Lorista ND tablets p/o 100mg/25mg №10×3

Name:
Lorista ND 100mg25mg
Description:
Lorista® ND is a combination of an angiotensin II receptor antagonist (losartan) and a diuretic (hydrochlorothiazide). Angiotensin II is a substance produced in the body that binds to receptors in blood vessels, causing them to constrict. This leads to an increase in blood pressure. Losartan prevents angiotensin II from binding to these receptors, causing blood vessels to relax, which in turn lowers blood pressure. Hydrochlorothiazide acts on the kidneys, causing them to pass more water and salt. It also helps lower blood pressure. Lorista® ND is intended for the treatment of arterial hypertension (high blood pressure). The main active ingredient Losartan + hydrochlorothiazide Release form: film-coated tablets Dosage 100 mg + 25 mg Drugs that act on the RAAS can lead to an increase in the concentration of urea and creatinine in the blood plasma in patients with bilateral renal artery stenosis or stenosis of the artery to a single kidney. These changes in renal function may be reversible and disappear after discontinuation of therapy. In patients with impaired renal function treated with NSAIDs (including COX-2 inhibitors), therapy with angiotensin II receptor antagonists may lead to further worsening of renal dysfunction, including acute renal failure, which is usually reversible, as well as increase the concentration of potassium in the blood plasma in patients with pre-existing renal impairment. This combination is recommended to be used with caution, especially in elderly patients. Patients should receive adequate fluids and monitor renal function before and after starting treatment with this combination. Patients should be monitored for early detection of clinical signs of fluid and electrolyte disturbances, such as dehydration, hyponatremia, hypochloremic alkalosis, hypomagnesemia, or hypokalemia, which may develop in the presence of concomitant diarrhea or vomiting. In such patients, it is necessary to control the content of electrolytes in the blood plasma. Therapy with thiazide diuretics may impair glucose tolerance. In some cases, it may be necessary to adjust the doses of hypoglycemic agents for oral administration and / or insulin. Thiazides can reduce the excretion of calcium by the kidneys and cause a short-term and slight increase in the concentration of calcium in the blood plasma. Severe hypercalcemia may indicate latent hyperparathyroidism. Due to the effect of thiazides on calcium metabolism, their use can distort the results of the study of parathyroid function, therefore, before examining the function of the parathyroid glands, the thiazide diuretic should be canceled. An increase in the concentration of cholesterol and blood triglycerides can also be associated with thiazide diuretic therapy. In some patients, the use of thiazide diuretics can lead to hyperuricemia and / or the development of gout. Since losartan reduces the concentration of uric acid, its combination with hydrochlorothiazide reduces the severity of diuretic-induced hyperuricemia. Hydrochlorothiazide is a sulfonamide that can cause an idiosyncratic reaction leading to the development of an acute attack of angle-closure glaucoma. In patients receiving thiazide diuretics, hypersensitivity reactions may occur even in the absence of a history of indications of allergic reactions or bronchial asthma. There are reports of the development of exacerbation or progression of systemic lupus erythematosus against the background of the use of thiazide diuretics. Influence on the ability to drive vehicles and mechanisms Care must be taken when driving vehicles and working with other technical devices that require increased concentration and speed of psychomotor reactions. Pharmacological action Combined antihypertensive agent. Losartan and hydrochlorothiazide have an additive antihypertensive effect, lowering blood pressure to a greater extent than either of the components separately. Losartan is a selective angiotensin II receptor (type AT1) antagonist for oral administration. In vivo and in vitro, losartan and its pharmacologically active metabolite E-3174 block all physiologically significant effects of angiotensin II on AT1 receptors, regardless of the route of its synthesis: it leads to an increase in plasma renin activity, reduces the concentration of aldosterone in blood plasma. Losartan indirectly causes the activation of AT2 receptors by increasing the concentration of angiotensin II. Does not inhibit the activity of kininase II, an enzyme that is involved in the metabolism of bradykinin. Reduces peripheral vascular resistance, pressure in the pulmonary circulation, reduces afterload on the myocardium, has a diuretic effect. Prevents the development of myocardial hypertrophy, increases exercise tolerance in patients with chronic heart failure (CHF). Taking losartan 1 time / day leads to a statistically significant decrease in systolic and diastolic blood pressure. Losartan evenly controls blood pressure throughout the day, while the antihypertensive effect corresponds to the natural circadian rhythm. The decrease in blood pressure at the end of the dose of the drug was approximately 70-80% of the maximum effect of losartan, 5-6 hours after ingestion. There is no withdrawal syndrome. Losartan has no clinically significant effect on heart rate, has a moderate and transient uricosuric effect. Hydrochlorothiazide is a thiazide diuretic, the diuretic effect of which is associated with impaired reabsorption of sodium, chlorine, potassium, magnesium, and water ions in the distal nephron; delays the excretion of calcium