plus, it was found that while maintaining the natural daily rhythm, blood pressure remains low for 24 hours. At the end of the dosing period, the decrease in blood pressure is approximately 70-80% of the effect, which is observed 5-6 hours after oral administration of losartan.

When patients with arterial hypertension stop taking losartan, a sharp increase in blood pressure (withdrawal syndrome) is not observed. The substance, despite a pronounced decrease in blood pressure, does not have a clinically significant effect on the heart rate.

The therapeutic effect of losartan does not depend on the sex and age of the patient.

Hydrochlorothiazide

Hydrochlorothiazide is a thiazide diuretic. Its main effects are a violation of the reabsorption of chlorine, sodium, magnesium and potassium ions in the distal nephron, promoting a delay in the excretion of uric acid and calcium. With an increase in renal excretion of these ions, an increase in the amount of urine is noted (due to osmotic binding of water).

The substance reduces the volume of blood plasma, while the activity of renin in the blood plasma increases and the biosynthesis of aldosterone is enhanced. Hydrochlorothiazide in high doses increases the excretion of bicarbonates, with prolonged use - a decrease in calcium excretion. The hypotensive effect develops due to a decrease in the volume of circulating blood, changes in the reactivity of the vascular wall, a decrease in the pressor effect of vasoconstrictor amines (adrenaline, norepinephrine) and an increase in the depressor effect on the ganglia. The substance has no effect on normal blood pressure. The diuretic effect is observed in 1-2 hours, the maximum effect develops in 4 hours, the duration of the diuretic effect is from 6 to 12 hours.

The therapeutic effect occurs after 3-4 days of administration, but to achieve the optimal antihypertensive effect, it takes 3 to 4 weeks.

Pharmacokinetics

Losartan

After oral administration, losartan is well absorbed from the gastrointestinal tract. Undergoes metabolism during the first passage through the liver by carboxylation with the participation of the cytochrome CYP2C9 isoenzyme, with the formation of an active metabolite. Systemic bioavailability is approximately 33%. Food intake has no effect on this indicator. The time to reach C _max (maximum concentration) of losartan and its active metabolite in the serum after oral administration is 1 and 3-4 hours, respectively.

The substance and its active metabolite bind to blood plasma proteins at a level of more than 99%, mainly albumin. V _d (volume of distribution) is 34 liters. Losartan practically does not penetrate through the blood-brain barrier.

The change in the pharmacokinetic parameters of the substance and its active metabolite after taking up to 200 mg of losartan is linearly dependent on the dose taken.

With the frequency of administration 1 time per day, a significant cumulation of losartan and its metabolite in the blood plasma is not observed. A single use in a daily dose of 100 mg does not cause a significant accumulation of the substance and its metabolite in the blood plasma.

Approximately 4% of the dose of losartan is converted to the active metabolite. After ingestion of ¹⁴ C- labeled losartan, the radioactivity of the circulating blood plasma is primarily associated with the presence of the substance and its active metabolite in it. In about 1% of cases, a low level of losartan metabolism is detected.

Plasma and renal clearance are (respectively): losartan - about 600 and 74 ml / min, its active metabolite - about 50 and 26 ml / min. About 4% of the dose of losartan is excreted unchanged by the kidneys, approximately 6% - as an active metabolite. Plasma concentrations of the substance and its active metabolite decrease polyexponentially with a terminal T _1/2 (half-life) of about 2 and 6-9 hours, respectively. Excretion is carried out by the kidneys and with bile. After taking labeled losartan with ¹⁴ C, approximately 58% of radioactivity is found in feces, 35% in urine.

Against the background of mild and moderate severity of alcoholic cirrhosis of the liver, in comparison with healthy male volunteers, the concentration of losartan and the active metabolite increases 5 and 1.7 times, respectively.

The concentration of losartan in blood plasma with CC (creatinine clearance) above 10 ml / min does not differ from that in the absence of renal dysfunction. In patients on hemodialysis, the AUC value (area under the concentration-time curve) is approximately 2 times higher than in the absence of impaired renal function. Losartan and its active metabolite are not removed by hemodialysis.

In women with arterial hypertension, the values of plasma concentrations of losartan exceed the corresponding values in men by two times, while the concentrations of the active metabolite do not differ in men and women. This pharmacokinetic difference has no clinical significance.

