Universal reference book for medicines
Product name: LOTOR (LOTOR)

Active substance: losartan

Type: Angiotensin II receptor antagonist

Manufacturer: HEMOFARM (Serbia)
Description of the active substance:
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..

PHARMACHOLOGIC EFFECT
Antihypertensive agent.
It is a non-peptidic blocker of angiotensin II receptors. It has high selectivity and affinity for AT 1 receptors (with the participation of which the main effects of angiotensin II are realized). Blocking these receptors, losartan prevents and eliminates the vasoconstrictive effect of angiotensin II, its stimulating effect on the secretion of aldosterone by the adrenal glands and some other effects of angiotensin II. Characterized by a prolonged action (24 hours or more), which is due to the formation of its active metabolite.
PHARMACOKINETICS
After oral administration, losartan is rapidly absorbed from the digestive tract.
Bioavailability is about 33%. Metabolized at the "first pass" through the liver to form a carboxyl metabolite, which has a more pronounced pharmacological activity than losartan, and a number of inactive metabolites. Cmax in the blood plasma of losartan and active metabolite is achieved after 1 hour and 3-4 hours, respectively. Binding to plasma proteins of losartan and active metabolite is high - more than 98%.
T 1/2 of losartan and active metabolite in the final phase is about 1.5-2.5 h and 3-9 h, respectively.
Losartan is excreted in the urine and with feces (with bile) in unchanged form and in the form of metabolites. About 35% is excreted in the urine and about 60% - with feces.
INDICATIONS
Arterial hypertension.

Reducing the risk of associated cardiovascular morbidity and mortality in patients with hypertension and left ventricular hypertrophy, manifested by a decrease in the total incidence of cardiovascular mortality, stroke and myocardial infarction.

Protection of the kidneys in patients with type 2 diabetes mellitus with proteinuria is a slowdown in the progression of renal failure, manifested by a decrease in the frequency of hypercreatininemia, the incidence of end-stage renal disease, requiring hemodialysis or renal transplantation, mortality rates, and a decrease in proteinuria.

Chronic heart failure (as part of combination therapy, with intolerance or ineffective therapy with ACE inhibitors).

DOSING MODE
The average dose for oral administration is 50 mg 1 time / day.
If necessary, the dose can be reduced to 25 mg / day or increased to 100 mg / day, in the latter case, application of 2 times / day is possible.
SIDE EFFECT
From the cardiovascular system: dizziness, orthostatic hypotension.

From the side of metabolism: hyperkalemia.

Allergic reactions: angioedema (including swelling of the face, lips, throat and / or tongue), urticaria.

From the digestive system: diarrhea, increased ALT activity.

From the side of the central nervous system: a headache.

Dermatological reactions: itching.

Other: impaired renal function, myalgia.

CONTRAINDICATIONS
Pregnancy, lactation, children and adolescents under 18 years, hypersensitivity to losartan.

PREGNANCY AND LACTATION
Contraindicated in pregnancy and lactation.

APPLICATION FOR FUNCTIONS OF THE LIVER
If violations of kidney function may require a decrease in the dose of losartan.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
In patients with a history of liver disease, losartan should be used in low doses.
With cirrhosis of the liver, the concentration of losartan in the blood plasma increases significantly.
APPLICATION FOR CHILDREN
Safety and efficacy of losartan in children have not been established.

APPLICATION IN ELDERLY PATIENTS
In elderly patients during the treatment period, the level of potassium in the blood should be monitored regularly.

SPECIAL INSTRUCTIONS
With caution should be used in arterial hypotension, lowering of the bcc, violations of water-electrolyte balance, bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney, with renal / hepatic insufficiency

Patients who have a deficiency of fluid and / or sodium before treatment should be corrected water-electrolyte disorders or apply a lower initial dose.

In patients with dehydration (for example, those receiving treatment with diuretics in high doses) at the beginning of treatment with losartan, symptomatic arterial hypotension may occur.

If violations of kidney function may require a decrease in the dose of losartan.

In patients with a history of liver disease, losartan should be used in low doses.
With cirrhosis of the liver, the concentration of losartan in the blood plasma increases significantly.
During the period of treatment, the level of potassium in the blood should be regularly monitored, especially in elderly patients, with renal dysfunction.

It should avoid simultaneous use of losartan with potassium-sparing diuretics.

Safety and efficacy of losartan in children have not been established.

DRUG INTERACTION
At simultaneous application with diuretics in high doses arterial hypotension is possible.

With the simultaneous use of potassium, potassium-sparing diuretics, the risk of developing hyperkalemia increases.

With simultaneous use with indomethacin, a decrease in the effectiveness of losartan is possible.

There is a report on the development of lithium intoxication with simultaneous application of lithium carbonate.

With simultaneous use with orlistat reduces antihypertensive effect of losartan, which can lead to a significant increase in blood pressure, the development of hypertensive crisis.

With simultaneous use with rifampicin, the clearance of losartan increases and its effectiveness decreases.

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