ions, uric acid. It has an antihypertensive effect, the action of which develops due to the expansion of arterioles. Virtually no effect on normal blood pressure. The diuretic effect occurs after 1-2 hours, reaches a maximum after 4 hours and lasts 6-12 hours. The maximum antihypertensive effect occurs after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect. Due to the diuretic effect, hydrochlorothiazide increases plasma renin activity, stimulates the secretion of aldosterone, increases the concentration of angiotensin II and reduces the concentration of potassium in the blood plasma. Taking losartan blocks all physiological effects of angiotensin II and, due to the suppression of the effects of aldosterone, may help reduce the loss of potassium associated with taking a diuretic. Hydrochlorothiazide causes a slight increase in the concentration of uric acid in the blood; the combination of losartan and hydrochlorothiazide helps to reduce the severity of diuretic-induced hyperuricemia. Pharmacokinetics The pharmacokinetics of losartan and hydrochlorothiazide with simultaneous use does not differ from that when they are used in monotherapy. Losartan After oral administration, losartan is well absorbed from the gastrointestinal tract. It undergoes significant metabolism during the “first pass” through the liver, forming a pharmacologically active carboxylated metabolite (E-3174) and inactive metabolites. Bioavailability is approximately 33%. The average Cmax of losartan and its active metabolite are reached after 1 hour and after 3-4 hours, respectively. Losartan and its active metabolite are more than 99% bound to plasma proteins (mainly albumin). Vd losartan is 34 liters. It penetrates very poorly through the BBB. Losartan is metabolized with the formation of an active (E-3174) metabolite (14%) and inactive, including two main metabolites formed by hydroxylation of the butyl group of the chain and a less significant metabolite, N-2-tetrazolglucuronide. The 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 about 1.23 ml/sec (74 ml/min) and 0.43 ml/sec (26 ml/min). 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 administered in doses up to 200 mg, losartan and its active metabolite have linear pharmacokinetics. Hydrochlorothiazide After oral administration, the absorption of hydrochlorothiazide is 60-80%. Cmax in blood plasma is achieved 1-5 hours after ingestion. Plasma protein binding – 64%. Penetrates through the placental barrier. It is allocated with breast milk. Hydrochlorothiazide is not metabolized and is rapidly excreted by the kidneys. T1 / 2 is 5-15 hours. At least 61% of the ingested dose is excreted unchanged within 24 hours. Method of application and doses The method of application and the dosing regimen of a particular drug depend on its form of release and other factors. The optimal dosage regimen is determined by the doctor. Compliance of the dosage form of a particular drug with indications for use and dosing regimen should be strictly observed. I take it orally, regardless of food intake. The recommended dose of the combination in terms of losartan is 50-100 mg 1 time / day. The maximum dose is 100 mg 1 time / day. The maximum antihypertensive effect is achieved within 3 weeks of therapy. Application during pregnancy and lactation Use during pregnancy and lactation (breastfeeding) is contraindicated. Interaction with other drugs Simultaneous use with potassium-sparing diuretics (spironolactone, eplerenone, triamterene, amiloride), potassium preparations or potassium-containing table salt substitutes, as well as the use of other drugs that increase the concentration of potassium in the blood plasma, increase the risk of developing hyperkalemia. NSAIDs, incl. selective COX-2 inhibitors may reduce the effect of diuretics and other antihypertensive drugs, including losartan. The antihypertensive effect of losartan, like other antihypertensive drugs, may be reduced when using indomethacin. Double blockade of the RAAS, i.e. adding an ACE inhibitor to an angiotensin II receptor antagonist therapy is possible only in selected cases under close monitoring of renal function. In patients with atherosclerosis, heart failure, or diabetes mellitus with target organ damage, dual blockade of the RAAS (with concomitant use of angiotensin II receptor antagonists, ACE inhibitors, or aliskiren) is accompanied by an increased incidence of arterial hypotension, syncope, hyperkalemia, and renal dysfunction (including acute renal insufficiency) in comparison with the use of the drug of one of the listed groups. Possible decrease in the excretion of lithium ions. Therefore, with the simultaneous use of angiotensin II receptor antagonists with lithium salts, serum lithium concentrations should be carefully monitored. When used simultaneously with thiazide diuretics, drugs such as ethanol, barbiturates and opioid analgesics may potentiate the risk of developing orthostatic hypotension. With simultaneous use, it is possible to increase the hypoglycemic effect of oral hypoglycemic agents (sulfonylurea derivatives) and / or insulin in patients with diabetes mellitus; with such combinations, an increase in glucose tolerance is possible, which may require dose adjustment of hypoglycemic agents for oral administration and / or insulin. With simultaneous use with other antihypertensive drugs – an additive effect. The absorption of hydrochlorothiazide is impaired in the presence of cholestyramine and colestipol. With simultaneous use with GCS, ACTH, there is a pronounced decrease in the content of electrolytes, in particular hypokalemia. There is a decrease in the severity of the