Hydrochlorothiazide

After oral administration, the substance is rapidly absorbed from the gastrointestinal tract (approximately 80%). Its systemic bioavailability is about 70%. Time to reach C _max in blood plasma is 2–5 hours. Binds to blood plasma proteins at 64%; V _d is in the range from 0.5 to 1.1 l / kg.

In the liver, hydrochlorothiazide is not metabolized. It is excreted mainly by the kidneys unchanged (from 95%). With normal renal function, T _1/2 is approximately 6-8 hours.

In patients with impaired renal function, T _1/2 increases, with severe renal failure (in patients with CC less than 30 ml / min) it reaches 20 hours.

Indications for use

Lozarel Plus tablets are prescribed for the treatment of hypertension in patients who are indicated for combination therapy.

Contraindications

Absolute:

severe renal failure (in patients with CC less than 30 ml / min);
severe liver failure (on the Child-Pugh scale more than 9 points);
anuria;
lactase deficiency, malabsorption syndrome and lactose intolerance;
Addison's disease;
symptomatic gout and / or hyperuricemia;
refractory hyper- and hypokalemia, hypercalcemia, refractory hyponatremia;
dehydration, including associated with taking high doses of diuretics;
difficult to control diabetes mellitus;
severe arterial hypotension;
combined therapy with aliskiren and aliskiren-containing drugs in patients with impaired renal function (at a glomerular filtration rate <60 ml / min / 1.73 m ²) and / or diabetes mellitus;
pregnancy and lactation;
age up to 18 years;
individual intolerance to the components of the drug, as well as to drugs that are derivatives of sulfonamide.

Relative (Lozarel Plus is prescribed under medical supervision):

combined therapy with non-steroidal anti-inflammatory drugs (including cyclooxygenase-2 inhibitors);
cerebrovascular insufficiency;
violations of the water and electrolyte balance of the blood, for example, associated with diarrhea or vomiting (hyponatremia, hypomagnesemia, hypochloremic alkalosis);
bilateral stenosis of the renal arteries or stenosis of an artery of a solitary kidney;
renal failure (in patients with CC 30-50 ml / min);
aggravated allergic history and bronchial asthma;
progressive liver disease and hepatic dysfunction (on the Child-Pugh scale less than 9 points);
systemic connective tissue diseases (including systemic lupus erythematosus);
heart failure with life-threatening arrhythmias;
stenosis of the aorta or mitral valve;
acute myopia and secondary angle-closure glaucoma (associated with hydrochlorothiazide);
cardiac ischemia;
hypertrophic obstructive cardiomyopathy;
primary hyperaldosteronism;
conditions after kidney transplantation (no experience of use);
diabetes;
belonging to the Negroid race.

Lozarel Plus, instructions for use: method and dosage

Lozarel Plus tablets are taken orally, regardless of food intake, once a day.

The usual starting and maintenance dose for hypertension is one tablet at a dosage of 12.5 mg + 50 mg.

If after 3-4 weeks of therapy there is no adequate therapeutic effect, a single dose is doubled (maximum).

With a reduced volume of circulating blood (for example, in the case of taking high doses of diuretics), losartan is recommended to be prescribed in an initial daily dose of 25 mg. In this regard, taking Lozarela Plus can be started after discontinuation of diuretic therapy and correction of hypovolemia.

Side effects

In clinical trials with losartan and hydrochlorothiazide, adverse reactions specific to this combination drug were not observed.

Side effects were limited to those that were already known when using the active ingredients of Lozarela Plus as monotherapy. The cumulative incidence of adverse events reported with this combination was comparable to that with placebo.

In general, therapy with a combination of losartan and hydrochlorothiazide is well tolerated. In most cases, adverse reactions were mild, transient and did not lead to the cancellation of Lozarela Plus.

According to the results of controlled clinical trials, in the treatment of essential hypertension, the only adverse reaction associated with the use of Lozarel Plus, the frequency of which exceeded that with the use of placebo more than 1%, was dizziness.

Also, during the research, it was found that in patients with left ventricular hypertrophy and arterial hypertension, the most frequent disorders were: increased fatigue, weakness, systemic / non-systemic dizziness.

