Mechanism of Action
Losartan: As a selective and competitive, nonpeptide angiotensin II receptor antagonist, losartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; Losartan increases urinary flow rate and in addition to being natriuretic and kaliuretic, increases excretion of chloride, magnesium, uric acid, calcium, and phosphate.
Hydrochlorothiazide: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions.
Pharmacokinetics
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Contraindications
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Hypersensitivity to Losartan, Hydrochlorothiazide, or sulfonamides
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Anuria
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Coadministration with Aliskiren in patients with diabetes
Adverse Reactions
Fatigue, Hypoglycemia, Chest pain, Cough, Diarrhea, URI, Hypotension, Dizziness, Nausea, Hypotension, Anorexia, Epigastric distress, Hypokalemia, Phototoxicity, Thrombocytopenia
Major Drug Interactions
Aliskiren - Sparsentan
Warnings
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Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death
Recommendations for Patient
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Pregnancy Considerations
Category: D
Breastfeeding Considerations
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.
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: Maybe acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
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