The mechanism of action of the drug Losartan in the treatment of hypertension - composition, dosage and analogues

Updated: 07/30/2019 18:35:39

Expert: Boris Kaganovich

Side effects

The most common side effects when using Clotrimazole usually include:

• the occurrence of areas of skin peeling;
• the appearance of swelling of the treated tissues;
• rashes;
• If the ointment gets into your eyes, rinse them immediately with running water.

On the part of the immune system, anaphylactic shock is likely to occur with hypersensitivity to the components of the drug, as well as symptoms of urticaria and swelling

Contact dermatitis, general skin irritation, increased dryness and pain - all these side effects should attract attention and the drug should be discontinued or replaced with a product that has a slightly different composition and has a similar effect on the affected skin

What is Losartan

INN (international nonproprietary name) – Losartan. In the RLS, the registry of drugs, Losartan is classified as a pharmacological subgroup of angiotensin 2 antagonists with a hypotensive effect. After administration, the effect persists for 24 hours, which is why the drug Losartan and its analogues are recognized by doctors as one of the most effective remedies.

Compound

The drug consists of main and auxiliary components. The active substance of the drug, which helps ensure the positive effect of use, is Losartanum potassium, a synonym for losartan potassium. Additional components used to combine the active substance include:

• lactose monohydrate;
• magnesium stearate;
• povidone;
• colloidal silicon dioxide;
• microcrystalline cellulose;
• croscarmellose sodium.

Mechanism of action

The mechanism of action is based on the blockade of angiotensin 2 receptors. The active substance neutralizes the spasmodic effect on blood vessels and supports the functioning of the heart muscles. The adrenal glands begin to produce the hormone aldosterone, and blood pressure drops. In addition, Losartan acts as a diuretic, helping to enhance the removal of fluid from the body.

Uric acid and sodium salts are excreted along with urine, but potassium salts, necessary for normal heart function, remain intact. After the tablets are ingested, the active substance losartan potassium dissolves and is absorbed through the gastrointestinal tract. Bioavailability is about 33%. Sufficient concentration in the blood is achieved after 1-1.5 hours. The breakdown of the drug occurs in the liver and is excreted through the intestines.

Indications for use

The drug belongs to a group of drugs that should not be used without a doctor’s recommendation. A specialist will help you choose an effective dosage, tell you about the main contraindications and possible side effects. In order to determine whether you need to see a therapist, you should measure your blood pressure regularly and focus on your own feelings.

If the tonometer readings exceed 140 to 90, and a person feels rapid heartbeat, weakness, and headache for 5-6 days, you should definitely go to see a doctor and find a remedy for hypertension. The main indications for use are:

• initial stage of hypertension;
• chronic coronary heart disease;
• type 2 diabetes mellitus with proteinuria (to protect the kidneys);
• chronic heart failure.

Regular use of the drug can significantly reduce the risk of associated cardiovascular morbidity and the mortality rate among patients. In addition, Losartan is used for the prevention of strokes and myocardial infarction in patients with left ventricular hypertrophy and stable high blood pressure. With the help of this tool, preparation is made for kidney transplantation and hemodialysis. Prescription for the treatment of chronic heart failure occurs after other drugs have proven ineffective.

Contraindications

Like many blood pressure medications, Losartan has a number of contraindications. All of them are indicated in the medication annotation, so you should study it carefully before taking it to avoid side effects. The ban on the use of Losartan applies to people who have:

• hypersensitivity to components containing potassium;
• severe renal failure;
• lactose intolerance.

Do not use the medicine during pregnancy and lactation. To treat hypertension during this period, it is recommended to use safer drugs that do not lead to birth defects in the child. Children under 18 years of age are another contraindication for taking Losartan. Patients with water-electrolyte imbalance or liver failure are advised to use the drug with caution. Dehydrated patients taking large doses of diuretics may experience symptomatic hypertension early in treatment.

Baths before applying the solution

Before using Clotrimazole, various foot baths are very useful, which will not only relieve fatigue, but will help get rid of the annoying fungus. These can be mixtures prepared according to folk recipes, or pharmacy versions of herbal infusions, which are recommended to combat the disease in question. Let's highlight the most popular foot baths, which are recommended to be used before Clotrimazole solution:

1. Dilute tar soap with warm water, add a few tablespoons of sea salt. Take the bath for 10-15 minutes, simply lowering your feet into it.
2. Mix a few grams of manganese and boric acid in a separate container. Dilute this liquid with 2-3 liters of warm water and dip your feet in it. Massage your feet and nails in water for 5 minutes, then pat dry with a towel.
3. Combine vinegar essence and pine needle extract in a 1:1 ratio and mix with 5 portions of water. It is allowed to take such a bath for up to 15 minutes, and after it apply Clotrimazole to the affected areas.
4. Prepare a paste from several heads of garlic (1-2) and dilute it with 2 liters of cold water, put your feet in the bath, take the treatment procedure for 5-7 minutes, after which you are allowed to rinse.

Losartan

Losartan is a pharmaceutical drug used to lower blood pressure (BP).

Active substance

This drug with the active substance of the same name belongs to the sartan group. Losartan is a biphenyl tetrazole derivative.

Chemical formula: C22H23ClN6O. Name: 2-Butyl-4-chloro-1-[[2′-(1H-tetrazol-5-yl)[1,1′-biphenyl]-4-yl]-methyl]-1H-imidazol-5-methanol .

In this drug, Losartan is represented by a potassium salt.

According to its physical properties, it is a white or whitish crystalline powder, highly soluble in water and ethyl alcohol, and poorly soluble in organic solvents.

Mechanism of action

The action of Losartan, like other sartans, is associated with the ability to influence the RAAS - the renin-angiotensin-aldosterone system. The end product of the reactions occurring in this system is angiotensin II. This protein compound is the end product of complex biochemical reactions.

In a simplified form, these reactions can be represented as follows. The liver synthesizes the protein angiotensinogen. Under the influence of another protein, renin, produced by the kidneys, angiotensinogen is converted into angiotensin I, which is physiologically inactive.

Next, angiotensin I, with the participation of angiotensin-converting enzyme (ACE), is activated into angiotensin II. It is through this compound that the RAAS exerts its effect on the body of mammals and humans. Under the influence of angiotensin II, small muscular arteries (arterioles) spasm, which leads to an increase in total peripheral resistance (TPR) of blood vessels and an increase in blood pressure.

Maintaining blood pressure at a stable level is vital. But its excessive growth (arterial hypertension) is a negative point, leading to the development of hypertension and cardiac pathology.

In addition, the RAAS activates the sympathetic nervous system. This system, through catecholamine mediators, adrenaline and norepinephrine, spasms blood vessels, and thereby aggravates hypertension. Angiotensin II stimulates the synthesis of aldosterone by the adrenal cortex and vasopressin by the neurohypophysis (posterior pituitary gland).

The action of these hormones is aimed at retaining sodium and water in the body. This phenomenon additionally stimulates an increase in blood pressure and is manifested by water and sodium retention in the body, a decrease in urination (diuresis) and an increase in circulating blood volume.

The negative effect of angiotensin II on blood vessels is also expressed in the fact that it stimulates the synthesis of low-density cholesterol (low-density lipoproteins), and thereby contributes to the formation of atherosclerotic plaques on the endothelium (inner wall) of blood vessels.

Under the influence of this substance, foci of proliferation of fibrous tissue are formed in the heart muscle. Structurally, this process is manifested by thickening (hypertrophy) of the myocardium, cardiosclerosis, and, as a consequence, arrhythmias due to disturbances in the conduction system of the heart.

Hardening of the kidneys (nephrosclerosis) in arterial hypertension is caused by spasm of the renal arteries. The name of this pathological condition is primary wrinkled kidney. This is a frequent companion to hypertension. Manifested by renal disorders (nephropathy) and progressive renal failure.

Nephropathy is a typical complication of diabetes mellitus. The problem is that angiotensin II also negatively affects carbohydrate metabolism. Under its action, the tolerance of fat cells to insulin increases, which leads to type II diabetes mellitus. Angiotensin II also slows down the excretion of uric acid salts by the kidneys, and this can lead to gout.

Angiotensin II exerts its effect by acting on receptors located in the corresponding tissues: in the vascular endothelium, in the myocardium, in the adrenal glands and in the kidneys, in adipose tissue. These receptors are heterogeneous. Therefore, there are several types of angiotensin (AT) receptors.

The negative effect is realized through AT-1 receptors. Stimulation of AT-2 receptors causes opposite effects: dilation (vasodilation) of blood vessels and inhibition of sclerotic processes in the heart and kidneys. The functions of the other AT-3 and AT-4 receptors are not fully understood.

Losartan selectively blocks AT-1 receptors. In this case, vasodilation, a decrease in blood pressure, and improved blood circulation in the myocardium, kidneys, and brain are noted. Cell tolerance to insulin increases, and the effectiveness of insulin in lowering blood sugar increases.

Intravascular atherosclerotic processes slow down. Clinically, this is manifested by stabilization of blood pressure and improved tolerance to physical activity. The frequency of angina attacks in coronary heart disease is reduced. Likewise, the risk of developing myocardial infarction is reduced.

Losartan does not block AT-2 receptors, but, on the contrary, indirectly stimulates them. The bottom line is that when the renal arteries dilate, the kidneys begin to compensatoryly synthesize renin.

This ultimately leads to an increase in the amount of angiotensin II. Not finding the point of application due to the blockade of AT-1 receptors, it begins to intensely act on AT-2 receptors, thereby causing the corresponding effects: vasodilation and improvement of metabolic processes in tissues.

Losartan competitively binds to AT-1 receptors. This means that when the level of angiotensin II increases, it binds to receptors, displacing it.

However, in the liver it is transformed to form the metabolite EXP-3174. In its activity, this metabolite is tens of times greater than the original substance, and non-competitively, i.e., irreversibly, binds to AT-1 receptors. The value of the drug also lies in the fact that neither it nor its metabolites accumulate in the body. This medicine is not addictive.

History of creation

Work on the synthesis of Losartan began back in 1980. Initially, this drug was codenamed S-8307. A little later, in 1986, the final version of the drug was obtained, which was 10,000 times more active than the original S-8307. In 1995

Losartan has been officially recommended by the US Food and Drug Administration for the treatment of cardiovascular diseases. This was the second of the sartans synthesized.

Although in essence it can be considered the first, because its predecessor, Saralazin, was never used in clinical practice due to its side effects. Sartans, selective AT-2 receptor antagonists, can be considered the “youngest” drug group.

Their effectiveness lies in the fact that they block the very last, final link of the RAAS. This is where sartans compare favorably with another group - ACE inhibitors.

The bottom line is that in addition to ACE, other enzyme compounds that are not affected by ACE inhibitors also participate in the synthesis of angiotensin II. And sartans, by blocking receptors, prevent the effect of angiotensin II on tissue, regardless of the route of its synthesis.

Currently, these drugs are included in most drug regimens for the treatment of arterial hypertension and cardiac pathology. It is actively used in the USA, Western countries. Europe, Russia and many post-Soviet countries.

Interesting Facts

In the first years of use, revenue from sales of Losartan worldwide amounted to $200 million. In 2005, the same amount exceeded the $3 billion mark.

Synthesis technology

The production technology of the drug involves the production of potassium salt nanocapsules enclosed in a xanthan gum shell. To do this, Losartan potassium is added to a suspension of gum in benzene in the presence of the enzymatic preparation E472C. The resulting mixture is stirred at a speed of 1000/sec. Hexane is then added, filtered and dried.

Release forms

Tablets 50 and 100 mg

Losartan is produced under generic names by many foreign (Lek, Sandoz, Teva, Richter) and domestic companies. Therefore, in the pharmaceutical market, in addition to Russian ones, you can find foreign (mainly Polish and Hungarian) analogues.

Among doctors and patients, the drug is better known under the trade name Cozaar, produced by Merck Sharp Dome in England. In Russia and the CIS countries, the generic Lorista, which is produced by the Russian branches of the KRKA company, is widespread.

Among other generics:

• Bloktran – Pharmstandard, Russia;
• Vasotens – Actavis, Iceland;
• Lozal – Zentiva, Slovakia;
• Losarel – Lek, Slovenia, Lek;
• Presartan - Ipka, India.

All these medications are tablets. The weight of the tablets is 50 and 100 mg. Bloktran can have a mass of 12.5 mg. The quality of generics, both Russian and foreign, is good.

But Russian drugs are cheaper. Abroad, the drug may be called Losanorm, Losarbon, Losium, Lostad, Sartkasal, and many others. Along with Losartan, biphenyl tetrazole derivatives are used, in which the active substances are: Candesartan, Valsartan, Tazosartan, Ibesartan.

Indications

• Arterial hypertension;
• Chronic heart failure;
• Diabetic nephropathy.

Dosages

The tablets are taken once in a daily dose. This dose is 50 mg in most cases. With a weak hypotensive effect, the daily dose can be increased to 100 mg as a single dose. The use of tablets does not depend on food intake.

The drug is taken over a long course, because the maximum hypotensive effect is achieved after 3-6 weeks of continuous use. Losartan can be combined with other antihypertensive drugs. In case of combination with diuretics, it is recommended to reduce the initial daily dose to 25 mg.

For chronic heart failure, it is recommended to start taking it with a minimum dose of 12.5 mg, increasing it to 25 and 50 mg over each subsequent week. Patients suffering from liver failure, as well as persons over 75 years of age, are recommended to take the drug at a daily dose of 25 mg.

Pharmacodynamics

The drug is absorbed into the gastrointestinal tract. Systemic bioavailability is 33%. In the liver, Losartan undergoes metabolic transformations, during which the active metabolite EXP-3174 and several other inactive metabolites are formed. Moreover, EXP-3174 accounts for about 14% of Losartan taken orally. The maximum concentration is formed 1 hour after its administration.

For the active metabolite, this figure is 3-4 hours. In patients suffering from liver cirrhosis, the concentrations of the drug and its metabolites may be several times higher than those in healthy individuals. About 99% of Losartan and EXP-3174 are bound to plasma proteins.

The drug is excreted through the kidneys and intestines. Moreover, 6% of the drug taken orally is excreted through the kidneys in the form of an active metabolite, and 4% is excreted unchanged. The half-life of Losartan is 2 hours, and EXP-3174 is 6-9 hours.

Side effects

• Cardiovascular system: dose-dependent hypotension, bradycardia, arrhythmias, nosebleeds, increased frequency of angina attacks;
• Gastrointestinal tract: anorexia, dry mouth, nausea, vomiting, constipation, flatulence, exacerbation of gastritis, hepatitis, increased liver enzymes in the blood plasma, jaundice;
• Central nervous system: general weakness, sleep disturbances, fainting, migraine, memory disorders, tremors of the extremities, peripheral sensitivity disorders such as paresthesia;
• Urinary system: impaired renal function, rarely – imperative urge to urinate;
• Musculoskeletal system: arthralgia and myalgia;
• Skin and mucous membranes: urticaria, itching, angioedema, erythema, increased sweating, photosensitivity, alopecia;
• Blood: anemia, eosinophilia, thrombocytopenic purpura, hyperkalemia;
• Sense organs: conjunctivitis, vision, taste disturbances, sensation of ringing in the ears;
• Reproductive system: decreased libido, impotence.

These side effects are rare, and many patients tolerate Losartan well.

Contraindications

• Individual intolerance to Losartan;
• Severe liver failure;
• Dehydration;
• Hypotension;
• Age up to 18 years.

Prescribed with caution for renal failure, renal artery stenosis, hyperkalemia, as well as mitral and aortic stenosis.

