Pharmacy No. 84. Delivery of medicines to your home and office.

Delivery on Sundays and holidays does not work!

Medicines

my basket

Apteka84.kz is an online pharmacy that offers its customers medicines, medicinal and decorative cosmetics, dietary supplements, vitamins, baby food, intimate products for adults, medical equipment and thousands of other medical and cosmetic products at low prices. All data presented on the Apteka84.kz website is for informational purposes only and is not a substitute for professional medical care. Apteka84.kz strongly recommends that you carefully read the instructions for use contained in each package of medicines and other products. If you currently have any symptoms of the disease, you should seek help from a doctor. You should always tell your doctor or pharmacist about all the medicines you take. If you feel you need further help, please consult your local pharmacist or contact our GP online or by telephone.

Instructions for use of LORISTA® H

Losartan

Caution is required when using the drug in patients with a history of angioedema (swelling of the face, lips, pharynx and/or tongue).

In patients with hypovolemia and/or hyponatremia (due to intensive diuretic therapy, low sodium diet, diarrhea or vomiting), hypotension may occur, especially after the first dose. These conditions require correction before starting treatment with the drug.

Electrolyte imbalances are common in patients with renal failure, especially those with diabetes mellitus. Thus, during treatment, the concentration of potassium in the blood plasma and CC should be monitored (in particular, in patients with CC 30-50 ml/min).

Lorista® N should be administered with caution to patients with a history of mild to moderate liver dysfunction. Since there are no data on the therapeutic use of losartan in patients with severe liver failure, Lorista® N is contraindicated in this category of patients.

As a result of suppression of the RAAS, renal dysfunction, including renal failure, was observed (in particular, in patients with dependence of renal function on the RAAS - patients with severe heart failure or chronic renal failure).

As is the case with other drugs acting on the RAAS, increased concentrations of urea and creatinine were observed in patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney. These changes are reversible upon cessation of therapy.

Losartan should be used with caution in patients with bilateral renal artery stenosis or stenosis of the artery of a solitary kidney.

There are no data on the use of the drug in patients who have undergone kidney transplantation.

Patients with primary hyperaldosteronism generally do not respond to antihypertensive drugs that suppress the RAAS. Therefore, the use of the losartan/hydrochlorothiazide combination is not recommended.

As with other antihypertensive drugs, a significant decrease in blood pressure in patients with coronary artery disease and cerebrovascular disease can lead to myocardial infarction or stroke.

Patients with heart failure (with or without renal failure) are at increased risk of developing severe hypotension and renal failure (often acute).

As with the use of other vasodilators, extreme caution should be taken when prescribing the drug to patients with aortic stenosis, mitral valve stenosis and obstructive hypertrophic cardiomyopathy.

It has been shown that ACE inhibitors, losartan and other angiotensin II receptor antagonists have a significantly less hypotensive effect when used in blacks. Perhaps this circumstance is explained by the fact that this category of patients often has low levels of renin in the blood.

Dual blockade of the RAAS is associated with an increased risk of hypotension, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy. Dual blockade of the RAAS using an ACE inhibitor, an angiotensin II receptor antagonist, or aliskiren cannot be recommended in any patient, especially in patients with diabetic nephropathy. In some cases, when the combined use of an ACE inhibitor and an angiotensin II receptor antagonist is absolutely indicated, careful supervision by a specialist and mandatory monitoring of renal function, water-electrolyte balance, and blood pressure are necessary. This applies to the use of candesartan or valsartan as adjunctive therapy to ACE inhibitors in patients with chronic heart failure. Carrying out double blockade of the RAAS under the careful supervision of a specialist and mandatory monitoring of renal function, water-electrolyte balance and blood pressure is possible in patients with chronic heart failure with intolerance to aldosterone antagonists (spironolactone), who have persistence of symptoms of chronic heart failure, despite other adequate therapy .

Hydrochlorothiazide

As with other antihypertensive therapy, symptomatic hypotension may occur in some patients. Therefore, the patient should be constantly monitored for clinical signs of fluid and electrolyte imbalance (hypovolemia, hyponatremia, hypochloremic alkalosis, hypomagnesemia or hypokalemia), for example, after diarrhea or vomiting. In such patients, plasma electrolytes should be regularly monitored. Patients with edema in hot weather may experience dilutional hyponatremia.