In the course of various studies, including post-marketing observation, the following side effects were recorded [> 10% - very often; (> 1% and 0.1% and 0.01% and <0.1%) - rarely; <0.01% - very rare)]:

liver and biliary tract: rarely - hepatitis;
nervous system: often - dizziness;
instrumental / laboratory data: rarely - increased activity of hepatic transaminases, hyperkalemia.

Possible undesirable side reactions from systems and organs due to taking losartan:

digestive system: often - diarrhea, nausea, abdominal pain, dyspepsia; infrequently - hepatic dysfunction, anorexia, xerostomia, toothache, vomiting, hepatitis, flatulence, constipation, gastritis; with an indefinite frequency - pancreatitis;
cardiovascular system: often - tachycardia, palpitations; infrequently - orthostatic hypotension (dose-dependent), marked decrease in blood pressure, arrhythmias (ventricular tachycardia, atrial and ventricular fibrillation, sinus bradycardia, tachycardia), epistaxis, vasculitis, cerebrovascular disorders, angina pectoris, myocardial infarction (II) degree, chest pain;
immune system: infrequently - urticaria, skin rash, exacerbation of gout, itching, hypersensitivity reactions in the form of anaphylactic responses, angioedema, including edema of the tongue and larynx, which causes obstruction of the airways, and / or edema of the lips, face, pharynx; in some cases, angioedema was noted earlier with the use of other drugs, including angiotensin-converting enzyme inhibitors;
respiratory system: often - upper respiratory tract infections, nasal congestion, cough, sinusitis; infrequently - pharyngitis, laryngitis, rhinitis, dyspnea, bronchitis;
nervous system: often - headache, dizziness, insomnia; infrequently - anxiety, drowsiness, peripheral neuropathy, paresthesia, confusion, hypesthesia, anxiety, tremor, depression, ataxia, panic states, vertigo, fainting, ringing in the ears, blurred / blurred vision, migraine, conjunctivitis, taste disturbance, sleep disturbance, and memory;
genitourinary system: infrequently - impotence, decreased libido, nocturia, urge to urinate, impaired renal function, urinary tract infections, renal failure;
musculoskeletal system: often - pain in the legs and back, muscle pain, cramps in the calf muscles, myalgia; infrequently - arthritis, arthralgia, pain in the hip joint, knee, arms, shoulder, muscle weakness, fibromyalgia; with an undefined frequency - rhabdomyolysis;
blood and lymphatic system: infrequently - hemolysis, anemia, eosinophilia, thrombocytopenia, Shenlein-Henoch purpura;
skin / subcutaneous tissue: infrequently - photosensitivity, dry skin, ecchymosis, erythema, alopecia, increased sweating, dermatitis;
instrumental / laboratory data: often - hypoglycemia, hyperkalemia (an increase in the plasma level of potassium to> 5.5 mmol / l); infrequently - an increase in the serum concentration of urea / residual nitrogen and creatinine in the blood; very rarely - hyperbilirubinemia, a moderate increase in the activity of hepatic transaminases (aspartate aminotransferase and alanine aminotransferase); with an undefined frequency - hyponatremia;
general disorders: often - increased fatigue, asthenia, peripheral edema, pain in the chest area; infrequently - fever, swelling of the face; with an uncertain frequency - flu-like symptoms, malaise.

Possible undesirable side reactions from systems and organs due to the intake of hydrochlorothiazide:

cardiovascular system: infrequently - orthostatic hypotension, arrhythmias, vasculitis;
digestive system: infrequently - irritation of the gastric mucosa, cholestatic jaundice, intrahepatic cholestasis, cholecystitis or pancreatitis, diarrhea, vomiting, nausea, spasms, constipation, sialadenitis, anorexia;
urinary system: infrequently - interstitial nephritis, renal failure, impaired renal function;
nervous system: often - headache; infrequently - dizziness, paresthesia, insomnia;
immune system: infrequently - respiratory distress syndrome (including noncardiogenic pulmonary edema and pneumonitis), urticaria, necrotizing vasculitis, purpura, Stevens-Johnson syndrome; rarely - anaphylactic reactions, possibly to shock;
blood and lymphatic system: infrequently - thrombocytopenia, leukopenia, agranulocytosis, aplastic / hemolytic anemia;
organ of vision: infrequently - xanthopsia, temporarily blurry vision; with an uncertain frequency - acute angle-closure glaucoma;
skin and subcutaneous tissue: infrequently - toxic epidermal necrolysis, photosensitivity; with an uncertain frequency - lupus erythematosus;
metabolism and nutrition: infrequently - hypomagnesemia, hypokalemia, hyperglycemia, hyponatremia, glucosuria, hyperuricemia with the development of an attack of gout, hypercalcemia and hypochloremic alkalosis (manifested in the form of xerostomia, feeling of thirst, irregular heart rhythm, changes in the psyche and pain in the mood, seizures muscle, nausea, vomiting, unusual tiredness or weakness; hypochloremic alkalosis can lead to the development of hepatic encephalopathy / hepatic coma); hyponatremia (manifested in the form of confusion, convulsions, lethargy, slowing down of the thinking process, excitability, increased fatigue, muscle cramps); with thiazide therapy, impairment of glucose tolerance is possible, while latent diabetes mellitus may manifest;in the case of high doses, serum lipid concentrations in the blood may increase;
others: infrequently - muscle twitching, decreased potency.