Interaction with other drugs

• Potassium-sparing diuretics, potassium supplements – worsening hyperkalemia;
• Rifampicin and Fluconazole - reduce the content of the active metabolite in the blood;
• Lithium preparations – increased toxicity;
• NSAIDs – weakening of the hypotensive effect of Losartan, reversible deterioration of renal function;
• Other antihypertensive drugs, neuroleptics, tricyclic antidepressants, Amifostine, Baclofen - increased hypotensive effect;
• Aleskiren (renin inhibitor) – hypotension, hyperkalemia, deterioration of renal function.

Pregnancy and lactation

There is no data on the negative effects of Losartan on the fetus. However, it has been established that all drugs that affect the RAAS are potentially dangerous in terms of fetal death, especially in the later stages of pregnancy - in the II-III trimesters. Therefore, during pregnancy, use is extremely undesirable. Lactation is also a contraindication to taking Losartan. Otherwise, breastfeeding should be stopped.

Storage

Store at a temperature not exceeding 300C. Shelf life – 2 years. The drug is available with a doctor's prescription.

Corinfar

Atenolol

Clotrimazole in the treatment of fungus

The main active substance clotrimazole is an element with a wide range of actions. Thanks to him the drug:

• slows down and then stops the biosynthesis of fungal sterol (the latter is a key component in the production of the parasite's intercellular membrane);
• destroys the structure of already developed fungal cells, increasing the degree of permeability of their membranes (not only the mycelium dies, but also the spores located on the skin surface);
• disinfects the surface;
• partially relieves symptomatic manifestations (swelling, itching, redness).

However, the medicine does not give immediate results, but acts gradually. For this reason, it is necessary to be patient and steadily follow the course of treatment. Clotrimazole anti-fungal solution fights the parasite faster.

Along with this drug, it is possible to use additional funds. For example, taking multivitamin complexes to strengthen the immune system.

As well as other antimycotic drugs (it is better to consult a doctor about this). In any case, an integrated approach will speed up the death of the fungus and recovery will come earlier.

Mechanism of action of Losartan

The active component of the drug Losartan is a selective competitive antagonist and blocker of AT1 type angiotensin receptors in the tissues of the adrenal cortex, liver and kidneys, heart, brain, and vascular smooth muscles. Taking the drug, according to the instructions, helps reduce total peripheral resistance, total venous return, and blocks all physiological effects of type II angiotensins, including the release of aldosterone.

This drug has a hypotensive effect after the first dose. The effect of the drug is expressed in a decrease in blood pressure, which is achieved after a few hours. A decrease in the effect of the drug is recorded after 24 hours. A stable hypotensive effect is observed after 3-6 weeks of use. A decrease in blood pressure occurs independently of the renin-angiotensin system, since plasma renin activity increases.

Regular use of the drug reduces the excretion of immunoglobulin G and albumin, helps to reduce the phenomena of proteinuria. Its active component stabilizes the level of urea in the blood without changing the content of norepinephrine. According to studies, in 9 thousand subjects suffering from arterial hypertension over the age of 55 with pressure levels of 160-200 mm, taking the medication reduced these indicators by 13-20%, and the mortality rate - by 25%.

A pronounced hypotensive effect of the drug is observed after the first dose, manifested in a decrease in the upper and lower pressure values. The greatest effect occurs after 6 hours. About 95% of losartan potassium is bound to plasma albumin. Plasma clearance reaches 600 ml/min, renal clearance – 74 ml/min. Losartan potassium is metabolized by the liver using the CYP2C9 isoenzyme and is excreted through the kidneys and intestines, partly unchanged, partly as an active metabolite.

Article on the topic: Ultrasound of cerebral vessels: what the diagnostic method reveals

Contraindications

When treating a number of diseases associated with the possibility of sexual transmission of infection, each partner must undergo a course of therapy at the same time, but this is not a reason to use one remedy. For some, the therapy will pass without consequences, but for others the drug may not be suitable due to individual intolerance

As with any medicine, you should take precautions or check with a specialist for some details. There are contraindications for Clotrimazole: the use of vaginal tablets should be limited or avoided in the following situations:

• age up to 12 years;
• sensitivity to the active substance;
• menstruation period;
• with bloody vaginal discharge (chronic, irregular);
• irritation, swelling, rash, blisters, open wounds on the woman’s genitals;
• cold, fever;
• nausea, vomiting, diarrhea;
• back pain.

Price

The drug Losartan can be purchased at a pharmacy; a doctor's prescription is not required to complete the purchase. You can preview the price range on specialized Internet resources. Cost for different forms of medication in Moscow pharmacies:

Features of the drug

This drug has the greatest effect in the development of diseases caused by molds, yeasts, as well as dermatophytes and other pathogens that are sensitive to the effects of clotrimazole, the active substance of the drug.

To see what the drug Clotrimazole is, watch the video below:

Composition of Clotrimazole

The main active ingredient is clotrimazole, of which 1 g of the product contains 10 mg (meaning 100% dry matter). Auxiliary components include the following:

• polyethylene glycol cetostearyl ether;
• propylene glycol;
• cetostearyl alcohol;
• polyethylene glycol 400;
• proxanol 268.

Externally, the drug is an ointment that is white in color, has a uniform consistency, and has a slight specific medicinal odor.

Dosage forms

The drug is offered for sale in the form of aluminum tubes with bouchons, which have an internal varnish coating that is approved for use.
The tube with a leaflet describing the composition and method of use is contained in a cardboard package. Clotrimazole is also sold in the following forms:

• vaginal tablets that have the appearance of a parallelepiped with slightly rounded corners. They contain 100 mg of active substance. There are 6 pieces in the blister;
• ointment (cream), white in color and uniform consistency, for external use. The active substance in the ointment is 10 mg per 1 g of ointment. The ointment is packaged in tubes of 30 g, 20 g. Vaginal cream 2% is offered in tubes of 50 g;
• a solution also used for external use. The solution (1%) is packaged in orange bottles and their volume can be 15 or 30 ml.

general description

Lorista is a medicine in tablet form. The main active ingredient is losartan. There is a drug with different amounts of the active component - from 12.5 to 100 mg. One pack may contain from 7 to 14 tablets.

Important! Lorista can be purchased at a pharmacy only with a prescription from a doctor. , which is located in Russia

After purchase, the tablets should be stored at an air temperature not exceeding 30°C. The shelf life of the medicinal product is 2 years from the date of manufacture, and for 50 mg tablets – a little more (5 years)

, which is located in Russia. After purchase, the tablets should be stored at an air temperature not exceeding 30°C. The shelf life of the medication is 2 years from the date of manufacture, and for 50 mg tablets – a little longer (5 years).

Instructions for use of Clotrimazole

This drug can be recommended by a doctor for therapy once or as a course, the choice depends on the symptoms and severity of the disease. The appointment should be made individually, after anamnesis and examination. If there are no additional instructions from a specialist, then typical instructions for using Clotrimazole to get rid of an infection look like this:

1. Read the annotation, which indicates the daily dose and permissible duration of therapy. Compliance with the dosage and time period is mandatory.
2. Before inserting the tablet into the vagina, observing hygiene standards, you should wash your hands.
3. For convenience, you should take a suitable position: lie on your back, bend your knees. The vaginal tablet should be inserted with light pressure, but carefully.
4. Lie in this position for a few more minutes so that the antifungal agent is evenly distributed.

During pregnancy

The period of bearing a child for a woman is associated with the risk of unpleasant sensations. Some are considered normal, while others are undesirable effects that the body can get rid of with the help of medications. Against the background of unstable hormonal levels, an inflammatory process, similar in symptoms to candidal vaginitis, is not uncommon. How to get rid of painful discomfort in the lower abdomen and burning sensation? Use Clotrimazole vaginal tablets during pregnancy, but before doing so, be sure to consult a gynecologist.

During menstruation

If in the later stages Clotrimazole during pregnancy is a way to quickly sanitize the birth canal before the birth of a child, then during menstruation the picture is somewhat different. This drug is not considered effective in preventing infection. Since Clotrimazole is not recommended during menstruation, it is worth starting a therapeutic course either before their onset or at the end of the cycle. The effect of the active substance will be minimal due to the risk of the tablet being washed out, so treatment of thrush with Clotrimazole will not bring the desired result.

Lorista tablets indications for use

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For the drug Prestarium, the main indication for use will be hypertension of any etiology.

In addition to the hypotensive effect, the drug has the ability to reduce ischemic processes in tissues and improve peripheral circulation. Doctors recommend that patients with certain cardiac and neurological pathologies take Prestarium pills.

1. Heart failure. With prolonged use, patients noticed a decrease in left ventricular hypertrophy and improved blood circulation.
2. Ischemic disease. The effect of perindopril erbumine promotes dilation of the coronary arteries and reduces myocardial oxygen demand.
3. Condition after a stroke. With cerebrovascular disorders, the risk of recurrent stroke is reduced.
4. Previous heart attack. Reviews from cardiologists regarding the use of the drug Prestarium after a heart attack allow us to conclude that patients who regularly take the pills reduce the degree of ischemic disorders and reduce the risk of complications.

Risk factors for stroke

The instructions for use note that the medication is well tolerated by patients and there are few prohibitions against its use. The instructions for Prestarium contain the following contraindications:

• allergy to ACE inhibitors (of any group);
• individual intolerance to perindopril;
• children under 18 years of age (safety for children has not been studied);
• intolerance to milk sugars (lactose);
• pregnancy and lactation;

For other diseases, medication can be prescribed; only for kidney or liver diseases, the selection begins with a minimum dosage.

The use of pharmaceutical preparations containing the same active substance losartan is contraindicated for pregnant women, nursing mothers, children under 18 years of age, as well as for the following pathologies:

• low blood pressure;
• high level of potassium in the blood;
• dehydration of the body;
• individual intolerance to the drug;
• lactose intolerance.

Contraindications

One of the popular drugs that fights heart failure and hypertension is Lorista. These tablets are quite effective, and many patients leave positive reviews about them.

But, like any other drug, Lorista (the price of which is quite affordable) has a number of contraindications and cannot guarantee 100% results for all patients. In this article, we will take a detailed look at this common medicine, as well as a number of its analogue drugs.

• hypertension of varying degrees;
• reducing the risk of stroke in patients with hypertension who also have ventricular hypertrophy. This should be confirmed with an ECG;
• to reduce blood pressure in patients with type 2 diabetes;
• treatment of heart failure. This disease is most often of a chronic type, which is typical for patients over 60 years of age. Lorista is used in patients who, for some reason, cannot take traditional medications (ACE inhibitors).

Contraindications

Lorista high blood pressure tablets are prohibited from being used in the following cases:

• the presence of hypersensitivity to one of the components of the drug;
• low pressure;
• intolerance to the absorption of certain substances (glucose, galactose);
• hyperglycemia, dehydration;
• period of pregnancy and lactation, childhood;
• presence of lactose intolerance.

Clotrimazole. Instructions for use

The algorithm for using the product is as follows (for both ointment with cream and solution):

1. Steam your nails or infected areas in a bath (you can add soda or unscented laundry soap). Steaming is necessary for greater penetration of the composition into the skin. The optimal water temperature is from 45 to 55 degrees. The duration of the procedure is 10-15 minutes.
2. Trim the nail plate as short as possible and file down its top layer (if the fungus has infected the nail). The surface should be rough.
3. Apply the composition to the infected area and wait until completely absorbed. You can also coat nearby areas with the composition, including the areas between your fingers. This is necessary for greater reliability and prevention. You need to apply a little bit - if you overdo it and apply too much, irritation may occur. Clotrimazole ointment for nail fungus is best used on the feet, and the solution on the nails.

The procedure is carried out 2-3 times a day. Preferably wearing gloves. Afterwards, wash your hands thoroughly to avoid getting the composition in your eyes. This especially applies to Clotrimazole ointment for nail fungus; reviews say that it is difficult to wash off.

Additional recommendations:

• For the procedure, you should always use a separate towel, or better yet, disposable napkins.
• Manicure instruments must also be individual and disinfected both before and after the procedure.
• Soap must be washed off as thoroughly as possible, otherwise it will neutralize the effect of the drug.

The speed at which the fungus goes away depends on its variety, location, degree of development of the disease and area of ​​infection. In most cases, the entire therapeutic course takes from 2 to 8 weeks.

As reviews about Clotrimazole emphasize, the fungus goes away on average in 1-1.5 months. To prevent relapses, it is worth continuing to apply the product even after recovery - for another 2-3 weeks after completion of the course of treatment.

Find out more

Composition and release form

The drug Losartan is available in the form of tablets for oral administration, containing the main active ingredient - losartan potassium - 12.5, 25, 50 or 100 mg. Tablets are round, biconvex, film-coated, white (12.5 and 25 mg), pink (50 mg) or yellow (100 mg), packaged in blisters of 10 or 15 pieces, 2, 3, 4, 6, 10 blisters in one package. Full composition of the medicinal product, according to the instructions for use:

What is Clotrimazole

An acute infection or a chronic form of the disease can be quickly treated thanks to a drug from the group of imidazole derivatives. Clotrimazole is a broad-spectrum antifungal agent that is available in the form of vaginal tablets, ointments, suppositories and other dosage forms. The active substance, which has proven effective in the treatment of certain gynecological diseases, disrupts the synthesis of ergosterol, which forms the cell membrane of the fungus, which contributes to its destruction.

A similar effect, when the active component contributes to the deformation of the cell membrane, is demonstrated by Clotrimazole tablets in relation to bacteria. By influencing the production of components that are necessary to strengthen membranes, the drug destroys the vital activity of microorganisms that provoke inflammation of the mucous membranes and skin. The main property of the drug will not manifest itself immediately: the symptoms of the disease of the female reproductive system may continue to bother you for several days after the start of using the medicine until it manifests itself.

Analogs

Effective analogues of Losartan include drugs that have the same health effects. They all contain a similar active substance. The original Losartan differs only in the appearance of the packaging, release form, dosage and manufacturer. Some drugs contain other auxiliary components.

Drug substitutes are prescribed if contraindications are identified. A qualified doctor should determine which of the similar drugs is best for arterial hypertension. The list of frequently used analogues includes:

• Blocktran;
• Lorista;
• Lozap plus;
• Renicard;
• Losarel;
• Vasotens;
• Brozaar;
• Presartan;
• Lakea;
• Zisakar;
• Losartan Richter;
• Carzartan;
• Hypothiazide;
• Losakor;
• Lotor;
• Vero Losartan;
• Losartan Canon.

Clotrimazole ointment for thrush detailed instructions

Clotrimazole is an ointment that helps with thrush. It has a thick consistency. The ointment is applied directly to the labia. The drug is white. It received this shade due to the presence of paraffin, alcohol, purified water and other components. The ointment was developed specifically to combat fungal spores of various origins.

It is usually used for candidiasis. Can be used not only by women, but also by men. It can also be used if fungal diseases begin to develop on the feet, skin and mucous cavities.

Women

• The ointment is used primarily to combat fungal plaques that provoke microsporia and lichen. The drug has been demonstrating its increased level of effectiveness for a long time.
• However, in order to overcome the disease, it is necessary to undergo a full course of therapy. It can be a minimum of 5 days and a maximum of 10 days.
• The duration of treatment will depend on the form of the disease and the degree of its complexity. The effectiveness of the drug is determined by how correctly the patient uses the ointment.

The drug Clotrimazole is manufactured in small tubes with a capacity of 20 ml.

From the very beginning, the first signs of the disease appear in the form of redness, severe burning, and itching in the genital area. If these symptoms occur, you should immediately consult a doctor. Based on the examinations performed, he will be able to make an accurate diagnosis and prescribe the necessary treatment.