therapeutic effect of hydrochlorothiazide against the background of the use of pressor amines (for example, epinephrine (adrenaline), norepinephrine (norepinephrine)). Hydrochlorothiazide enhances the effect of muscle relaxants of a non-depolarizing type of action (for example, tubocurarine chloride). Diuretics reduce the renal clearance of lithium and increase the risk of lithium toxicity. Simultaneous use is not recommended. With simultaneous use with barbiturates, narcotic analgesics, antidepressants, ethanol, the risk of developing orthostatic hypotension increases. Drugs used to treat gout (probenecid, sulfinpyrazone and allopurinol): hydrochlorothiazide can increase the serum concentration of uric acid, so dose adjustment of uricosuric drugs may be required – an increase in the dose of probenecid or sulfinpyrazone. The simultaneous use of thiazide diuretics may increase the frequency of hypersensitivity reactions to allopurinol. Simultaneous use with cyclosporine may increase the risk of developing hyperuricemia and exacerbate the course of gout. Anticholinergics (eg, atropine, biperiden) increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility and gastric emptying rate. Thiazide diuretics can reduce the renal excretion of cytotoxic drugs (cyclophosphamide, methotrexate) and increase their myelosuppressive effect. In the case of the use of salicylates in high doses, hydrochlorothiazide may increase their toxic effects on the central nervous system. There are limited data on the development of hemolytic anemia with the simultaneous use of hydrochlorothiazide and methyldopa. Caused by thiazide diuretics, hypokalemia or hypomagnesemia can lead to the development of arrhythmias against the background of the use of cardiac glycosides. Contraindications Anuria; severe renal failure (CC <30 ml / min); severe liver dysfunction; pregnancy; lactation period (breastfeeding); children and adolescents up to 18 years of age; hypersensitivity to the components of the drug; hypersensitivity to sulfonamide derivatives. With caution Violations of the water and electrolyte balance of the blood (hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), bilateral stenosis of the renal arteries, stenosis of the artery of the only functioning kidney, condition after kidney transplantation, hypercalcemia, hyperuricemia and / or gout, aggravated allergic history, bronchial asthma, systemic connective tissue diseases (including systemic lupus erythematosus), simultaneous use of NSAIDs, including COX-2 inhibitors, diabetes mellitus, impaired liver function, impaired renal function (CC from 30-50 ml / min) , hypovolemia (including against the background of taking diuretics in high doses), an acute attack of angle-closure glaucoma. Composition: potassium hydrochlorothiazide 100 mg 25 mg Excipients: pregelatinized starch, microcrystalline cellulose, lactose monohydrate, magnesium stearate. Shell composition: hypromellose, talc, macrogol 4000, titanium dioxide (E171), quinoline yellow dye (E104). 7 pcs. - blisters (4) - packs of cardboard. 10 pieces. - blisters (3) - packs of cardboard. 10 pieces. - blisters (6) - packs of cardboard. 14 pcs. - blisters (2) - packs of cardboard. 14 pcs. - blisters (4) - packs of cardboard. Side effects From the immune system: rarely - anaphylactic reactions, angioedema (including swelling of the larynx and tongue, causing airway obstruction and / or swelling of the face, lips, pharynx), urticarial rash. On the part of the hematopoietic system: infrequently - anemia, Shenlein-Genoch purpura, ecchymosis, hemolysis, agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, thrombocytopenia. From the nervous system: often - headache, dizziness, insomnia, increased fatigue; infrequently - migraine, anxiety, confusion, depression, sleep disturbances, memory impairment, drowsiness, nervousness, paresthesia, tremor, fainting. From the side of the cardiovascular system: often - orthostatic hypotension (dose-dependent), palpitations, tachycardia; infrequently - AV block II degree, chest pain, myocardial infarction, arrhythmias; rarely - vasculitis. From the respiratory system: often - cough, infections of the upper respiratory tract, sinusitis, swelling of the nasal mucosa, nasal congestion; infrequently - pharyngitis, laryngitis, rhinitis, dyspnea, bronchitis, epistaxis. From the digestive system: often - diarrhea, dyspepsia, nausea, vomiting, abdominal pain; rarely - hepatitis, liver dysfunction. From the urinary system: infrequently - urinary tract infections, frequent urination, nocturia, glucosuria. From the reproductive system: infrequently - weakening of libido, decreased potency. From the senses: infrequently - blurred vision, burning sensation in the eyes, conjunctivitis. From the skin: often - alopecia, dry skin, erythema, photosensitivity, increased sweating; infrequently - urticaria, pruritus. From the musculoskeletal system: often - myalgia, back pain; infrequently - arthralgia. Others: often - asthenia, weakness, peripheral edema; infrequently - anorexia, exacerbation of the course of gout. On the part of laboratory parameters: often - hyperkalemia, a slight decrease in the concentration of hemoglobin and hematocrit; infrequently - a moderate increase in the concentration of urea and creatinine in the blood plasma, hyperglycemia, hyperuricemia, disturbances in the water and electrolyte balance; rarely - increased activity of ALT; very rarely - an increase in ACT activity and bilirubin concentration. Storage conditions The drug should be stored out of the reach of children; no special storage conditions are required. Buy Lorista ND tablets p/o 100mg/25mg No. 10x3