Overdose

The main symptoms of an overdose of the active ingredients of Lozarela Plus:

losartan: tachycardia, marked decrease in blood pressure, bradycardia (associated with vagal stimulation);
hydrochlorothiazide: loss of electrolytes (in the form of hypokalemia, hyperchloremia, hyponatremia), as well as dehydration due to excessive diuresis; in the case of simultaneous administration with cardiac glycosides, hypokalemia can lead to an aggravation of the course of arrhythmias.

Therapy: supportive and symptomatic. If a little time has passed since the reception, you need to rinse the stomach; according to indications, correction of water-electrolyte disturbances is carried out. Losartan and its active metabolites are not removed by hemodialysis.

special instructions

Losartan

Drugs that affect the RAAS (renin-angiotensin-aldosterone system) in patients with bilateral renal artery stenosis or stenosis of a solitary kidney artery may increase the concentration of blood urea and serum creatinine. Such effects have been reported with losartan. These renal dysfunctions were reversible and disappeared after discontinuation of therapy. There is evidence that in some patients taking the drug, due to suppression of the RAAS function, reversible changes in renal function, including renal failure, occurred.

As with the use of other drugs with an antihypertensive effect, as a result of an excessive decrease in blood pressure in ischemic cardiovascular and cerebrovascular diseases, myocardial infarction and stroke may develop.

In patients with heart failure with / without impaired renal function, acute renal failure and a decrease in blood pressure may develop.

Like other angiotensin II receptor antagonists, losartan is less effective in black patients due to low renin activity.

Patients after kidney transplantation have no experience with losartan.

Hydrochlorothiazide

As with any other drugs with an antihypertensive effect, with hydrochlorothiazide therapy, in some cases, symptomatic arterial hypotension may develop. The condition of patients should be monitored for the timely detection of clinical symptoms of violations of water and electrolyte balance, in particular, hyponatremia, dehydration, hypochloremic metabolic alkalosis, hypokalemia or hypomagnesemia, which may occur against the background of vomiting or intercurrent diarrhea. Such patients require monitoring of serum electrolytes in the blood.

The use of thiazides can lead to the development of impaired glucose tolerance. Some patients may need to change the dose of hypoglycemic drugs, including insulin.

Thiazide therapy can cause a decrease in the excretion of calcium by the kidneys and, as a result, a slight and episodic increase in serum calcium in the blood. In the case of severe hypercalcemia, it is logical to assume the presence of latent hyperparathyroidism.

Since hydrochlorothiazide affects calcium metabolism, the results of the study of the function of the parathyroid glands may be distorted while taking it. In this regard, before carrying out hormonal studies to determine the level of parathyroid hormone in the blood, the thiazide drug must be canceled.

Thiazide diuretic therapy can lead to an increase in serum cholesterol and triglyceride concentrations.

In some cases, taking hydrochlorothiazide causes hyperuricemia and / or an exacerbation of gout. In the presence of such conditions, a diuretic is contraindicated. However, the use of losartan helps to reduce the concentration of uric acid, therefore, with the combined use of these substances, a decrease in the severity of hyperuricemia caused by hydrochlorothiazide is noted.

Hypersensitivity reactions in patients receiving thiazide diuretics can be observed even in the absence of a burdened history of allergies or bronchial asthma. While taking hydrochlorothiazide, an exacerbation or progression of systemic lupus erythematosus may occur.