During thrush, the drug is used according to the following scheme:

• The ointment should be applied in a thin layer to the vaginal walls.
• The drug must be applied no more than once per day.
• The duration of therapy is 3 days or more.

Before you decide to use the ointment, you must perform important procedures - take a bath or shower. This is necessary so that the infection cannot enter the vagina.

Use the ointment with extreme caution, without violating the rules from the instructions. Simply apply the product in circular motions into the skin

The dosage is approximately 5 g.

Prestarium A dispersible tablets

The type of medication with the letter A means that the tablet contains Peridopril arginine instead of Perindopril erbumine. Both salts have the same mechanism of influence on the body, the slight difference will only be in the dosage: Perindopril arginine is available in Prestarium doses of 10 mg, 5 mg, and 2.5 mg.

The medication Prestarium 5 mg and Prestarium 10 mg can be divided in half; for this purpose, a convenient double-sided mark is applied to the pill.

Prestarium A dispersible tablets should be taken as follows:

1. Place the pill on your tongue.
2. Wait until the tablet disintegrates into small pieces under the influence of saliva.
3. Swallow the mass that has formed in the mouth.

Find out how to help yourself with hypertension from the following video:

https://youtube.com/watch?v=hb10kIncFF8

WHAT IS BETTER PRESTARIUM OR LOSARTAN

. Cured it myself! Speaking about whether Prestarium or Losartan is better, it can be noted that ACE inhibitors are prescribed more often than angiotensin receptor blockers. Losartan or Lozap:

which is better? Analogues of the drugs Lozap and Losartan:

reviews. What is the difference between Lozap and Losartan? Nortivan; Prestarium; Micardis; Lakea; Kozaar; Lotor; Renicard and others. Cons:

Prestarium is an expensive drug and should be used with caution in old age. Losartan is an affordable and effective drug for high blood pressure

prestarium losartan. Which is better for daily use: losartan or prestarium. Is it possible to combine resitarium with lozap? losartan or Replacing Prestarium with losartan. Galina Female, 62 years old. Russia Krasnodar region. It turned out that losartan clearly works better than atenolol in patients with type 2 diabetes. What is better to take together, Concor and Prestarium or Concor and Capoten?

Prestarium contains 6.79 mg of perindopril. Operating principle. Which is better Prestarium or losartan - NO MORE PROBLEM! Prestarium belongs to the second generation of antihypertensive drugs. The body reacts well, there were no side effects. Elena Aleksandrovna, 45 years old To figure out which is better Prestarium or Perindopril (or other options), you need Lorista. Available in the form of white or yellow tablets containing losartan potassium at a dosage of 12.5, 25, 50 or 100 mg per tablet. This article will look at two similar drugs in which very few differences can be found. Namely, it will be decided whether Losartan or Lorista is better?

Which drug to normalize blood pressure to choose:

Valsartan or Losartan?

To determine which one is more effective, you need to compare the characteristics of these drugs. What is better to take together, Concor and Prestarium or Concor and Capoten?

Losartan potassium, the active ingredient of the drug Lozap (manufactured in Slovakia) is a medicine intended for the treatment of Choosing the most effective medicine:

Losartan or Lorista, which is better to take?

Whatever the diagnosis of your medical record, you will definitely be able to find the right medicine for yourself. Losartan, Cordaflex, Prestarium, Bisoprolol, Propranolol. Long-acting medications for hypertension. Well suited for the treatment of high blood pressure in people with heart failure, diabetes. Patients were randomized by the “envelope method” into 2 groups (30 patients in each group):

Group I took perindopril (Prestarium A, Servier) in a daily dose of 10 mg, group II took losartan (Cozaar, Merck Sharp Dohm) in Perindopril (Prestarium A, Perineva) are available in 2 dosages. This is what the doctors “read because they have nothing to do”!

It would be better if you Nadezhda gave advice. You can replace enalapril with valsartan (Valz) or losartan (Lozap or Lozap plus). Prestarium with losartan can theoretically be taken, but such a combination is considered irrational, since these are drugs with a similar mechanism of action. 17. Losartan significantly reduced serum uric acid levels, whereas irbesartan had no effect on them 14 . Therapy with Lozap and Prestarium is well tolerated. Prestarium or Lisinopril, which is better?

Prestarium or Lorista. Lorista contains the active substance losartan. This remedy helps in the fight against high blood pressure. Reviews about Losartan or its analogues are mostly positive. But since then I’ve been taking the medicine without a break and I feel good and the engine no longer lets me down. Which is better Prestarium or losartan

- 100 PERCENT! Listen to the doctors. Which is better Lozap or Losartan:

Clotrimazole ointment for men

A large percentage of fungal diseases occur in lesions of the genital organs. Among men's problems, thrush (candidal balanitis) is distinguished. The disease is caused by fungi of the genus Candida. Thrush is transmitted sexually; the disease is transmitted by one of the partners - a man or a woman. Often candidiasis is not accompanied by pronounced symptoms: sometimes dryness, burning and itching of the genital organ, pain when urinating, and discomfort during sexual intercourse are disturbing.

If you have the listed symptoms or if your partner is ill, you should consult a doctor for a consultation, because an advanced fungal disease can cause the development of prostatitis or chronic diseases of the genitourinary system. To treat candidiasis, doctors often prescribe Clotrimazole for men.

The formulation of the drug in the form of a cream received positive feedback during treatment - a positive effect is achieved so quickly and it is convenient to use. Nuances:

Small doses of the drug quickly stop the development of the disease; further use of the drug leads to the death of the pathogen within a week.

1. For complete recovery, the course of treatment can last up to three weeks.
2. To achieve a therapeutic effect, it is necessary to apply a thin layer of cream to the washed affected area two to three times a day.
3. The ointment is poorly absorbed, so it is recommended not to get dressed immediately after applying the drug.
4. During treatment, you should wear comfortable, breathable clothing made from natural fibers.

Candida fungi are always present in the body, but begin to multiply quickly and cause inflammation when the immune system is weakened or antibiotics are taken, so a greater treatment effect is achieved with fortifying medications and diet. The patient is prescribed fermented milk foods, dietary supplements, and a diet excluding sweet, hot, spicy and fried foods is recommended.

Description of Losartan

Losartan is a drug based on the substance of the same name, the action of which is aimed at lowering blood pressure. Manufacturer: Belmedpreparaty, release form: white tablets.

The drug is effective throughout the day. Has a vasoconstrictor effect. Maintains electrolyte balance, has a protective effect on the kidneys in diabetes, promotes the removal of water and salt from the body.

The drug Losartan blocks angiotensin 2 receptors in blood vessels, heart, liver, and brain. Reduces blood pressure, prevents hypertrophy of the heart muscle, increases endurance in cardiovascular pathologies. Does not block channels important for the functioning of the heart and does not change the heart rate.

Research and effectiveness

Conducted studies show that the effectiveness of Losartan and Enalapril is comparable. The degree of reduction in blood pressure during treatment with these drugs occurs within 8-12 weeks of treatment.

A drug based on losartan can be used effectively for mild to moderate arterial hypertension. With long-term use of the drug, there is an improvement in the prognosis for the development of cardiovascular complications.

Source: “Study of the effectiveness of Losartan in patients with arterial hypertension.” Chazova I.E. Cardiovascular therapy and prevention. 2007.

Contraindications

Losartan has the following restrictions for use:

1. hypersensitivity to the composition;
2. allergy;
3. severe liver dysfunction;
4. pregnancy;
5. childhood.

Side effects

The likelihood of developing side effects increases in the presence of concomitant cardiovascular diseases. Frequent undesirable symptoms include drowsiness, headaches, and insomnia.

Other possible side effects:

1. tachycardia, angina pectoris;
2. hyperkalemia;
3. symptomatic hypotension;
4. thrombocytopenia, anemia;
5. genitourinary infections;
6. flu-like conditions;
7. loss of consciousness;
8. erectile disfunction;
9. depression;
10. decreased sodium levels;
11. vasculitis;
12. allergic manifestations;
13. arthralgia, myalgia;
14. cough;
15. anaphylactic reactions;
16. kidney pathologies.

Dosage

Losartan is taken once a day, regardless of meals. The recommended dose is 50 mg.

The hypotensive effect is observed no earlier than after 3-6 weeks of use of the drug. The dosage can be increased to 100 mg per day. For kidney disease and taking diuretics, the dosage may be reduced to 25 mg/day.

In case of overdose, hypotension, tachycardia, and bradycardia occur. Hemodialysis is recommended. Be sure to wash the stomach and take enterosorbent.

Who is it suitable for?

The drug Losartan is prescribed for hypertension, heart failure as part of complex therapy, and ineffective use of ACE inhibitors. Long-term use of the drug reduces the likelihood of stroke due to high blood pressure. The medicine is also prescribed to maintain the condition of the kidneys in diabetes mellitus.

Features of Clotrimazole solution

The anti-fungal solution contains 1% clotrimazole - 10 mg of active substance per 1 ml. The base of the drug is 96% ethyl alcohol and isopropyl myristate (helps to evenly distribute the composition over the surface).

The liquid preparation is packaged in bottles with a dropper or spray with a capacity of 15, 20, 30 ml, and then in cardboard boxes with attached instructions for use. The solution is clear or slightly yellowish, with a specific alcoholic odor.

Indications for use of the drug

Use 1% clotrimazole solution in the following cases:

• fungal infections of the mucous membranes and epidermis caused by various pathogens (fungal stomatitis, various candidiasis, dermatophytosis, microsporia, etc.),
• pityriasis versicolor and versicolor versicolor, erythrasma,
• mycotic lesions complicated by bacterial infection and suppuration (pyoderma),
• periungual felons,
• complex treatment of onychomycosis,
• preventive treatment of the birth canal.

Contraindications and warnings

The drug is prohibited if you are allergic to clotrimazole or other substances from the imidazole group. Another possible obstacle is related to the presence of ethyl alcohol in the solution. It, unlike the active substance, is easily absorbed through the mucous membranes and skin. This is not advisable for pregnant women and children under 12 years of age. In addition, alcohol often causes burning and dry skin.

No studies have been conducted on the safety of Clotrimazole in the first trimester of pregnancy, so it is not indicated for use during this period. It is unknown whether clotrimazole passes into breast milk, so use during lactation should also be avoided. In the second and third trimester of pregnancy, use is permitted only as prescribed by a doctor.

The drug in the form of an alcohol solution is intended exclusively for topical use and cannot be taken orally.

It is important to avoid getting the composition into the eyes - this will cause a chemical burn to the mucous membrane. For the same reason, the solution is not applied to damaged skin (wounds, scratches, severe scratching)

In this case, alcohol will cause a strong burning sensation.

Side effects

Possible negative reactions of the body to the drug include:

• tingling and burning at the site of application of the solution,
• skin redness,
• rash like urticaria,

• blisters with clear fluid,
• edema,
• irritation, peeling and dryness of the dermis (associated with the presence of alcohol).

In case of allergic manifestations, the clotrimazole solution is replaced with agents from other pharmacological groups. In case of minor short-term irritation, discontinuation of the drug is not required.

Trade names

Clotrimazole 1% drops can be purchased at any pharmacy. There are other trade names for this drug:

• Clotrimazole Akrikhin. Manufacturer: Medana Pharma (Poland) commissioned by the Russian company Akrikhin. 15 ml bottle with dropper. Approximate price 200 rubles,
• Candide. Manufacturer: Glenmark (India). Bottle with dropper 20 and 30 ml. Average cost 350-450 rubles,
• Candida for the oral cavity. Bottle 15 ml. A solution with the addition of glycerol and propylene glycol. Approximate price 300 rubles,
• Kanizon. Manufacturer: Agio Pharmaceuticals (India). Bottle with a capacity of 20 ml. Costs about 120 rubles.

Important! Clotrimazole solution in the form of a spray is produced by the German companies Bayer and Ratiopharm (Kanesten and Kandibene), but they are currently not sold in Russia

Use during pregnancy and breastfeeding

Noliprel is contraindicated for use during pregnancy and breastfeeding.
Adequate and controlled studies on the use of Noliprel during pregnancy in humans have not been conducted. ACE inhibitors can cross the placental barrier and lead to increased morbidity and mortality in the fetus and newborn. Exposure of the fetus to ACE inhibitors in the second and third trimesters of pregnancy can lead to the development of arterial hypotension, renal failure, deformation of the skull and facial bones, and even death in the newborn.

There are reports of the development of oligohydramnios (a pronounced decrease in the volume of amniotic fluid), which is caused by impaired renal function in the fetus. Oligohydramnios may be accompanied by the appearance of contractures of the upper and lower extremities in the fetus, deformations of the bones of the skull and face, hypoplastic development of the lungs and slowing of intrauterine development. Infants exposed to an ACE inhibitor in utero should be carefully evaluated to rule out hypotension, oliguria, and hyperkalemia. Treatment of oliguria should be combined with maintaining adequate blood pressure and renal perfusion.

There are reports of intrauterine growth retardation, premature birth, patent ductus arteriosus, and fetal death while taking ACE inhibitors during pregnancy. However, it is not possible to establish exactly to what extent in these situations the drug prescription played a decisive role, and to what extent it was the background disease of the mother.

There are currently no data on the effect of an ACE inhibitor prescribed in the first trimester of pregnancy.

If pregnancy occurs while taking an ACE inhibitor, there is no need to interrupt it, but you should immediately stop taking the drug and perform an ultrasound of the fetal skull. Women who become pregnant while taking an ACE inhibitor should be informed of the potential danger to the health of the fetus.

Taking diuretics, including indapamide, can cause the development of placental insufficiency and intrauterine growth retardation.

Both perindopril and indapamide can pass into breast milk. If it is necessary to prescribe Noliprel during lactation, breastfeeding should be discontinued.

Pharmacological effect

Clotrimazole is a drug with pronounced antifungal properties, which belongs to the imidazole derivative. The use of the drug makes it possible to inhibit the synthesis of ergosterol, thereby disrupting the permeability of fungal cells, causing their death. Clotrimazole - the active component of the ointment is effective against dermatophytes, yeast, mold fungi, and has an antibacterial effect against staphylococcal and streptococcal infections. This drug can be used for various fungal diseases.

After application to the skin, the active component is quickly absorbed into the upper and deep layers of the epidermis and practically does not penetrate into the bloodstream. A special feature of the drug is the fact that after use the therapeutic effect will not be noticeable immediately, but after a while. However, with long-term use, the effect of the drug will be 100%

It is very important to maintain skin hygiene when using the ointment, and also not to skip its application.

This ointment not only allows you to get rid of a fungal infection, but also significantly reduces infection of the skin with other bacteria, which often complicate the treatment process and the course of the disease.

Russian analogue Noliprel

Hypertension is not a death sentence!

It has long been a well-established opinion that it is impossible to get rid of HYPERTENSION forever. To feel relief, you need to continuously drink expensive pharmaceutical drugs. Is it really? Let's figure out how hypertension is treated here and in Europe...

Noliprel is a Russian analogue of the drug Prestarium, recommended for high blood pressure, has a combined effect, that is, one tablet contains two active substances - indapamide and perindopril.

These substances belong to different categories of drugs for the treatment of arterial hypertension. Indapamide is a diuretic, and perindopril is an angiotensin-converting enzyme inhibitor. In their symbiosis, they help lower blood pressure, and the effect is quite powerful and pronounced.

It can be said that Noliprel often helps in situations where therapy with other means has been unsuccessful, and it is this fact that justifies its relatively high cost.

