Sign Out
Agents Increasing Serum Potassium: Coadministration of losartan with other drugs that raise serum potassium levels may result in hyperkalemia. Monitor serum potassium in such patients.
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, HYZAAR PLUS, or HYZAAR FORTE and lithium.
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. These effects are usually reversible. Monitor renal function periodically in patients receiving losartan and NSAID therapy.
The antihypertensive effect of angiotensin II receptor antagonists, including losartan, may be attenuated by NSAIDs, including selective COX-2 inhibitors.
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. Therefore, when HYZAAR, HYZAAR PLUS, or HYZAAR FORTE and non-steroidal anti-inflammatory agents including selective COX-2 inhibitors are used concomitantly, observe closely to determine if the desired effect of the diuretic is obtained.
In patients receiving diuretic therapy, coadministration of NSAIDs with angiotensin receptor blockers, including losartan, may result in deterioration of renal function, including possible acute renal failure.
These effects are usually reversible. Monitor renal function periodically in patients receiving hydrochlorothiazide, losartan, and NSAID therapy.
Dual Blockade of the Renin-Angiotensin-Aldosterone System (RAAS): Clinical trial data has shown that dual blockade of the RAAS through the combined use of angiotensin II receptor blockers, ACE inhibitors, or aliskiren is associated with a higher frequency of adverse events such as hypotension, syncope, hyperkalemia, and decreased renal function (including acute renal failure) compared to the use of a single RAAS-acting agent.
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 of hyperkalemia and acute kidney injury compared with the monotherapy group.
Closely monitor blood pressure, renal function, and electrolytes in patients on HYZAAR, HYZAAR PLUS, or HYZAAR FORTE and other agents that affect the RAS.
Do not coadminister aliskiren with HYZAAR, HYZAAR PLUS, or HYZAAR FORTE in patients with diabetes. Avoid use of aliskiren with HYZAAR, HYZAAR PLUS, or HYZAAR FORTE in patients with renal impairment (GFR <60 mL/min).
The Use of Hydrochlorothiazide with Other Drugs: When administered concurrently, the following drugs may interact with thiazide diuretics [see Pharmacology: Pharmacokinetics under Actions]: Antidiabetic drugs (oral agents and insulin): Dosage adjustment of the antidiabetic drug may be required.
Cholestyramine and colestipol resins: Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind the hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by up to 85 and 43 percent, respectively. Stagger the dosage of hydrochlorothiazide and the resin such that hydrochlorothiazide is administered at least 4 hours before or 4 to 6 hours after the administration of the resin.