Therapy with thiazide diuretics can lead to impaired glucose tolerance. Dosage adjustment of antidiabetic agents may be necessary, incl. insulin. When using thiazide diuretics, latent diabetes mellitus can manifest itself.

Thiazide diuretics can reduce the excretion of calcium in the urine and thereby lead to a short-term slight increase in its concentration in the blood plasma. Severe hypercalcemia may indicate hidden hyperparathyroidism. Before testing the function of the parathyroid glands, thiazide diuretics should be discontinued.

Increases in cholesterol and triglycerides in the blood may be associated with the use of thiazide diuretics.

In some patients, therapy with thiazide diuretics may provoke hyperuricemia and/or an attack of gout. Since losartan reduces the concentration of uric acid, its combination with hydrochlorothiazide reduces the likelihood of hyperuricemia associated with the use of diuretics.

In patients with liver failure or progressive liver disease, thiazide diuretics should be used with caution, because they can cause intrahepatic cholestasis, and minor changes in water and electrolyte balance can trigger the development of hepatic coma. Lorista® N is contraindicated in patients with severe liver failure.

Patients taking thiazide diuretics may experience hypersensitivity reactions, regardless of a history of allergies or bronchial asthma.

There are reports of exacerbation or recurrence of systemic lupus erythematosus with the use of thiazide diuretics.

Lorista® N

Lorista® N contains lactose and is therefore contraindicated in patients with rare hereditary diseases such as galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption.

Impact on the ability to drive vehicles and operate machinery

When carrying out antihypertensive therapy, dizziness and drowsiness sometimes occur, especially at the beginning of treatment or when increasing the dose, so care should be taken when carrying out activities that require increased attention and speed of psychomotor reactions (driving vehicles, working with complex mechanisms).

Lorista N 100, 90 pcs., 12.5 mg+100 mg, film-coated tablets

The pharmacokinetics of losartan and hydrochlorothiazide when used simultaneously does not differ from that when used in monotherapy.

Losartan

Absorption

Losartan is well absorbed from the gastrointestinal tract (GIT) when taken orally. It undergoes significant metabolism during the “primary passage” through the liver, forming a pharmacologically active carboxylated metabolite (E-3174) and inactive metabolites. Bioavailability is approximately 33%. Average maximum concentrations of losartan and its active metabolite are achieved after 1 hour and after 3-4 hours, respectively.

Distribution

Losartan and its active metabolite are more than 99% bound to plasma proteins (mainly albumin). The volume of distribution of losartan is 34 liters. It penetrates the blood-brain barrier very poorly.

Metabolism

Losartan is metabolized to form an active (E-3174) metabolite (14%) and inactive ones, including two major metabolites formed by hydroxylation of the butyl group of the chain and a less significant metabolite, N-2-tetrazole glucuronide.

Removal

Plasma clearance of losartan and its active metabolite is approximately 10 ml/sec (600 ml/min) and 0.83 ml/sec (50 ml/min), respectively. The renal clearance of losartan and its active metabolite is approximately 1.23 ml/sec (74 ml/min.) and 0.43 ml/sec (26 ml/min.). The half-life (T1/2) of losartan and the active metabolite is 2 hours and 6-9 hours, respectively. It is excreted mainly with bile through the intestines - 58%, by the kidneys - 35%. Does not accumulate.

When taken orally in doses up to 200 mg, losartan and its active metabolite have linear pharmacokinetics.

Hydrochlorothiazide

After oral administration, absorption of hydrochlorothiazide is 60-80%. The maximum concentration in blood plasma is achieved 1-5 hours after oral administration. Connection with blood plasma proteins - 64%.

Hydrochlorothiazide is not metabolized and is rapidly excreted through the kidneys. T1/2 is 5-15 hours. At least 61% of the dose taken orally is excreted unchanged within 24 hours.

Penetrates the placental barrier and is excreted in breast milk. Pharmacokinetics in selected patient groups

Losartan + hydrochlorothiazide

Elderly patients

The concentrations of losartan and its active metabolite in the blood plasma and the rate of absorption of hydrochlorothiazide in elderly patients with arterial hypertension do not differ significantly from these indicators in young patients with arterial hypertension.