Indications for use:

1. When a patient’s high blood pressure is not caused by kidney pathologies, disruption of the functionality of the endocrine system and other pathologies. That is, hypertension is primary.
2. If the patient has high blood pressure combined with type 2 diabetes.

As for the use of the drug, Noliprel, like Prestarium, must be taken once a day with a glass of water (250 ml). Instructions for use of the product say the following:

• Take the tablets exclusively on an empty stomach.
• Can be taken in the morning with plenty of liquid – 250 ml.
• In some situations, if the therapeutic effect is little pronounced, you can increase the dosage to several tablets per day.

It is worth noting that tablets such as Noliprel must be taken throughout your life, so even after your blood pressure has decreased and normalized, you do not need to stop taking the medication without the consent of your doctor.

Many patients are interested in what is better, Noliprel or Prestarium? Two medications have a cumulative effect and are therefore not suitable for emergency lowering of blood pressure. The drug is produced in both Russia and France, the only difference between the Russian analogue is that it is cheaper.

Prestarium is the brand name under which the medicine “perindopril” is hidden, but Noliprel is a combination medicine that combines indapamide and perindopril.

Approximate cost of the drug

Clotrimazole is sold in almost every pharmacy, as it is a very popular medicine for the treatment of fungal diseases. It is also allowed to be ordered on the Internet, since if the required temperature is maintained, the medicinal drug can exist for a long time and not lose its qualities. Here is a list of retail outlets and their prices where it is easy to buy Clotrimazole:

Reviews

Inga, 56 years old

The doctor prescribed me to take Losartan according to the instructions after a mini-stroke. Before this, I took another medicine that was cheaper. After I started taking it, I started feeling dizzy, but I achieved the desired effect - my blood pressure dropped quickly. When I told the doctor about the problem, he ordered me to reduce the dosage. The dizziness didn't bother me anymore.

Tatyana, 26 years old

Losartan was prescribed to my mother for blood pressure. The pharmacy near her house did not sell this drug, so I decided to make a purchase in the online store. True, they did not have courier delivery and had to order by mail, but they sent it quickly. The price of the drug Losartan is not high; compared to other drugs for hypertension, it is not so expensive.

Elena, 41 years old

Recently my blood pressure has started to rise. At the appointment, the therapist recommended taking half a tablet of Losartan Teva. He warned that the drug has negative compatibility with alcohol. A week later, it turned out that this dose was not enough for me for the day, the doctor advised me to take a whole tablet at night. After this, the pressure returned to normal.

Clotrimazole ointment for women

Thrush or candidal vulvitis in women is accompanied by symptoms:

• itching, burning and swelling of the genitals;
• mucous discharge is yellowish or white, sometimes there is copious liquid discharge or curdled flakes;
• unpleasant smell.

Clotrimazole for women is used in the treatment of thrush. The use of ointment for the treatment of candidiasis has received positive reviews - it immediately eliminates unpleasant itching and burning. The ointment comes on sale with a nozzle convenient for douching. The cream is administered once a day for three days. For chronic disease, it is recommended to use the cream three times a day for two weeks.

A prerequisite for recovery is adherence to the rules of personal intimate hygiene, wearing cotton underwear, exclusion of sexual activity during treatment and simultaneous treatment of the sexual partner. The drug can be prescribed without the presence of characteristic signs of the disease for the sanitation of the birth canal for women in the last trimester of pregnancy.

Directions for use and dosage

Losartan tablets, according to the instructions, are recommended to be taken regardless of meals, without chewing, once a day. It is advisable to coordinate the time of administration with your doctor, and take the medicine at the same hour every day. The daily dosage is selected depending on the diagnosis, and may be:

• For arterial hypertension – 50-100 mg/day.
• For heart failure - 12.5 mg/day in the first days of treatment, after a week of treatment the dose is doubled.
• To reduce the risk of cardiovascular pathologies – 50 mg/day.
• For liver failure – 25 mg/day.

During the course of treatment, constant monitoring of blood pressure dynamics is necessary. The product is intended for continuous use; dosages can be decreased or increased by the doctor depending on changes in the patient’s condition. After the age of 75 years, the minimum daily dosage should not be exceeded (25 mg/day).

Instructions for use of Clotrimazole ointment

An antifungal drug in the form of an ointment is intended for external and vaginal use. The aluminum tube with the medication has an outer packaging - a cardboard box. The drug comes with instructions for using Clotrimazole. You can buy this medicine at a pharmacy without a doctor's prescription; it can be stored for two years in a dry place without sunlight.

When Clotrimazole ointment is prescribed, the instructions for use inform the consumer that the ointment must be applied in small portions (dosage is 5 millimeters) onto a clean, dry surface and rubbed in with light circular movements. The duration and frequency of use of the cream is strictly individual for each person, the type of lesion, and is determined when the drug is prescribed by a doctor. According to the annotation, the ointment can be applied to areas of inflammation:

• skin of the whole body;
• mucous membranes of the oral cavity, genital organs (excludes the mucous membrane of the eyes).

Composition of Clotrimazole ointment

The drug is made on the basis of petroleum jelly (paraffin). Clotrimazole contains excipients:

• propylene glycol;
• polyethylene oxide;
• methyl parahydroxybenzoate or methylparaben (nipagin).

The active substance of the drug comes from the imidazole group. The mechanism of the therapeutic effect of the substance is based on the fact that it disrupts the synthesis of ergosterol in fungal cells. This leads to disruption of the structure and damage to cell membranes. Additionally, the substance interacts with fungal enzymes, promotes the formation and accumulation of hydrogen peroxide in cells, which destroys cells.

Indications for use of Clotrimazole ointment

The properties of the drug to have a destructive effect on pathogens of fungal and infectious diseases are used to treat various diseases. It suppresses the action of pathogens:

• mycoses (yeast, mold, dermatophytes);
• coccal infections (streptococci, staphylococci);
• trichomonas infections.

According to the instructions, there are indications for the use of Clotrimazole:

• candidal balanitis and vulvitis;
• stomatitis;
• trichophytosis (ringworm);
• paronychia (inflammation of the periungual fold);
• trichomoniasis;
• pityriasis (pityriasis rosea);
• psoriasis;
• erythema;
• erythrasma (bacterial infection of the skin in folds);
• inflamed hemorrhoids.

Side effects of Clotrimazole ointment

The drug should be used with caution during lactation. The instructions for Clotrimazole ointment contain warnings - when using the cream for the first time, it is recommended to apply it to a small area and see the reaction

When used, possible side effects of Clotrimazole ointment:

• at the sites of application - irritation, allergic reaction (peeling, redness of the skin, hives, tingling, itching, burning, blistering);
• headache, indigestion:
• frequent urination - in the treatment of genital candidiasis.

Contraindications for Clotrimazole ointment

If there are indications for the use of the drug and hypersensitivity to the active substance, the drug should not be used. There are contraindications for Clotrimazole:

• during pregnancy in the first months;
• when drinking alcohol and antibiotics;
• child under 12 years old;
• liver diseases;
• during menstruation in case of vaginal administration.

Description of Enalapril

Enalapril is an antihypertensive and vasodilator drug. Used for CHF and hypertension. The effectiveness of the drug has been confirmed by clinical studies and has been well studied. Enalapril is produced in tablets by the companies Jaka, Krasnaya Zvezda, Ozon, Lubnypharm.

The drug blocks the enzyme that converts angiotensin 1 into angiotensin 2. The latter leads to increased blood pressure and affects the development of cardiovascular pathologies.

An antihypertensive drug reduces the concentration of aldosterone and releases substances that lower blood pressure.

The main effects of the drug Enalapril are:

1. reducing the risk of stroke;
2. increased life expectancy with CHF;
3. improvement of the condition of patients with ischemia;
4. prevention of left gastric hypertrophy in CHF;
5. improving kidney function in diabetes mellitus.

Research and effectiveness

The drug Enalapril is effective not only in lowering blood pressure, but also in preventing complications that arise against the background of hypertension.

A placebo-controlled study found that patients taking Enalapril and Lisinopril experienced sustained reductions in diastolic and systolic blood pressure.

The safety profile of the drug and its mechanism of action have been well studied. Enalapril is on the list of vital drugs.

The therapeutic effect increases with a high concentration of renin in the blood. When it decreases, the clinical effect of the drug becomes less pronounced. It may take several weeks of taking the medicine to achieve the desired effect.

Sources:

1. "Enalapril in the treatment of arterial hypertension." Tolpygina S.N. RMJ. 2008.
2. Whelton A., Dunne B. Jr., Glazer N., Kostis JB, Miller WE, Rector DJ, Tresznewsky ON "Daily hypotensive effect of a single dose of lisinopril, enalapril, and placebo in patients with mild to moderate hypertension." 1992.

Contraindications

The drug Enalapril has the following contraindications for use:

1. hypersensitivity to the composition;
2. previously suffered Quincke's edema as a result of taking ACE inhibitors;
3. renal artery stenosis;
4. kidney transplantation;
5. renal failure;
6. up to 12 years, pregnancy, lactation.

Side effects

Taking Enalapril may cause dizziness, convulsions, nervousness, nausea, headache, palpitations, and fatigue.

The following side symptoms are also likely:

1. angina pectoris;
2. decreased libido in men, impotence;
3. dry cough;
4. glossitis;
5. failure of kidney and liver function;
6. neutropenia;
7. alopecia;
8. allergic manifestations.

Dosage

For hypertension in adults, 10-20 mg/day is prescribed. This is the initial dosage, which then changes depending on the condition and severity of hypertension. The maximum dose is 40 mg.

For CHF, ½ tablet is indicated with a gradual increase in dosage. Tablets are taken 1-2 times a day. Therapy lasts 2-4 weeks. At the beginning of treatment, you need to monitor your kidney function and monitor your blood pressure.

After 65 years, the drug is prescribed at 2.5 mg, followed by an increase in dose. Treatment may be supplemented with diuretics.

Who is it suitable for?

Enalapril is used to treat arterial hypertension. The drug is prescribed when traditional remedies do not give the desired result. The drug is also used for congestive heart failure, ischemia and bronchospasm.

Adverse reactions

When administered vaginally, there may be adverse reactions. In some cases there are:

• swelling of the labia,
• increased burning sensation,
• discharge,
• painful sensations during sexual intercourse.

Side effects provoke discomfort in the vagina, irritation and redness of the mucous membranes. Signs of cystitis and urticaria rarely develop. The appearance of the above symptoms requires interrupting therapy and making an appointment with a doctor.

The drug is prescribed with caution to patients over 60 years of age and people suffering from liver failure. Vaginal tablets are not prescribed for men

For this category of patients, topical creams, ointments and systemic antifungal drugs are used.

Lorista or Losartan: which is better, reviews, difference

What is better and more effective – Losartan or Lorista? Is this the same thing or not? What do reviews from cardiologists and patients say? What is the difference between Lorista and Losartan?

Today we will talk about type 2 angiotensin blockers, which are prescribed for arterial hypertension, diabetes mellitus (impaired kidney function), enlarged left ventricle, and chronic heart failure.

Angiotensin antagonists are an alternative to ACE inhibitors when the latter demonstrate low effectiveness with drug therapy. The advantages of angiotensin antagonists include a low likelihood of side effects and high bioavailability.

The active ingredient of the drugs in question is losartan potassium. The difference lies in the composition of the excipients and the film shell. Answering the question of which is better: Lorista or Losartan, then, according to clinical studies, the first drug demonstrated greater effectiveness. However, this does not mean that Lorista is better than Losartan.

It should also be noted that Lorista is more expensive. However, reviews from patients and cardiologists often indicate that Losartan and Lorista are the same thing, so the difference between the drugs is minimal. The similarity of the drugs is also indicated by the instructions for use. —> The drugs are taken orally, regardless of food intake. Most often, it is enough to take one tablet of Lorista or Losartan per day. The maximum hypotensive effect is observed 5-6 hours after taking the tablet. It lasts for 24 hours. The drugs have a cumulative effect, so the patient feels the greatest healing effect in the 3-6th week of drug treatment.

Before you start using angiotensin II blockers, like any other drugs, you should carefully study the instructions for use. Losartan and Lorista may not be suitable if there are certain contraindications. The latter include breastfeeding, pregnancy, age under 18 years, lactose intolerance (Lorista), the use of aliskiren-containing drugs (for renal failure, diabetes), individual intolerance to the components of the tablets, severe liver dysfunction.

Analogues of Losartan and Lorista include:

• Brozaar, Lozap, Losakor, Karzartan,
• Lozarel, Zisacar, Bloktran, Cozaar,
• Lotor, Vasotens, Presartan, Renicard, etc.

The hypotensive effect of Losartan or Lorista may be enhanced when taken simultaneously with diuretics, sympatholytics, and beta-blockers. Concurrent use of drugs containing potassium or lithium requires caution.

Marina, 47 years old About a year ago, the doctor prescribed me the drug Lorista to treat arterial hypertension. However, it did not suit me for the price. I decided to replace it with a cheap analogue. I read on the forums that Losartan and Lorista are the same thing, there are practically no differences. Reviews from cardiologists and patients once again summarized that the difference between the drugs Losartan and Lorista is minimal. I took one 50 mg tablet for blood pressure. However, the starting dosage did not suit me, I had to increase it to 75 mg. At the very beginning of therapy, I encountered side effects such as cough and sore throat. A couple of days after increasing the dosage, I felt the desired hypotensive effect. After a while, I consulted with a doctor, he recommended that I reduce the dose of losartan potassium to 50 mg. Normal blood pressure levels continue to remain.

Yulia, 39 years old It turned out that I was diagnosed with chronic heart failure and periodically suffered from high blood pressure. For complex therapy, I was prescribed Losartan. Unfortunately, ACE inhibitors did not cope with the task. There was hope in Losartan, but I was confused by the price of the drug. The pharmacy advised me to purchase one of the patented names of Losartan - Lorista. I am the type of person who prefers not to save on their health. The starting dosage was 12.5 mg. Then it was gradually increased to 25 mg, and a week later - to 50 mg. I was very pleased with the mild hypotensive effect of the drug. I began to feel better. Side effects passed me by. Actually, this is another reason why I buy more expensive drugs. It is believed that the manufacturer (especially the European one) makes them cleaner, as a result they are less likely to provoke unwanted reactions. Before starting drug therapy, be sure to see your doctor. He, analyzing existing contraindications, will select the necessary drug, explain the instructions for use, and help in the fight against the disease.

Section: Medicines

Interaction with other drugs

An antifungal drug with the same active substance can inhibit the action of other drugs. In the vast majority of cases, this refers to medications for external use, while Clotrimazole in tablets belongs to a different category of drugs. If a doctor has prescribed this broad-spectrum antifungal agent to fight an infection, then, as a specialist, he knows that vaginal tablets with this active ingredient cannot be combined with Nystatin, Natamycin or other polyene antibiotics.

There is also the opposite phenomenon, when taking certain medications can greatly affect the effectiveness of Clotrimazole. Interaction with other drugs in such cases is undesirable, since the recovery process will take time; among such drugs is Dexamethasone. If there is a need to enhance the antimycotic properties of clotrimazole, then adding p-hydroxybenzoic acid propyl ester to the treatment regimen will help achieve the desired result, and the latter must be taken in high concentration.

Which drug is better

1. Both drugs are good for treating hypertension. They have a positive effect on CHF and hypertension. Their contraindications also coincide. Medicines should not be used during pregnancy, pediatrics, or severe kidney and liver diseases.
2. The drugs differ in their mechanism of action and dosage. Losartan is taken 50 mg per day, Enalapril - 20 mg 2 times. The first is considered more gentle, and the second has more serious contraindications.
3. Losartan is one of the modern drugs for the treatment of hypertension. It is well tolerated with long-term use. Both drugs must be prescribed by a doctor.