In the case of progressive liver diseases or violations of hepatic function, intrahepatic cholestasis may appear, in which minor changes in the water-electrolyte balance can lead to the development of hepatic coma. In these patients, a thiazide diuretic should be administered under medical supervision.

Hydrochlorothiazide can lead to an idiosyncratic reaction and, as a consequence, to acute angle-closure glaucoma and acute transient myopia. The main symptoms are a sudden decrease in visual acuity or pain in the eyes. As a rule, these signs appear within a few hours to a week from the moment you start taking the drug. If untreated, the consequence of acute angle-closure glaucoma can be complete loss of vision. In such cases, immediate withdrawal of hydrochlorothiazide is indicated. If intraocular pressure cannot be controlled, urgent surgery or medication may be required. The main risk factors for the development of acute angle-closure glaucoma are allergic reactions to penicillin or sulfonamides in history.

Antihypertensive drugs acting through inhibition of the RAAS are usually ineffective in patients with primary hyperaldosteronism; therefore, hydrochlorothiazide is not prescribed to them.

Influence on the ability to drive vehicles and complex mechanisms

When driving vehicles, especially at the beginning of the use of Lozarela Plus and when increasing the dose, patients should be careful.

Application during pregnancy and lactation

Lozarel Plus is not prescribed during pregnancy / lactation.

When using the drug in the II-III trimesters of pregnancy, it is possible to harm the developing fetus, in some cases, therapy can cause its death. The risk of the following disorders in the fetus also increases: embryonic jaundice and neonatal jaundice. The mother may develop thrombocytopenia. Lozarel Plus should be canceled immediately after pregnancy is confirmed.

When assessing the benefits and risks of using Lozarel Plus in lactating women, it should be taken into account that thiazides are excreted in breast milk, and the safety profile of losartan has not been studied. If it is necessary to use Lozarela Plus, breastfeeding should be interrupted.

Pediatric use

The safety profile for patients under 18 years of age has not been studied, therefore Lozarel Plus is not assigned to this group of patients.

With impaired renal function

In patients with severe renal insufficiency (CC less than 30 ml / min), drug therapy is contraindicated.

In case of moderate renal failure (CC 30-50 ml / min), Lozarel Plus is prescribed with caution.

Correction of the initial dose in patients with moderate renal insufficiency, including those on dialysis, is not required.

For violations of liver function

Patients with severe hepatic impairment (on the Child-Pugh scale of more than 9 points) are contraindicated in therapy with this combined antihypertensive agent.

With progressive liver disease and hepatic dysfunction less than 9 points on the Child's scale - Pugh Lozarel Plus is used under medical supervision.

Use in the elderly

Elderly patients do not need to adjust the initial dose of Lozarela Plus.

Drug interactions

With simultaneous use with losartan:

potassium-sparing diuretics (triamterene, spironolactone, amiloride), potassium-containing supplements or potassium salts: serum potassium in the blood increases;
fluconazole and rifampicin: the plasma concentration of the active metabolite of losartan decreases (clinical significance is unknown); it has been shown that in patients who do not metabolize losartan into an active metabolite, there is a specific and very rare defect of the P450 2C9 isoenzyme;
nonsteroidal anti-inflammatory drugs, including selective inhibitors of cyclooxygenase-2, acetylsalicylic acid in a daily dose of 3000 mg or more: reduce the effectiveness of losartan;
non-steroidal anti-inflammatory drugs: possibly impaired renal function, including increased plasma potassium and acute renal failure, especially in the presence of reduced renal function; this disorder is usually reversible; if necessary, combined use in such patients requires caution;
angiotensin-converting enzyme inhibitors: the incidence of fainting, arterial hypotension, hyperkalemia and impaired renal function (including with the onset of acute renal failure) increases in patients with atherosclerosis, diabetes mellitus or heart failure; the question of using a combination of these funds should be decided individually, in the case of prescribing a combination, regular monitoring of renal function is required;
lithium: the concentration of lithium in the blood plasma may increase; before prescribing this combination, it is necessary to assess the benefits and harms, if necessary, combined use during the period of therapy requires monitoring the plasma concentration of lithium in the blood;
antihypertensive drugs (diuretics, beta-blockers, sympatholytics): the effect of drugs is mutually reinforced;
diuretics: there is a high probability of an additive effect;
antipsychotics, tricyclic antidepressants, amifostine, baclofen (drugs that lower blood pressure): the risk of developing arterial hypotension increases.

