Initial treatment: Hydrochlorothiazide 12.5 mg-Losartan 50 mg orally once a day; if blood pressure remains uncontrolled after 2 to 4 weeks, may initiate maximum dose. However, rifampin has been shown to decrease the AUC of losartan and its active metabolite by 30% and 40%, respectively. Precautions. Sections. commonly, these are generic drugs. Losartan/HCTZ is contraindicated in patients with severe hepatic impairment (see section 4.3.). Maximum dose: Hydrochlorothiazide 25 mg-Losartan 100 mg orally once a day Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert. Usual Adult Dose of Losartan for Diabetic Nephropathy: Initial dose: 50 mg orally once a day. Comments: -If hypertensive patients with left ventricular hypertrophy or type 2 diabetic nephropathy patients require titration from initial dose, increase to 100 mg orally once a day. Does Losartan-Hydrochlorothiazide Interact with other Medications? Losartan is excreted in the urine, and in the feces via bile, as unchanged drug and metabolites. /viewarticle/942382 The amount of medicine that you take depends on the strength of the medicine. Child dosage (ages 6–17 years) The dosage is based on your child’s weight. Merck & Co., Inc. Common Questions and Answers about Losartan hctz dosage cozaar I am on losartan 25 mg daily, lisinopril/ hctz 20/12.5 daily and metroprolol 50mg at night. Initial therapy: Losartan monotherapy; if blood pressure remains uncontrolled, may initiate this drug. Helmer A, Slater N, Smithgall S. … Losartan/hydrochlorothiazide, sold under the trade name Hyzaar among others, is a combination medication used to treat high blood pressure when losartan is not sufficient. Comments: Use: Treatment of hypertension. Severe Interactions. If dose titrated upward, not to exceed final titration of 100 mg/25 mg PO qDay or 50 mg/12.5 mg PO q12hr, Decrease losartan to 25 mg PO qDay initially if volume depleted, Treat with losartan monotherapy; if reduction in blood pressure inadequate, initiate losartan /hydrochlorothiazide, Initial: 50 mg/12.5 mg PO qDay; may increase to 100 mg/12.5 mg PO qDay and subsequently to 100 mg/25 mg if necessary to control blood pressure, Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death (see Pregnancy & Lactation), Hypersensitivity to losartan, hydrochlorothiazides, or sulfonamides, Coadministration with aliskiren in patients with diabetes, In patients with activated renin-angiotensin system, such as volume-or salt-depleted patients (eg, those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of treatment; correct volume or salt depletion prior to administration; do not use drug combination as initial therapy in patients with intravascular volume depletion, Stroke risk reduction may be less effective in African-Americans, Intravascular volume or salt depletion should be corrected prior to use, Monitor serum lithium levels in patients receiving lithium and hydrochlorothiazide, Inform female patients of childbearing age about consequences of exposure to losartan during pregnancy and importance of informing their physician about a pregnancy while on therapy; discontinue if pregnancy detected, Monitor for signs of fluid or electrolyte imbalance, including hyponatremia, hypomagnesemia, hypochloremic alkalosis, and hypokalemia, Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides, If oliguria or hypotension occurs in neonate with history of in utero exposure, direct attention toward support of blood pressure and renal perfusion; exchange transfusions or dialysis may be required as a means of reversing hypotension and/or substituting for disordered renal function, Acute transient myopia and acute angle-closure glaucoma have been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide), Coadministration with corticosteroids, ACTH, or glycyrrhizin (found in liquorice) may intensify electrolyte depletion, particularly hypokalemia, Monitor renal function and potassium in susceptible patients, Exacerbation of systemic lupus erythematosus reported, Dual blockade of the renin-angiotensin-aldosterone system (ie, ARB plus an ACE inhibitor) in patients with established atherosclerotic disease, heart failure, or with diabetes with end organ damage is associated with a higher frequency of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) as compared with use of a single renin-angiotensin-aldosterone system agent; closely monitor blood pressure, renal function and electrolytes in patients on losartan and other agents that affect the renin-angiotensin system (RAS), Hyperuricemia may occur or frank gout may be precipitated in patients receiving thiazide therapy; because losartan decreases uric acid, losartan in combination with hydrochlorothiazide attenuates diuretic-induced hyperuricemia, Hydrochlorothiazide decreases urinary calcium excretion and may cause elevations of serum calcium; monitor calcium levels, Concomitant use of other drugs that may increase serum potassium may lead to hyperkalemia, Photosensitivity reported; instruct patients to protect skin from sun and undergo regular skin cancer screening, Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on renin-angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death, Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in first trimester have not distinguished drugs affecting renin-angiotensin system from other antihypertensive agents; when pregnancy is detected, discontinue therapy as soon as possible, Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (eg, need for cesarean section, post-partum hemorrhage), Hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly, Not known whether losartan is excreted in human milk, but significant levels of losartan and its active metabolite were shown to be present in rat milk; thiazides appear in human milk; because of potential for adverse effects on nursing infant, a decision should be made whether to discontinue nursing or discontinue drug, taking into account importance of drug to mother. 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