Clotrimazole ointment contraindications

To prevent negative reactions early in pregnancy, avoid the drug in any form. Start therapy no earlier than the 12th week of pregnancy. During lactation, use the ointment carefully. The most favorable form of remedy during the treatment of thrush is considered to be a cream or ointment.

We note that it is strictly forbidden to use the ointment while breastfeeding if a woman is treating the mammary glands with the drug. The components of the ointment enter the child’s body, causing poisoning in the baby and intoxication.

There are also contraindications

Also, doctors do not allow the use of ointment in the following cases:

• If a woman has kidney or liver disease.
• During the menstrual cycle. This is because the ointment can enter the body with the blood, thereby causing side effects.
• For candidiasis of the eye mucosa. Irreversible changes may develop, even causing vision loss.

Drug Lozap

At various forums dedicated to the fight against hypertension, the question often comes up in discussions: “Lozap or Lorista - which is better?” Opinions on this issue often differ, and this is not surprising, because despite the similar principle of action, drugs can affect each organism differently and the effect of their use by people who have the same diagnoses can also be different.

Interest in the topic: "Lozap or Lorista - which is better?" This is explained by the fact that these drugs contain the same active substance – losartan. Accordingly, the principle of action, indications for use, side effects and contraindications for these drugs are almost the same. By and large, they differ only in manufacturer and price category. "Lorista" is cheaper than "Lozapa". If 30 tablets of the first drug cost on average 130-150 rubles, then this amount of the second drug will cost on average about 280-300 rubles. But the final decision on prescribing Lozap or Lorista should be made only by the attending physician.

Side effects

The use of Clotrimazole as vaginal tablets may cause side effects:

• headache,
• burning, itching and swelling in the vaginal mucosa,
• discharge,
• gastralgia,
• cystitis,
• frequent urination,
• pain during intercourse,
• burning sensation in the partner's penis.

Attention!

1. To prevent recurrence of a urogenital infection, it is necessary for both sexual partners to undergo treatment.
2. Until partners complete treatment, sexual intercourse is undesirable, as it can cause re-infection.
3. Do not use the applicator during pregnancy.
4. Patients with liver failure require periodic monitoring of liver condition.
5. If there is no effect of treatment within a month, then confirmation of the diagnosis is necessary.

Interaction with other drugs

1. Vaginal administration of suppositories reduces the effectiveness of amphotericin B and other polyene antibiotics.
2. Concurrent use of nystatin weakens the effect of Clotrimazole.
3. It is allowed to combine treatment with suppositories and taking vitamin and herbal supplements.

Instructions for Losartan

The dosage and duration of use are calculated by the therapist based on the instructions. Additional methods for determining treatment tactics are interviewing the patient and studying the medical record, which lists chronic diseases. According to the annotation, if Losartan is prescribed for the first time, you need to take half the dose to find out if there is an allergy to the drug. For each disease there is a different dosage regimen.

Arterial hypertension

When prescribing Losartan for the treatment of arterial hypertension, according to the instructions, it is recommended to drink the tablets without chewing, regardless of what you eat. During the treatment period, you need to monitor the dynamics of the disease using daily blood pressure measurements. Depending on the severity of the condition, patients are prescribed to take 50 mg per day. At the discretion of the therapist, the dose can be increased to a maximum daily value of 100 mg.

Chronic heart failure

In order to reduce the risk of complications in heart failure, Losartan tablets are started with a minimum dosage of 12.5 mg/day. Every week the dose is doubled. For maintenance therapy of heart failure, do not use more than 50 mg per day. It is recommended to carry out regular monitoring with a tonometer to avoid a strong decrease in blood pressure.

Pharmacodynamics and Pharmacokinetics

This drug has a hypotensive effect immediately after the first oral administration. The effect of the drug is expressed in a decrease in systolic and diastolic blood pressure, which is achieved at most 6 hours after administration. After a day, the effect of the drug decreases. A stable hypotensive effect is observed after 3-6 weeks of taking Losartan.

In people suffering from arterial hypertension, this drug reduces proteinuria, albumin and immunoglobulin G . In addition, the active substance helps stabilize the urea content in the blood plasma without affecting the content of norepinephrine in the blood plasma.

Losartan is characterized by excellent absorption from the gastrointestinal tract. Of no less importance is the ability of the active substance to be metabolized during a single passage through the liver by carboxylation with the participation of the CYP2C9 isoenzyme, which produces an active metabolite.

Systemic bioavailability of the active substance is approximately 33%. After approximately 60 minutes, the maximum concentration of the active substance in the blood serum is reached. The bioavailability of Losartan is not affected by food intake.

The degree of penetration of Losartan through the blood-brain barrier is minimal. Almost 99% of the substance binds to albumin and other blood plasma proteins.

Plasma clearance is approximately 600 ml/min and 50 ml/min. Renal clearance is approximately 74 ml/min and 26 ml/min. After taking the drug, approximately 4% of the dose taken is excreted through the kidneys unchanged and approximately 6% is excreted through the kidneys in the form of an active metabolite.

Basically, the active substance of this drug is excreted from the body through the kidneys and intestines.

special instructions

Patients taking the drug are recommended to limit driving and operating machinery until reactions to the drug are detected (the first week of treatment).

Potassium levels in the blood should be checked regularly to rule out electrolyte imbalances in the body.

It is important to adjust the dosage of the medication when prescribed to elderly and pediatric patients suffering from pathologies of the heart and liver, low blood volume, and diabetes mellitus.

The dosage of the drug and the manufacturer influence the cost of Losartan:

• 12.5 mg No. 30 costs from 41 rubles;
• 25 mg No. 30 - from 100 rubles;
• 50 mg No. 30 - from 44 rubles;
• 100 mg No. 30 - from 70 rubles;
• Losartan N 100/25 No. 30 - from 161 rubles;
• Losartan N 50/12.5 No. 30 - from 134 rubles.

What are the most effective pills for high blood pressure?

Have you been struggling with HYPERTENSION for many years without success?

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Which high blood pressure pills are the most effective and safe? Despite the huge selection of antihypertensive drugs, it is very difficult to give an unambiguous answer to this question today. Any specialist will tell you that there is no ideal cure for hypertension. Without exception, all medications intended to normalize high blood pressure have their own contraindications and side effects. Treatment for hypertension should always be prescribed by a qualified physician. Only in this case will the patient be able to select an effective antihypertensive drug, the use of which will cause minimal harm to his body.

Types of medications

Arterial hypertension, or hypertension, is one of the most common diseases of mankind, which is the main cause of myocardial infarction and stroke. To prevent the negative consequences of the disease, hypertensive patients need to constantly monitor their blood pressure levels, and if it increases, take medications prescribed by a doctor. In severe cases of arterial hypertension, the patient has to take high blood pressure pills constantly. Today in pharmacies you can see a huge number of drugs designed to combat hypertension. The most effective among them are drugs belonging to the following groups:

• ACE inhibitors;
• diuretics;
• beta blockers;
• calcium channel blockers;
• Sartanov.

ACE inhibitors are emergency high blood pressure pills.
They are prescribed in cases of hypertensive crisis and attack, when it is necessary to quickly normalize blood pressure and pulse rate. When ingested by a patient, ACE inhibitors prevent the narrowing of venous and arterial vessels, obstruct blood flow to the heart and reduce the likelihood of hardening of the heart muscle. Diuretics are antihypertensive diuretic drugs that normalize blood pressure by increasing water levels in the body and increasing diuresis. Thanks to this, it is possible to reduce swelling in the walls of blood vessels, which makes it possible to increase the gaps inside them and normalize the level of pressure.

Beta blockers are the most effective pills for combating severe hypertension. Prescribed to people suffering from atrial fibrillation, angina pectoris, and heart failure. Additionally used as part of combination therapy after myocardial infarction.

Calcium channel blockers are a group of drugs intended for the complex treatment of hypertension. Prescribed mainly to elderly people suffering from angina pectoris, cardiac arrhythmias and atherosclerosis.

Sartans are medications that effectively reduce blood pressure and maintain it normal throughout the day. They are characterized by rapid action and do not cause severe adverse reactions from the body. This allows them to be used for the treatment of hypertension for a long time.

ACE inhibitors and diuretics

Among the most well-known representatives of the group of ACE inhibitors is the drug Capoten, the main active ingredient of which is captopril. In addition to hypertension, it is prescribed for chronic heart failure, diabetic nephropathy and problems associated with the functioning of the left ventricle in the post-infarction period. Contraindications to taking the drug are:

• hypersensitivity to its components;
• individual intolerance to ACE inhibitors;
• severe liver and kidney pathologies;
• condition after kidney transplant;
• renal artery stenosis;
• hyperkalemia;
• aortic stenosis;
• pregnancy;
• lactation period;
• age under 18 years.

Capoten is an effective but not safe medicine. In some patients, its use has side effects on the body in the form of decreased blood pressure, tachycardia, dry cough, headache, diarrhea, anemia, acidosis. In addition to Capoten, the group of ACE inhibitors includes: Enap, Lotensin, Zocardis, Prestarium, Parnavel, Diroton, Epsitron, Irumed, Quinopril, Renitek, etc. All of these drugs have different chemical compositions, but are equally effective for high blood pressure.

Tablets for high blood pressure Hypothiazide is a time-tested diuretic, the effectiveness of which has been confirmed by many hypertensive patients. The active component of the drug is hydrochlorothiazide. In medical practice, hypothiazide is used to treat arterial hypertension and edema syndrome, as well as to prevent the formation of stones in the urinary system. The drug should not be taken by people suffering from:

• individual intolerance to its components;
• hypersensitivity to sulfonamides;
• progressive diabetes mellitus;
• insufficient urine output;
• severe renal or liver failure;
• Addison's disease.

Hypothiazide is not prescribed in the first trimester of pregnancy. In the second and third trimesters, it is used when absolutely necessary. When using the drug during the lactation period, you should temporarily stop breastfeeding. In pediatric practice, this diuretic is not prescribed to children under 3 years of age.

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Patients do not always take Hypothiazide without side effects. In some cases, against the background of its use, patients develop allergic reactions, pancreatitis, cholecystitis, constipation, nephritis, arrhythmia, and water-electrolyte imbalance. Increased side effects are observed with long-term use of the drug, so treatment should be carried out under the supervision of a specialist. If Hypothiazide is intolerant, the doctor may recommend the patient another medicine belonging to the group of diuretics (for example, Indapamide, Arifon, Cyclomethiazide or Tenoric).

Beta blockers

Treatment of high blood pressure in people with concomitant cardiovascular diseases is carried out using beta-blockers. A drug belonging to this group is Atenolol, which lowers blood pressure and normalizes heart rate. Indications for its use: hypertension, diseases accompanied by abnormal heart rate and angina pectoris. The medicine should not be prescribed to patients who have:

• hypersensitivity to Atenolol;
• heart rate less than 40 beats/min;
• vasospastic angina;
• tendency to hypotension;
• heart failure of chronic or acute type;
• cardiogenic shock;
• cardiomegaly.

The drug is not used in the treatment of children and adolescents under 18 years of age, pregnant and breastfeeding women. The most pronounced side effects during treatment with Atenolol include: allergic reactions, decreased blood pressure, increased manifestations of heart failure, depression, nausea, vomiting, bronchospasm, insomnia, sexual dysfunction. In addition to this medication, the doctor may prescribe other drugs belonging to the group of beta-blockers to the patient. These are: Coronal, Carvidil, Diatrend, Bisogamma, Concor, Acridilol.

For elderly people whose hypertension develops against the background of concomitant diseases of the cardiovascular system, complex therapy is recommended, combining the simultaneous use of several groups of drugs. Calcium channel blockers are often used in this treatment. A well-known representative of this group is Amlodipine, a drug widely used in the treatment of hypertension, vasospathic angina and exertional angina. The medicine is contraindicated in the following conditions:

• pregnancy and lactation;
• under 18 years of age;
• individual intolerance to Amlodipine;
• low blood pressure;
• collapse;
• unstable angina;
• cardiogenic shock.

When taking Amlodipine, it should be taken into account that it can cause undesirable consequences in the patient in the form of pain in the epigastric region, nausea, fatigue, palpitations, shortness of breath, and allergic reactions. To ensure that drug treatment does not have a negative impact on the patient’s well-being, it must be taken under the supervision of a specialist. In addition to Amlodipine, calcium channel blockers such as Corinfar, Phenigidine, Tenox, Dialtizem, Calcigard, and Diacordin have proven themselves to be effective.

Group of sartans

Some experts are confident that the best blood pressure pills are sartans, which include Losartan. This drug is used in the treatment of hypertension and chronic heart failure. Contraindications to its use are:

• hypersensitivity to the components of the drug;
• age under 18 years;
• period of gestation and lactation;
• dehydration of the body;
• severe liver pathologies;
• hyperkalemia.

Losartan is usually well tolerated by patients. Side effects from its use occur in approximately 5% of people and are characterized by tachycardia, nausea, diarrhea, headache, insomnia, muscle cramps, and peripheral edema. The low likelihood of developing unwanted reactions allows you to take Losartan for as long as necessary. In case of intolerance, the doctor may prescribe the patient other drugs from the sartan group (Tvinsta, Diovan, Valz, Atakand, Kozar). All of them have a similar effect to Losartan and effectively reduce high blood pressure.

Often, to treat severe hypertension, a specialist prescribes a patient treatment consisting of several antihypertensive drugs belonging to different groups.

This approach allows you to enhance the effect of the tablets and achieve a faster reduction in blood pressure. Before prescribing a particular drug to a patient, the doctor carefully examines his cardiogram and test results, and also takes into account his age and general health.

Pharmacological properties

Pharmacodynamics

Losartan Canon is an antihypertensive drug. Its active ingredient, losartan potassium, is a selective antagonist of angiotensin II receptors (type AT1). Angiotensin II is a powerful vasoconstrictor, the main active hormone of the renin-aldosterone-angiotensin system (RAAS) and a decisive pathophysiological link in the development of arterial hypertension. As a result of selective binding of angiotensin II to AT1 receptors, which are located in the smooth muscle tissues of blood vessels, in the heart, adrenal glands and kidneys, it narrows the lumen of blood vessels (especially arteries), releases aldosterone and performs other important biological functions. Angiotensin II also potentiates the proliferation of smooth muscle cells. Losartan, unlike certain peptide angiotensin II antagonists, does not have agonist effects. The action of the substance and its pharmacologically active metabolite (E-3174) is aimed at blocking all physiological effects of angiotensin II, in vitro and in vivo, regardless of the source or route of synthesis.

Losartan is characterized by selective binding to AT1 receptors; it does not affect the receptors of other hormones and ion channels that are actively involved in regulating the function of the cardiovascular system. It does not inhibit the angiotensin-converting enzyme (ACE) responsible for the destruction of bradykinin. Therefore, the development of bradykinin-mediated and other effects not directly related to AT1 receptor blockade are not related to the action of losartan. Thus, peripheral edema was observed when taking losartan in 1.7% of cases, and in the placebo group in 1.9%.

When losartan is taken orally, TPVR (total peripheral vascular resistance), the concentration of aldosterone and norepinephrine in the blood, blood pressure (BP) and pressure in the pulmonary circulation decrease, and a diuretic effect appears. Afterload is reduced, the risk of developing myocardial hypertrophy is reduced, and in case of chronic heart failure, tolerance to physical activity increases. Losartan increases plasma renin activity, causing an increase in the content of angiotensin II in the blood plasma.