With simultaneous use with hydrochlorothiazide:

barbiturates, narcotic analgesics, ethanol: the risk of developing orthostatic hypotension increases;
lithium preparations: the combination is not recommended, since against the background of taking diuretics, the renal clearance of lithium decreases and the risk of its toxic effect increases;
pressor amines (norepinephrine, epinephrine): the effect of pressor amines is slightly reduced, which does not prevent their appointment;
non-depolarizing muscle relaxants (tubocurarine): their effect is enhanced;
glucocorticosteroids, adrenocorticotropic hormone: electrolyte loss may increase, hypokalemia may worsen;
cytotoxic drugs: the renal excretion of these drugs may decrease, the myelosuppressive effect may increase;
hypoglycemic agents (for oral administration and insulin): it may be necessary to adjust their dose;
metformin: the combination requires caution, since there is a possibility of lactic acidosis associated with possible renal failure due to hydrochlorothiazide intake;
antihypertensive drugs: additive effect;
colestipol, cholestyramine: there is a violation of the absorption of hydrochlorothiazide;
amphotericin B (intravenous), glycyrrhizic acid (found in licorice root), laxatives: the risk of hypokalemia increases;
probenecid, allopurinol, sulfinpyrazone (drugs for the treatment of gout): it may be necessary to adjust their dose, this is due to an increase in the serum concentration of uric acid in the blood due to hydrochlorothiazide; an increase in the incidence of hypersensitivity reactions to allopurinol is possible; gout and / or hyperuricemia are contraindications for taking hydrochlorothiazide;
anticholinergic drugs (biperiden, atropine): the bioavailability of hydrochlorothiazide increases, which is associated with a decrease in gastrointestinal motility and the rate of gastric emptying;
cytotoxic agents (methotrexate, cyclophosphamide): renal excretion of these agents is reduced;
salicylates (in high doses): their toxic effect on the central nervous system increases;
methyldopa: there are reports of the development of hemolytic anemia;
cyclosporine: the likelihood of developing hyperuricemia and exacerbation of the course of gout increases;
cardiac glycosides: the risk of developing cardiac arrhythmias increases, which is associated with hypokalemia or hypomagnesemia due to the intake of hydrochlorothiazide;
drugs that affect the serum potassium content in the blood (antiarrhythmic drugs, cardiac glycosides), drugs that can lead to the development of ventricular tachycardia such as pirouette (including some antiarrhythmic drugs): monitoring of the ECG and potassium content in the blood serum is necessary;
class IA and III antiarrhythmics (hydroquinidine, quinidine, disopyramide, amiodarone, dofetilide, sotalol, ibutilide), some antipsychotics (chlorpromazine, cyamemazine, trifluoroperazine, sulpiride, tiapride, amisulpride, haloperidol, pimozide, thiopride, dultoprizine) other drugs (bepridil, diphemanil, mizolastine, cisapride, intravenous erythromycin, halofantrine, pentamidine, intravenous vincamycin, terfenadine): the combination requires caution, which is associated with the risk of hypokalemia;
calcium preparations: regular monitoring of serum calcium in the blood and dose adjustment of these drugs is necessary, which is associated with the likelihood of an increase in serum calcium due to hydrochlorothiazide;
carbamazepine: symptomatic hyponatremia may develop; monitoring of serum sodium in the blood is recommended;
iodine-containing drugs in high doses: the risk of developing acute liver failure increases, rehydration should be carried out before iodine drugs are prescribed.

Analogs

Lozarela Plus analogs are Lorista N, Losartan-N, Prezartan N, Simartan-N, etc.

Terms and conditions of storage

Store at temperatures up to 25 ° C. Keep out of the reach of children.

Shelf life is 2 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Lozarelle Plus

Reviews about Lozarelle Plus are few. Most of them characterize the drug as highly effective. The development of side effects is rarely reported.

The price of Lozarel Plus in pharmacies

Approximate price for Lozarel Plus for 30 tablets per package, depending on the dosage:

12.5 mg + 50 mg - 231-312 rubles;
25 mg + 100 mg - 303–356 rubles.

Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!