hydrochlorothiazide/losartan

7.4 Dual Blockade of the Renin-Angiotensin System (RAS) Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Do not coadminister aliskiren with HYZAAR in patients with diabetes. Avoid use of aliskiren with HYZAAR in patients with renal impairment (GFR <60 mL/min).

Mechanism: These drugs work on the same pathway to lower blood pressure, and taking both can lead to dangerously high potassium or sudden kidney failure.

What to do: This combination should not be used in patients with diabetes or kidney disease.

( 7.1 ) Lithium: Risk of lithium toxicity. 7.2 Lithium Increases in serum lithium concentrations and lithium toxicity have been reported with concomitant use of angiotensin II receptor antagonists or thiazide diuretics. Monitor lithium levels in patients receiving HYZAAR and lithium.

Mechanism: These blood pressure medications can cause the amount of lithium in your body to rise to dangerous levels. This happens because the drugs change how your kidneys get rid of lithium.

What to do: Your doctor should monitor your lithium blood levels closely. They may need to adjust your lithium dose while you are taking this medication.

The Veterans Affairs Nephropathy in Diabetes (VA NEPHRON-D) trial enrolled 1448 patients with type 2 diabetes, elevated urinary-albumin-to-creatinine ratio, and decreased estimated glomerular filtration rate (GFR 30 to 89.9 mL/min), randomized them to lisinopril or placebo on a background of losartan therapy and followed them for a median of 2.2 years. Patients receiving the combination of losartan and lisinopril did not obtain any additional benefit compared to monotherapy for the combined endpoint of decline in GFR, end-stage renal disease, or death, but experienced an increased incidence...

Mechanism: Combining these two similar types of blood pressure drugs does not offer extra protection for your heart or kidneys and increases the risk of side effects.

What to do: Your doctor will likely avoid using this combination because it provides no additional benefit over taking a single medication.

( 7.5 ) 7.1 Agents Increasing Serum Potassium Coadministration of losartan with other drugs that raise serum potassium levels may result in hyperkalemia. 7.3 Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors Losartan Potassium In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists (including losartan) may result in deterioration of renal function, including possible acute renal failure...

Mechanism: Taking these medications together can cause your potassium levels to become dangerously high or lead to kidney problems.

What to do: Your doctor should regularly check your blood potassium levels and monitor how well your kidneys are working.

Hydrochlorothiazide The administration of a non-steroidal anti-inflammatory agent including a selective COX-2 inhibitor can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Monitor renal function periodically in patients receiving hydrochlorothiazide, losartan, and NSAID therapy. 7.5 The Use of Hydrochlorothiazide with Other Drugs When administered concurrently, the following drugs may interact with thiazide diuretics [see Clinical Pharmacology (12.3) ]: Antidiabetic drugs (oral agents and insulin) — dosage adjustment of the a...

Mechanism: Pain relievers like NSAIDs can stop blood pressure medicines and water pills from working as well as they should. Taking these together can also put extra stress on your kidneys.

What to do: Your doctor should check your kidney function regularly while you are taking these medicines. You may also need to monitor your blood pressure more closely.