A single dose of Losartan Canon provides a maximum reduction in systolic and diastolic blood pressure after 6 hours, then the antihypertensive activity of the drug gradually decreases over 24 hours. With regular use of losartan, hypotensive activity and a decrease in plasma aldosterone concentrations appear after 14 and 42 days of therapy, indicating effective blockade of angiotensin II receptors. 3 days after replacing losartan with another drug, a decrease in plasma renin activity and angiotensin II levels is observed to the values ​​noted before the start of treatment.

The activity of the E-3174 metabolite is 10–40 times higher than the activity of losartan. The affinity of the active substance and its active metabolite for AT1 type receptors is higher than for AT2 type receptors.

Pharmacokinetics

After oral administration, losartan is well absorbed from the gastrointestinal tract. At the same time, with the participation of the CYP2C9 isoenzyme, the active substance is metabolized by carboxylation during the first passage through the liver to form the active metabolite E-3174.

Systemic bioavailability is approximately 33%. The maximum concentration (Cmax) in the blood serum of losartan is reached after 1 hour, the active metabolite - after approximately 3-4 hours. Concomitant food intake does not affect the bioavailability of losartan.

Plasma protein binding of losartan and E-3174 is 99% (mainly with albumin).

Vd (volume of distribution) – 34 l.

Losartan practically does not cross the blood-brain barrier.

In doses up to 200 mg, losartan and its active metabolite exhibit linear pharmacokinetics. During therapy of 100 mg 1 time per day, clinically significant accumulation in the blood plasma of neither losartan nor its active metabolite occurs.

Approximately 14% of the dose of losartan is transformed into the active metabolite E-3174. In addition, as a result of hydroxylation of the butyl side chain, two main metabolites and one minor metabolite are formed - N-2-tetrazole glucuronide. They do not have biological activity.

Plasma clearance of losartan is about 600 ml/min, E-3174 – 50 ml/min, renal clearance is 74 and 26 ml/min, respectively.

About 4% of the dose of losartan taken orally is excreted unchanged through the kidneys, including about 6% in the form of an active metabolite.

Plasma concentrations of the drug decrease polyexponentially, the final half-life (T1/2) of losartan is approximately 2 hours, E-3174 is 6–9 hours.

The drug is excreted through the intestines with bile up to 58% and kidneys - about 35%.

In elderly men with arterial hypertension, the concentration levels of losartan and the E-3174 metabolite in the blood plasma do not differ significantly from these indicators in younger male patients with hypertension.

In case of arterial hypertension in women, the plasma concentration of losartan is 2 times higher than in men, and the level of the active metabolite is the same in men and women. This pharmacokinetic difference is not clinically significant.

In patients with mild to moderate alcoholic cirrhosis of the liver, the concentration of losartan in the blood plasma is 5 times higher than in young healthy male volunteers, for the active metabolite this figure is 1.7 times.

In cases of impaired renal function with creatinine clearance (CC) above 10 ml/min, plasma concentrations of losartan are comparable to those in individuals with unchanged renal function. In patients undergoing hemodialysis, the total concentration of losartan in the blood plasma increases approximately 2 times. Plasma concentrations of the active metabolite do not change in patients with impaired renal function or on hemodialysis. The drug is not removed by hemodialysis.

Drug interactions

The interaction of the active substance of the drug with other pharmacological agents is described in the instructions for use of Losartan Canon 50 mg / 100 mg. Thus, no significant influence on each other of losartan and warfarin, hydrochlorothiazide, digoxin, ketoconazole, phenobarbital, cimetidine, or erythromycin was detected.

Fluconazole and rifampicin can reduce the concentration of the active metabolite losartan. Its use in conjunction with other drugs that lower high blood pressure is not prohibited, but at the same time the latter can increase the effectiveness of losartan.

Tricyclics, antipsychotics, baclofen, amifostine, and other pharmacological agents that directly or indirectly lower blood pressure can also enhance the effect of taking Losartan Canon, increasing the risk of low blood pressure {amp}gt;

than 20% of the original / normal values. Concomitant use of potassium-sparing diuretics, potassium salts and potassium supplements can increase the amount of potassium ions in the plasma. Parallel use with NSAIDs can reduce the activity of losartan.

In patients with renal dysfunction, simultaneous use of angiotensin II antagonists, diuretics, and NSAIDs may worsen their functioning, leading to sudden severe impairment or cessation of renal function and an increase in potassium levels.

This combination is especially dangerous for older people. The combined use of lithium and losartan requires regular monitoring of the concentration of the former in the blood, since there is evidence of the toxicity of combining lithium with ACE inhibitors, and in extremely rare cases, lithium with angiotensin II receptor antagonists.

The results of using losartan with diuretics are cumulative. The combined use of beta-blockers and sympatholytics mutually increases the effect of taking each of them. The decision to double block the RAAS should be made for each patient individually, since in patients with atherosclerosis, heart failure, diabetes mellitus, the combination of, for example, an angiotensin II receptor antagonist with aliskiren significantly increases the risk of excessive decrease in blood pressure, fainting, increased potassium levels in the bloodstream and impaired renal function.

can be used simultaneously with other antihypertensive drugs.

There were no clinically significant drug interactions between losartan and hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole and erythromycin.

Rifampicin and fluconazole have been reported to reduce plasma concentrations of the active metabolite. The clinical significance of these interactions is currently unknown.

As with the use of other drugs that block the formation of angiotensin II and its effects, the concomitant administration of potassium-sparing diuretics (spironolactone and eplerenone, triamterene, amiloride), potassium supplements and salts containing potassium may lead to an increase in the content of potassium ions in the blood serum.

Antihypertensive drugs may increase the antihypertensive effect of losartan.

Tricyclic antidepressants, antipsychotics, baclofen, amifostine, which reduce blood pressure as a main or side effect and may increase the risk of arterial hypotension, can also enhance the antihypertensive effect of losartan.

With simultaneous use of angiotensin II receptor antagonists and nonsteroidal anti-inflammatory drugs (NSAIDs) (including selective cyclooxygenase-2 inhibitors, acetylsalicylic acid as an anti-inflammatory agent), the antihypertensive effect of losartan may be reduced.

In patients with impaired renal function, concomitant use of angiotensin II receptor antagonists or diuretics and NSAIDs may cause a further deterioration of renal function, including acute renal failure and an increase in serum potassium. This combination should be used with caution, especially in elderly patients.

With simultaneous use of lithium with ACE inhibitors, a reversible increase in the concentration of lithium in the blood serum and the development of toxicity were recorded; in very rare cases this has been observed with the use of angiotensin II receptor antagonists.

Mutually enhances the effect of beta-blockers and sympatholytics; combined use of losartan with diuretics causes an additive effect.

Dual blockade of the RAAS (eg, by combining an angiotensin II receptor antagonist with an ACE inhibitor or aliskiren) in patients with established atherosclerosis, heart failure, or diabetes mellitus with end-organ damage is associated with a higher incidence of hypotension, syncope, hyperkalemia, and dysfunction. kidneys (including the development of acute renal failure) compared with the use of a single-component blockade of the RAAS.

The issue of using double blockade of the RAAS should be decided in each case individually and with careful monitoring of blood pressure, water-electrolyte balance of the blood and renal function.

Hydrochlorothiazide

With thiazide diuretics, drugs such as ethanol, barbiturates and narcotics may potentiate the risk of orthostatic hypotension.

Hypoglycemic agents (oral and insulin) - dosage adjustment of hypoglycemic agents may be required. Metformin should be used with caution due to the risk of lactic acidosis due to possible renal failure associated with hydrochlorothiazide.

Other antihypertensive agents—additive effects may occur. Corticosteroids, ACTH (adrenocorticotropic hormone) - a marked decrease in electrolyte levels, in particular hypokalemia.

Pressor amines (eg, epinephrine, norepinephrine) - decreased response to pressor amines.

Muscle relaxants of a non-depolarizing type of action (for example, tubocurarine) - enhance the effect of muscle relaxants.

Lithium - diuretics reduce the renal clearance of lithium and increase the risk of lithium toxicity; simultaneous use is not recommended.

NSAIDs (including cyclooxygenase-2 inhibitors) - may reduce the diuretic, natriuretic and antihypertensive effects of diuretics.

Anticholinergics (atropine, biperiden) - increase the bioavailability of thiazide diuretics due to a decrease in gastrointestinal motility and the rate of gastric emptying.

Cytotoxic drugs (cyclophosphamide, methotrexate) - Thiazides can reduce the renal excretion of cytotoxic drugs and stimulate their myelotoxic effect.

Salicylates - when taking high doses of salicylates, hydrochlorothiazide can enhance their toxic effect on the central nervous system.

Methyldopa: Cases of hemolytic anemia have been reported separately with the concomitant use of hydrochlorothiazide and methyldopa.

Cyclosporine - co-administration with cyclosporine may increase the risk of hyperuricemia and gout-like complications.

Cardiac glycosides - Thiazide-stimulated hypokalemia or hypomagnesemia may contribute to the development of cardiac arrhythmias when co-administered with cardiac glycosides.

antiarrhythmics (eg, quinidine, hydroquinidine, disopyramide, amiodarone, sotalol) some antipsychotics (eg, thioridazine, chlorpromazine, levomepromazine, trifluoperazine, cyamemazine, sulpiride, sultopyride, amisulpiride, tiapride, pimozide, haloperidol, droperidol);

Calcium salts - thiazide diuretics can increase the calcium level in the blood serum due to a decrease in its excretion. If it is necessary to use calcium supplements, the dose is selected under the control of calcium levels in the blood serum.

Vitamin D - increases the risk of hypercalcemia.

Interference with Laboratory Tests - Due to their effects on calcium excretion, thiazides may interfere with tests of parathyroid function.

Carbamazepine - increases the risk of symptomatic hyponatremia. Serum sodium levels must be monitored.

Iodine contrast agents - with dehydration caused by taking diuretics, the risk of developing acute renal failure increases, especially when high doses of iodine-containing drugs are administered. Before administering such drugs, the patient must be rehydrated.

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Amphotericin B, corticosteroids, adrenocorticotropic hormone and laxatives - when used together, hydrochlorothiazide can aggravate electrolyte imbalances, especially causing the development of hypokalemia.

The effect of the drug is enhanced when taken simultaneously with diuretics.

The antihypertensive effect is enhanced by simultaneous use of diuretics, adrenergic blockers and sympatholytics. The effect is reduced when the drug is used together with the substances rifampicin, fluconazole or NSAIDs.

Features of the drug Lozap

To determine whether Lozap and alcohol can be combined, it is necessary to consider the mechanism of action of the drug. The medication belongs to the category of angiotensin II receptor antagonist drugs.

Lozap is an antihypertensive drug with a mild diuretic effect.

The main effect of Lozap is antihypertensive and mild diuretic. The effect is achieved by blocking angiotensin II receptors, which prevents the substance from binding to AT1 receptors.

The following changes occur with the use of Lozap:

1. the concentration of the hormone adrenaline decreases;
2. aldosterone levels decrease;
3. pressure in the pulmonary circulation decreases;
4. there is a mild diuretic effect.

The use of Lozap in accordance with the doctor’s recommendations serves as a reliable prophylaxis against thickening and enlargement of the myocardium. Patients reported increased endurance during exercise, especially among those with heart problems.

Chemical composition of the drug

To assess whether Lozap can be taken with alcohol, it is worth studying the composition of the medicine. The main active ingredient of the drug is losartan potassium. Depending on the dosage, each tablet may contain 12.5, 50 or 100 mg of the active ingredient.

Losartan is the structural formula of the active substance of the drug Lozap

In addition to the active ingredients, Lozap includes the following components:

• microcrystalline cellulose;
• mannitol;
• crospovidone;
• silica;
• magnesium stearate;
• talc;
• dye;
• macrogol 6000.

Lozapa tablets are film-coated. The drug is well absorbed through the walls of the gastrointestinal tract. During metabolism, the active substance is converted into an even more active metabolite than losartan itself. The bioavailability of the product is 33%. The maximum content of the active substance in the blood is achieved after 1-4 hours.

The active compounds of the drug fully bind to blood proteins. The medicine is well distributed. The maximum distribution is 34 l.

About 14% of the substance is converted into an active metabolite. In the process, several metabolites are formed, including inactive ones.

Excretion is carried out with urine and feces. The half-life is 2-9 hours.

The recommended dosage and dosage regimen is usually not affected by the patient's age. In women, the concentration of the active component in the blood is higher than in men.

When assessing whether it is possible to combine Lozap and alcohol, it is worth considering the fact that among patients suffering from liver cirrhosis associated with alcohol dependence, the concentration of losartan in the blood plasma was 1.7-5 times higher than in healthy people.

In what situations should Lozap be used?

The compatibility of Lozap and alcohol is often determined by the disease itself for which the drug was prescribed. Alcohol may be contraindicated due to the risk of exacerbation of the underlying disease.

Lozap is used for cardiovascular diseases associated with high blood pressure

Lozap is prescribed by a doctor after a medical examination.

The use of the medication is necessary in the presence of the following conditions and diseases:

1. long-term hypertension;
2. stroke prevention;
3. complex therapy of chronic heart failure;
4. individual intolerance to other drugs that lower blood pressure;
5. kidney diseases;
6. low effectiveness of the use of other antihypertensive drugs;
7. type 2 diabetes mellitus.

Lozap can be taken for both preventive and therapeutic purposes. The doctor determines the dosage individually.

It is necessary to refuse therapy with Lozap if you have the following conditions and pathologies:

• hyperkalemia;
• chronic form of gastritis;
• low blood pressure;
• pregnancy;
• lactation;
• age under 18 years;
• dehydration;
• acute heart failure.

Doctors' opinion

Analogs of Lozap differ in both price and active ingredient. Therefore, the choice of drug depends on several indicators:

• results of tests and medical examinations;
• presence of chronic diseases;
• the presence of intolerance to one or another component.

Also, at the doctor’s appointment, you should tell what medications you are currently taking, whether you are planning a pregnancy, and whether a decrease in concentration will affect your everyday life. By collecting a complete medical history of the patient, the doctor can choose the best treatment option.

Lozap is a modern drug that lowers blood pressure. It is safe because the active substance is of natural origin. But, in this regard, it can also cause allergies. If you experience side effects, tell your doctor and he will prescribe an effective analogue.

To treat arterial hypertension, drugs of different pharmacological groups are used. Drugs belonging to the category of angiotensin two inhibitors performed especially well. Lorista belongs to such medicines.

Description of the rhythm norm and its analogues

At the moment, cardiac problems have become one of the main serious diseases of mankind. This is due to their wide distribution, lethality and significant impact on people’s livelihoods. That is why many pharmacological companies create many different drugs every year to normalize the functioning of the heart muscle. The same Ritmonorm has analogues in different groups of medications, which is why patients can choose exactly the type of medication that is most suitable for them due to their specific characteristics of the body.

Description of Rhythmonorma

The drug Ritmonorm is an antiarrhythmic drug for the treatment of certain cardiac diseases. The action of the medication is based on the properties of propafenone, the main component that can normalize the functioning of myocardial membranes.

The use of Rhythmonorm reduces spontaneous excitability by increasing the sensitivity threshold of the heart muscle. The same applies to electrical excitability, which is controlled by raising the threshold of ventricular fibrillation.

Ritmonorm does not cause adverse reactions in the left ventricle of the heart. That is why this structure does not lose its functionality and continues to operate as before. Problems can arise only in those patients whose ventricular function is significantly impaired. It is possible that heart function may deteriorate while taking the drug in a person with severe heart failure.