Losartan

Plasma concentrations of losartan were 2 times higher in women with hypertension compared with men with hypertension. This pharmacokinetic difference is not clinically significant. The concentration of the active metabolite does not differ between men and women.

Liver and kidney dysfunction

When losartan was taken orally by patients with mild and moderate alcoholic cirrhosis, the concentrations of losartan and its active metabolite in the blood plasma were, respectively, 5 - 1.7 times higher than in young male volunteers.

Plasma concentrations of losartan in patients with creatinine clearance (CC) above 10 ml/min did not differ from those in patients with preserved renal function. When comparing the area under the concentration-time curve (AUC) in patients with normal renal function, the AUC of losartan in patients on hemodialysis was approximately 2 times greater. Plasma concentrations of the active metabolite do not change in patients with impaired renal function or patients on hemodialysis. Losartan and its active metabolite cannot be removed by hemodialysis.

Lorista® h 100 (Lorista® h 100)

Losartan

Renal dysfunction

With the use of losartan, reversible impairment of renal function is possible, including renal failure, which disappears after discontinuation of losartan. Drugs that affect the RAAS may lead to increased plasma urea and creatinine concentrations in patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney. These changes in renal function may be reversible and disappear after discontinuation of therapy. In patients with impaired renal function who have been treated with NSAIDs (including COX-2 inhibitors), therapy with angiotensin II receptor antagonists may lead to further worsening of impaired renal function, including acute renal failure, which is usually reversible, and may also increase plasma potassium concentrations in patients with pre-existing renal impairment. This combination is recommended to be used with caution, especially in elderly patients. Patients should receive sufficient fluids and have their renal function monitored before and after starting treatment with Lorista® N 100.

Hydrochlorothiazide

Arterial hypotension and water-electrolyte imbalance

As with any antihypertensive drug, patients may experience symptomatic hypotension. Patients should be monitored for clinical signs of fluid and electrolyte disturbances, such as dehydration, hyponatremia, hypochloremic alkalosis, hypomagnesemia or hypokalemia, which may develop with concomitant diarrhea or vomiting. In such patients, it is necessary to monitor the content of electrolytes in the blood plasma.

Metabolic and endocrine effects

Thiazide diuretic therapy may impair glucose tolerance. In some cases, dose adjustments of oral hypoglycemic agents and/or insulin may be required.

Thiazides may reduce renal excretion of calcium and cause a short-term and slight increase in plasma calcium concentrations. Severe hypercalcemia may indicate latent hyperparathyroidism.

Due to the effect of thiazides on calcium metabolism, their use may distort the results of testing the function of the parathyroid glands, therefore, before testing the function of the parathyroid glands, the thiazide diuretic should be discontinued.

Increased blood cholesterol and triglyceride concentrations may also be associated with thiazide diuretic therapy.

In some patients, the use of thiazide diuretics may lead to hyperuricemia and/or the development of gout. Since losartan reduces uric acid concentrations, its combination with hydrochlorothiazide reduces the severity of diuretic-induced hyperuricemia.

Acute attack of angle-closure glaucoma

Hydrochlorothiazide is a sulfonamide that can cause an idiosyncratic reaction leading to an acute attack of angle-closure glaucoma.

Symptoms: sudden decrease in visual acuity or eye pain, which usually appears within a few hours or weeks of starting hydrochlorothiazide therapy. If left untreated, an acute attack of angle-closure glaucoma can lead to permanent vision loss.

Treatment: Stop taking hydrochlorothiazide immediately. If intraocular pressure remains uncontrolled, emergency medication or surgery may be required.

Risk factors for developing an acute attack of angle-closure glaucoma are a history of an allergic reaction to sulfonamide or benzylpenicillin.

Other effects

In patients receiving thiazide diuretics, hypersensitivity reactions can be observed even in the absence of a history of indications of allergic reactions or bronchial asthma. There are reports of exacerbation or progression of systemic lupus erythematosus during the use of thiazide diuretics.

Excipients

It should be taken into account that the excipients of the drug Lorista® N 100 include lactose monohydrate, therefore the drug is contraindicated in patients with lactase deficiency, lactose intolerance, and glucose-galactose malabsorption syndrome.

Impact on the ability to drive vehicles and operate machinery

For patients

Care must be taken when driving vehicles and working with other technical devices that require increased concentration and speed of psychomotor reactions.