Analogues of the drug include Lidocaine, Afobazole, Zelenin drops, Asparkam, etc.

Indications for use of Ritmonorma

The instructions for use allow you to take a drug such as Ritmonorm even as a prophylaxis for people who are susceptible to the problem of heart rhythm disturbances.

Ritmonorm may be prescribed in the following cases:

• with paroxysmal supraventicular tachyarrhythmias;
• with venticular arrhythmias.

The form of the disease does not play a significant role, since Ritmonorm does not have any warnings in this regard. In some cases, the drug should be taken as an addition to the standard course of treatment if it does not give the desired result and does not significantly improve the condition of the sick person. Thus, by combining different medications, it is possible to eliminate arrhythmia and normalize the functioning of the heart muscle.

Contraindications Ritmonorma

First of all, Ritmonorm should not be taken by those patients who are intolerant to its main component – ​​propafenone. In such cases, the drug can provoke severe allergic reactions.

Doctors also do not recommend taking Ritmonorm in the following cases:

• with Brugada syndrome;
• with organic pathologies of the heart muscle;
• with a pronounced decrease in heart rate;
• when there are changes in the water-electrolyte balance in cases where it cannot be normalized;
• with a significant decrease in blood pressure;
• with sinus node dysfunction;
• with blockade of the His complex;
• with atrioventricular block;
• for atrial conduction disorders, etc.

Rytmonorm should be taken with caution in many cases with heart problems. That is why you should not buy the drug yourself without consulting your doctor. It is also worth noting that Ritmonorm is often not used in pediatrics and pediatric cardiology.

Methods of using Ritmonorm

Ritmonorm has a tablet form of release, which is why it is taken orally. There is no need to crush the medicine. It is best to take the tablets after meals with plenty of liquid.

Treatment with Ritmonorm is carried out with a dosage of 150 milligrams three times a day. If necessary, you can change the dose after three days to 300 milligrams twice a day. If this amount of the drug has been prescribed, but it does not bring the desired effect, the maximum dose that can be increased to is 300 milligrams three times a day.

In some cases, the dosage must be selected individually depending on other human diseases, primarily those affecting the heart and cardiovascular system. You should also be careful when taking the drug for people whose body weight does not exceed 70 kilograms.

Ritmonorm reviews are generally positive and quite good.

Possible adverse reactions of Ritmonorma

Patients note an improvement in their condition immediately after starting to take the drug. If Ritmonorm does not bring the desired effect, there are some of its analogs that should be selected together with your doctor.

If myocardial rhythm is disturbed, it is mandatory to take any cardiac medications. Each of them has its own side reactions, since human organisms are individual special structures that are not able to react equally to the same substances. This also applies to taking Ritmonorm, which in some fairly rare cases can cause an adverse reaction in the body of a sick person. Doctors note the following adverse reactions:

• the occurrence of anemia, poor blood clotting, leukopenia and hematomas under the skin;
• sleep disturbances, anxiety, confusion and some other neurological symptoms;
• sensations of a strong heartbeat, cardiac conduction disturbances, disruptions in the functionality of the heart muscle;
• the occurrence of dyspnea;
• disorders of the gastrointestinal tract and digestive system;
• increased levels of certain substances in the body (AST, ALT, phosphatase);
• the appearance of jaundice, cholestasis and hepatitis;
• the occurrence of myasthenia gravis, muscle cramps;
• impaired renal function;
• manifestation of erectile dysfunction, etc.

About 5 different studies have confirmed that the components of Ritmonorm provoke some of the above symptoms. The frequency of their occurrence is not more than a fraction of a percent, but it cannot be ignored.

Some features of using Ritmonorm

Studies that would confirm the clear impact of Ritmonorm on the body of a woman and fetus have not been conducted. What specific side effects the drug causes in this group of patients cannot yet be accurately predicted. That is why the appointment in such cases should be carried out only if certain vital signs exist, under the supervision of experienced doctors.

Many patients are interested in whether Ritmonorm can be taken with certain medications. The answer to this question is very difficult, since each group of medications should be considered separately. It is worth noting the following features of Ritmonorm:

• ability to raise serum levels of Digoxin and Warfarin;
• the possibility of increasing the serum concentration of Metoprolol and Propranolol;
• complete contraindication with simultaneous use of Ritonavir;
• the need to adjust the dose taken together with Amiodarone, etc.

There are many other combinations of Ritmonorm and certain drugs that are worth paying attention to. That is why it is very important for cardiologists and attending physicians to always fully name all the medications that the patient is taking.

It is worth remembering that if the heart rhythm is disrupted once, it can happen again, so it is very important to carry out treatment even as a preventive measure.

Analogues of Ritmonorm

There are many different drugs that can normalize a person’s heart rate. That is why Ritmonorm has a lot of analogues, among which doctors identify the following drugs:

• Soritmik;
• Validol;
• Rhythmcore;
• Propanorm;
• Bisoprolol;
• Lidocaine;
• Afobazole;
• Zelenin drops;
• Asparkam;
• Arythmil, etc.

The above medications have their own characteristics of action, which is why their use should be strictly individual.

The instructions for use of the drug Soritmic indicate the effect on heart rhythm within 1 hour after administration. Increasing the dose does not always lead to an improvement in the effect of this drug. You can take Soritmic in the following cases:

• for tachyarrhythmias;
• for ventricular heart rhythm disturbances;
• with atrial fibrillation.

Doctors recommend taking 1-2 tablets for arrhythmia. This remedy slightly dilates blood vessels and normalizes heart function. The drug irritates the receptors under the tongue, which causes an immediate vascular reaction to the active ingredients of the drug.

Rhythmocor refers to drugs with a combined effect on the human body. It stabilizes membranes, is an antioxidant and helps normalize the rhythm of the heart muscle. Rhythmocor significantly increases the effectiveness of some other cardiac medications. The maximum concentration of the drug in the body is reached 1-1.5 hours after administration. Rhythmocor is almost completely eliminated from the human body 48 hours after consumption. In this case, metabolism occurs primarily in the kidneys. Rhythmocore is available in various forms, including capsules and injections. In general, the drug is well tolerated by patients and causes almost no adverse reactions. Rhythmocor is indicated in the following cases:

• for arrhythmias due to decreased levels of Potassium and Magnesium;
• with extrasystolic arrhythmias;
• for arrhythmias caused by taking glycosides;
• as a prophylactic agent.

Propanorm belongs to a group of drugs that block sodium channels. The effect reaches its maximum just an hour after ingestion. Propanorm reaches its maximum effect after 2-3 hours. The drug is completely eliminated from the human body after 8-12 hours. Propanorm has quite a number of contraindications, which is why it must be taken with caution in many cases. The effectiveness and safety of use in patients under 18 years of age has not yet been studied. It is better not to take Propanorm during pregnancy. First of all, this concerns the first trimester of gestation.

Bisoprolol is most often prescribed for the prevention of tachycardia and the prevention of angina pectoris. The dosage is selected strictly individually. Bisoprolol is most often prescribed to be taken only once a day, in the morning before meals. The course of therapy is usually long-term or permanent. Bisoprolol is available in tablet form, 0.005 or 0.01 grams per unit. There are many contraindications to taking this drug, primarily associated with severe heart disease. Bisoprolol also has an analogue, Concor.

Another analogue of Ritmonorm is Lidocaine. This anesthetic also has an antiarrhythmic effect. Lidocaine causes blockade of sodium channels of excitable membranes of neurons and membranes of cardiomyocytes. The drug is used in the form of injections. When used intravenously, the effect is achieved in 45-90 seconds, when used intramuscularly - in 10-20 minutes. Lidocaine is best taken in medium therapeutic doses.

Afobazole is not a purely antiarrhythmic drug. It is used for many diseases and pathologies. Afobazole should not be taken by women under 18 years of age or during pregnancy and breastfeeding. Therapy is also contraindicated for people with hypersensitivity to the components of the drug. Afobazole has rare side effects.

Zelenin drops are distinguished by the fact that they belong to herbal medicines. Most often, the drug is prescribed for VSD, increased excitability, colic in the liver and kidneys. Zelanin drops are only an aid for arrhythmias and heart problems. The main side effects of the drug are problems with the gastrointestinal tract. Zelanin drops should not be used by children under 12 years of age. The drops are released in bottles of different sizes.

Asparkam is used for various heart diseases. Indications are also arrhythmias associated with magnesium and potassium deficiency. Asparkam should not be taken if there is loss of cardiac function. It is also not recommended to carry out therapy with it in severe myasthenia gravis, even in cases where the heart rhythm is disrupted. Asparkam causes adverse reactions in some cases, so you should monitor your health when taking it.

Arythmil is also a good drug that normalizes heart function, the instructions for use of which allow it to be taken for many other heart diseases.

Compound

The composition of this drug includes the active substance - losartan potassium in the amount of 25 mg / 50 mg / 100 mg, depending on the form of release of the drug.

The following are used as excipients:

• lactose monohydrate;
• microcrystalline cellulose;
• pregelatinized starch;
• magnesium stearate in quantity.

The shell includes:

• polyvinyl alcohol;
• titanium dioxide;
• macrogol;
• talc.

Pharmacological characteristics

The instructions for Losartan note that the drug is classified as a specific angiotensin II receptor antagonist. The drug Losartan, which has a hypotensive effect, reduces total peripheral vascular resistance.

It is involved in lowering blood pressure, reducing the content of adrenaline and aldosterone in the blood, reducing the load on the heart muscle, and also providing a diuretic effect. Losartan helps increase exercise tolerance in patients with signs of heart failure, and also prevents the development of myocardial hypertrophy.

The principle of action of the drug

The product is available in the form of film-coated tablets. The surface is painted light yellow. The tablets are oval in shape, slightly convex. There is a chamfer on one of the sides.

The therapeutic effect is achieved due to the presence of the active substance losartan potassium . Each tablet contains this element in the amount of 12.5, 25, 50 or 100 mg.

Additionally, the central part contains microcrystalline cellulose, magnesium stearate, anhydrous colloidal silicon dioxide, pregelatinized starch, cellactose. The film shell contains dye E104, titanium dioxide, talc, hypromellose, propylene glycol.

Losartan potassium blocks all hemodynamic and proliferative effects of angiotensin type II. The active substance selectively binds to AT1 receptors. It does not affect the activity of other receptors and does not disrupt the production of hormones involved in regulating the functioning of the cardiovascular system.

The main component does not suppress the activity of the kininase two enzyme, on which the production of bradykinin, which expands the arterial lumen and reduces pressure in the bloodstream, depends.

Regular use of tablets leads to the following results:

• the total peripheral vascular resistance decreases;
• afterload on the myocardium decreases;
• excess fluid is removed from the body;
• pressure in the pulmonary circulation is normalized;
• tolerance to physical activity increases in patients with chronic heart failure.

Lorista prevents hypertrophic changes in the myocardium. The medication affects systolic and diastolic blood pressure. The effect of the medicine lasts for 24 hours after administration. The maximum hypotensive effect is observed 5-6 hours after taking the tablet.

The cost of Lorist varies from 140 to 650 rubles per package. Much depends on the concentration of the active substance and the pricing policy of the distributor. So, for 30 tablets with a dosage of 12.5 mg you will have to pay 145 rubles, for 25 mg - 190 rubles. A package of Lorista of 30 pieces with a potassium losartan concentration of 50 mg costs 200 rubles. The price of 100 mg tablets is 230 rubles for 30 pieces and 650 rubles for 90.

Pharmacotherapeutic group:

angiotensin II receptor blocker

ATX code: S09CA01

Pharmacological properties

Pharmacodynamics

The antihypertensive drug is a specific angiotensin II receptor antagonist (ATI subtype). Does not inhibit kinase II, an enzyme that destroys bradykinin. Reduces total peripheral vascular resistance (TPVR), blood concentrations of adrenaline and aldosterone, blood pressure (BP), pressure in the pulmonary circulation; reduces afterload and has a diuretic effect. Prevents the development of myocardial hypertrophy, increases exercise tolerance in patients with heart failure.

After a single dose, the hypotensive effect (systolic and diastolic blood pressure decreases) reaches a maximum after 6 hours, then gradually decreases over 24 hours.

The maximum hypotensive effect is achieved 3-6 weeks after starting the drug.

Pharmacological data indicate that the plasma concentration of losartan in patients with liver cirrhosis is significantly increased, so patients with a history of liver disease should be used at a lower dose.

Pharmacokinetics

Losartan is rapidly absorbed from the gastrointestinal tract. Bioavailability is about 33%. It has a “first pass” effect through the liver, is metabolized by carboxylation with the participation of the 2C9 isoenzyme of cytochrome P450 to form an active metabolite. Communication with blood plasma proteins – 99%.

The time to reach the maximum concentration of losartan is 1 hour, the active metabolite is 3-4 hours, after oral administration. The half-life is 1.5 - 2 hours, and its main metabolite is 6-9 hours, respectively. About 35% of the dose is excreted in the urine, about 60% through the intestines.

Indications for use

• Arterial hypertension;
• Chronic heart failure (as part of combination therapy, with intolerance or ineffectiveness of therapy with ACE inhibitors).

Contraindications

• Hypersensitivity to the components of the drug; –
• Arterial hypotension;
• Hyperkalemia;
• Dehydration;
• Pregnancy and lactation;
• Age up to 18 years (efficacy and safety have not been established).

Directions for use and doses

Losartan is taken orally, regardless of food intake, the frequency of administration is 1 time per day.

For arterial hypertension, the average daily dose is 50 mg. In some cases, to achieve a greater effect, the dose is increased to 100 mg in two doses or once a day.

The starting dose for patients with heart failure is 12.5 mg once daily. Typically, the dose is increased at weekly intervals (i.e., 12.5 mg/day, 25 mg/day, and 50 mg/day) to a mean maintenance dose of 50 mg once daily, depending on patient tolerance.

When prescribing the drug to patients receiving diuretics in high doses, the initial dose of Losartan should be reduced to 25 mg 1 time per day. No dose adjustment is required for elderly patients or patients with impaired renal function, including patients on hemodialysis. Patients with impaired liver function should be prescribed lower doses of Losartan.

In elderly patients, as well as in patients with impaired renal function, including patients on dialysis, there is no need to adjust the initial dose.

Use in pediatrics

The safety and effectiveness of the drug in children have not been established.

Side effect

* Side effects are marked, the incidence of which is comparable to placebo.

The association of side effects occurring in less than 1% of cases with the use of losartan has not been proven.

In most cases, Losartan is well tolerated, side effects are transient and do not require discontinuation of the drug.

From the nervous system and sensory organs:

1% or more – dizziness, asthenia, headache, fatigue, insomnia; less than 1% – anxiety, sleep disturbance, drowsiness, memory disorders, peripheral neuropathy, paresthesia, hypoesthesia, migraine, tremor, ataxia, depression, syncope, tinnitus, taste disturbance, vision changes, conjunctivitis.

From the respiratory system:

1% or more – nasal congestion, cough*, upper respiratory tract infections (fever, sore throat, sinusopathy*, sinusitis, pharyngitis), less than 1% – dyspnea, bronchitis, rhinitis.

From the gastrointestinal tract:

1% or more – nausea, diarrhea*, dyspeptic symptoms*, abdominal pain; less than 1% - anorexia, dry mouth, toothache, vomiting, flatulence, gastritis, constipation.

From the musculoskeletal system:

1% or more – convulsions, myalgia*, pain in the back, chest, legs; less than 1% - arthralgia, pain in the shoulder, knee, arthritis, fibromyalgia.

From the cardiovascular system:

orthostatic hypotension (dose-dependent), palpitations, tachycardia or bradycardia, arrhythmias, angina pectoris, anemia.

From the genitourinary system:

less than 1% – urinary urgency, urinary tract infections, renal dysfunction, decreased libido, impotence.

From the skin:

less than 1% – dry skin, erythema, flushing, photosensitivity, increased sweating, alopecia.

Allergic reactions:

less than 1% – urticaria, rash, itching, angioedema, incl. face, lips, pharynx and/or tongue.

Other:

hyperkalemia (serum potassium more than 5.5 mmol/l).

Overdose

Symptoms: marked decrease in blood pressure, tachycardia; bradycardia may appear due to parasympathetic (vagal) stimulation.

Treatment: forced diuresis, symptomatic therapy; hemodialysis is ineffective.

Interaction with other drugs

May be prescribed with other antihypertensive drugs. There were no clinically significant interactions with hydrochlorothiazide, digoxin, indirect anticoagulants, cimetidine, or phenobarbital. In patients with dehydration (previous treatment with large doses of diuretics), a pronounced decrease in blood pressure may occur. Strengthens (mutually) the effect of other antihypertensive drugs (diuretics, beta-blockers, sympatholytics). Increases the risk of hyperkalemia when used together with potassium-sparing diuretics and potassium supplements.

special instructions

It is necessary to correct dehydration before prescribing Losartan or begin treatment with the drug at a lower dose. Drugs that affect the renin-angiotensin system may increase blood urea and serum creatinine concentrations in patients with bilateral renal stenosis or arterial stenosis of a solitary kidney. During the treatment period, the concentration of potassium in the blood should be regularly monitored, especially in elderly patients with impaired renal function.

Pregnancy and lactation

There are no data on the use of losartan during pregnancy. However, it is known that drugs that directly affect the renin-angiotensin system, when used in the second and third trimesters of pregnancy, can cause developmental defects or even death of the developing fetus. Therefore, if pregnancy occurs, Losartan should be stopped immediately.

When prescribed during lactation, a decision should be made to stop breastfeeding or to stop treatment with Losartan.

Release form

Film-coated tablets, 50 mg. 10 tablets in a strip of aluminum foil, 1 or 3 strips in a cardboard box along with instructions for use.

Storage conditions

In a dry place, protected from light and out of reach of children, at a temperature not exceeding 25° C.

Best before date

2 years. Do not use after the expiration date stated on the package.

Conditions for dispensing from pharmacies

On prescription

Manufactured by Okasa Pharma Ltd., under the technical supervision of Cipla Ltd., Mumbai - 400001, India Quality claims should be sent to: 107120, Moscow, st. Sergius of Radonezhsky, 29/31 building 1

pharmachologic effect

Losartan is a selective, competitive antagonist and AT1 receptor blocker in various tissues, including the brain, adrenal cortex, liver, kidneys, heart and vascular smooth muscle, reducing the effect of angiotensin II .

Administration of the active substance of the drug leads to a decrease in total peripheral resistance (afterload) and cardiac venous return (preload). All physiological effects of angiotensin II , including stimulation of aldosterone , are blocked by the action of Losartan. A decrease in blood pressure occurs regardless of the state of the renin-angiotensin . As a result of the use of this drug, plasma renin activity increases due to the removal of angiotensin II .

The effect of this drug was confirmed during the Life study (Losartan Intervention For Endpoint reduction in hypertension study), which involved 9,193 people suffering from essential arterial hypertension . The age of the subjects was 55-80 years with a blood pressure of 160-200 mm Hg. After taking Losartan, this figure decreased by 13%, and mortality among such patients decreased by 25%.

Compatibility with other drugs

The effect of the drug is enhanced when taken simultaneously with diuretics.
The antihypertensive effect is enhanced by simultaneous use of diuretics, adrenergic blockers and sympatholytics. The effect is reduced when the drug is used together with the substances rifampicin, fluconazole or NSAIDs. Concomitant use with antidepressants, antipsychotics, baclofen and amifostine is not recommended, as this can lead to a sharp decrease in blood pressure.

Additionally

Losartan

In patients with reduced blood volume (for example, receiving high doses of diuretics), symptomatic arterial hypotension may occur, therefore, before starting treatment, it is necessary to replenish the blood volume or begin treatment with Losartan-N Canon at a lower dose.

During treatment, plasma potassium levels and creatinine clearance should be regularly monitored, especially in elderly patients and with impaired renal function.

DETAILS: What to do: weakness, dizziness

Drugs that affect the renin-angiotensin-aldosterone system may increase blood urea and serum creatinine concentrations in patients with bilateral renal stenosis or arterial stenosis of a solitary kidney.

Caution should be exercised when prescribing the drug Losartan-N Canon to patients with a burdened allergic history (including patients in whom angioedema previously developed while taking other drugs, including ACE inhibitors), as well as patients with bronchial asthma.

In patients with liver cirrhosis, the concentration of losartan in the blood plasma increases significantly, and therefore, in the presence of a history of liver disease, it should be prescribed in lower doses.

There is no need for special selection of the initial dose for elderly patients. The drug may increase plasma urea and creatinine concentrations in patients with bilateral renal artery stenosis or renal artery stenosis of a solitary kidney. There is no experience with the use of losartan in patients after kidney transplantation.

Like all drugs that have a vasodilating effect, Losartan-N Canon should be prescribed with caution to patients with aortic or mitral stenosis, or obstructive hypertrophic cardiomyopathy.

In patients with severe chronic heart failure, drugs that affect the RAAS can lead to severe hypotension and acute renal failure. There are isolated reports of the development of oliguria and/or increasing azotemia and acute renal failure, including death.

There is insufficient experience with the use of losartan in patients with heart failure with concomitant severe renal failure, in patients with severe chronic heart failure (NYHA functional class IV), in patients with heart failure with life-threatening arrhythmias.

In patients with ischemic cerebrovascular diseases, an excessive decrease in blood pressure can lead to stroke. Medical supervision is recommended when titrating the dose. Patients with primary hyperaldosteronism usually do not respond to antihypertensive agents that act through inhibition of the renin-angiotensin system. Therefore, it is not recommended to use the drug Losartan-N Canon to treat such patients.

Hydrochlorothiazide

Hydrochlorothiazide can increase arterial hypotension and water-electrolyte imbalance (decrease in blood volume, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypokalemia), impair glucose tolerance, reduce calcium excretion in the urine and cause a transient, 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 may distort the results of studying the function of the parathyroid glands, therefore, before studying the functions 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, taking thiazide diuretics may lead to hyperuricemia and/or exacerbation of gout.

Hydrochlorothiazide can cause an idiosyncratic reaction leading to the development of acute transient myopia and an acute attack of angle-closure glaucoma. Symptoms include: sudden decrease in visual acuity or eye pain, usually occurring within hours to 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 as soon as possible. If intraocular pressure remains uncontrolled, emergency medication or surgery may be required.

In patients receiving thiazides, hypersensitivity reactions may occur even in the absence of indications of allergies or a history of bronchial asthma. There are reports of exacerbation or progression of systemic lupus erythematosus while taking thiazide diuretics.

No studies have been conducted on the effects on driving and using technology. However, caution must be exercised when driving or using machinery.

Registration number:

LP-002884

Tradename:

Losartan

International nonproprietary name:

Losartan

Dosage form:

film-coated tablets

Compound

1 tablet contains: active substance: losartan potassium - 12.5 mg, 25 mg or 50 mg. excipients: lactose monohydrate (milk sugar) - 114.63 mg, 149.50 mg or 270.60 mg, microcrystalline cellulose - 5.72 mg, 12.24 mg or 26.60 mg, croscarmellose sodium (primellose) - 4.29 mg, 9.18 mg or 15.20 mg, colloidal silicon dioxide (Aerosil) - 1.43 mg, 2.04 mg or 3.80 mg, magnesium stearate - 1.43 mg, 2, 04 mg or 3.80 mg. shell composition: for dosage 12.5 mg and 25 mg - Opadry II white (polyvinyl alcohol (E1203) - 40.0%, titanium dioxide (E 171) - 25.0%, macrogol (polyethylene glycol) (E1521) - 20, 2%, talc (E553b) - 14.8%) - 2.983 mg or 3.975 mg, simethicone emulsion 30% (water - 50.0-69.5%, polydimethylsiloxane - 25.5-33.0%, polyethylene glycol sorbi- tan tristearate - 3.0-7.0%, methylcellulose - 1.0-5.0%, silica gel - 1.0-5.0%) - 0.017 mg or 0.025 mg; for a dosage of 50 mg - Opadry II pink (polyvinyl alcohol (E1203) - 40.0%, titanium dioxide (E 171) - 24.18%, macrogol (polyethylene glycol) (E1521) - 20.2%, talc (E553b) - 14.8%, carmine red dye (E120) – 0.54%, aluminum varnish based on sunset yellow dye (E110) – 0.15%, aluminum varnish based on charming red dye (E129) – 0.08%, aluminum varnish based on quinoline yellow dye (E104) - 0.05%) - 9.923 mg, simethicone emulsion 30% (water - 50.0-69.5%, polydimethylsiloxane - 25.5-33.0%, polyethylene glycol sorbitan tristearate – 3.0-7.0%, methylcellulose – 1.0-5.0%, silica gel – 1.0-5.0%) – 0.077 mg. DESCRIPTION Film -coated tablets, white or white with a grayish tint (for dosages of 12.5 mg and 25 mg) or pink (for dosages of 50 mg), round, biconvex. Slight surface roughness is acceptable. The color of the tablets when broken is white or white with a yellowish tint.

Pharmacotherapeutic group: Angiotensin II receptor antagonist (AT1 subtype).

ATX code: C09CA01.

Pharmacological properties.

Pharmacodynamics. Losartan is a specific angiotensin II receptor antagonist (AT1 subtype) for oral administration. Does not inhibit kininase II, an enzyme that catalyzes the reaction of converting angiotensin I into angiotensin II. Angiotensin II selectively binds to AT1 receptors found in many tissues (vascular smooth muscle, adrenal glands, kidneys and heart) and performs several important biological functions, including vasoconstriction and aldosterone release. Angiotensin II also stimulates the proliferation of smooth muscle cells. Losartan and its pharmacologically active metabolite (E 3174) both in vitro and in vivo block all physiological effects of angiotensin II, regardless of the source or route of synthesis. Losartan selectively binds to AT1 receptors and does not bind or block receptors of other hormones and ion channels that play an important role in regulating the function of the cardiovascular system. In addition, losartan does not inhibit angiotensin-converting enzyme (ACE) kininase II, and, accordingly, does not interfere with the destruction of bradykinin, so side effects indirectly associated with bradykinin (for example, angioedema) occur quite rarely. When using losartan, the absence of negative feedback influence on renin secretion leads to an increase in plasma renin activity. An increase in renin activity leads to an increase in angiotensin II in the blood plasma. However, antihypertensive activity and a decrease in plasma aldosterone concentrations persist, indicating effective blockade of angiotensin II receptors. Losartan and its active metabolite have a greater affinity for angiotensin I receptors than for angiotensin II receptors. The active metabolite is 10-40 times more active than losartan. After a single oral dose, the antihypertensive effect (systolic and diastolic blood pressure (BP) decreases) reaches a maximum after 6 hours, then gradually decreases over 24 hours. The maximum antihypertensive effect develops 3-6 weeks after starting the drug. In patients with arterial hypertension without concomitant diabetes mellitus with proteinuria (more than 2 g/day), the use of the drug significantly reduces proteinuria, albumin and immunoglobulin G excretion. Stabilizes the concentration of urea in the blood plasma. Does not affect autonomic reflexes and does not have a long-term effect on the concentration of norepinephrine in the blood plasma. Losartan at a dose of 150 mg per day does not affect the concentration of triglycerides, total cholesterol and high-density lipoprotein (HDL) cholesterol in the blood serum of patients with arterial hypertension. At the same dose, losartan does not affect fasting blood glucose concentrations. Pharmacokinetics. Absorption When taken orally, losartan is well absorbed from the gastrointestinal tract (GIT) and undergoes first-pass metabolism through the liver by carboxylation with the participation of the CYP2C9 isoenzyme to form an active metabolite. The systemic bioavailability of losartan is approximately 33%. The time to reach the maximum concentration of losartan and its active metabolite is achieved in the blood serum approximately 1 hour and 3-4 hours, respectively, after oral administration. Food intake does not affect the bioavailability of losartan. Distribution More than 99% of losartan and its active metabolite are bound to plasma proteins, mainly albumin. The volume of distribution of losartan is 34 l. Studies in rats have shown that losartan practically does not penetrate the blood-brain barrier. Metabolism Approximately 14% of losartan taken orally or administered intravenously is converted into an active metabolite. In addition to the active metabolite, pharmacologically inactive metabolites are formed, including two major metabolites formed as a result of hydroxylation of the butyl side chain, and one minor one - N-2-tetrazole glucuronide. Elimination Plasma clearance of losartan and its active metabolite is approximately 600 ml/min and 50 ml/min, respectively. The renal clearance of losartan and its active metabolite is approximately 74 ml/min and 26 ml/min, respectively. When taken orally, approximately 4% of the dose taken is excreted unchanged by the kidneys and about 6% is excreted by the kidneys in the form of an active metabolite. Losartan and its active metabolite have linear pharmacokinetics when losartan is administered orally in doses up to 200 mg. The half-life is 1.5 - 2 hours, and its main metabolite is 6-9 hours, respectively. When taking the drug at a dose of 100 mg per day, neither losartan nor its active metabolite accumulates significantly in the blood plasma. Losartan and its metabolites are excreted from the body through the intestines with bile and kidneys. Pharmacokinetics in special groups of patients In patients with mild to moderate alcoholic cirrhosis, the concentration of losartan is 5 times higher, and the active metabolite is 1.7 times higher than in healthy male volunteers. When creatinine clearance (CC) is above 10 ml/min, the concentration of losartan in the blood plasma does not differ from that with normal renal function. In patients requiring hemodialysis, the area under the concentration-time curve (AUC) is approximately 2 times higher than in patients with normal renal function. Neither losartan nor its active metabolite is removed from the body by hemodialysis. Plasma concentrations of losartan and its active metabolite in elderly male patients with arterial hypertension do not differ significantly from the values ​​of these parameters in young male patients with arterial hypertension. Plasma concentrations of losartan in women with arterial hypertension are 2 times higher than the corresponding values ​​in men with arterial hypertension. Concentrations of the active metabolite do not differ between men and women. This pharmacokinetic difference is not clinically significant. . INDICATIONS FOR USE

• Arterial hypertension.
• Chronic heart failure (as part of combination therapy, with intolerance or ineffectiveness of therapy with angiotensin-converting enzyme inhibitors).
• Reducing the risk of developing cardiovascular diseases (including stroke) and mortality in patients with arterial hypertension and left ventricular hypertrophy.
• Diabetic nephropathy or hypercreatininemia and proteinuria (urine albumin to creatinine ratio more than 300 mg/day) in patients with type 2 diabetes mellitus and concomitant arterial hypertension (reducing the progression of diabetic nephropathy to end-stage chronic renal failure).

CONTRAINDICATIONS Hypersensitivity to the components of the drug; severe liver failure (more than 9 points on the Child-Pugh scale); age under 18 years; simultaneous use with aliskiren or aliskiren-containing drugs in patients with diabetes mellitus and/or renal impairment; lactose intolerance, lactase deficiency or glucose-galactose malabsorption; pregnancy and breastfeeding period. WITH CAUTION Arterial hypotension; reduced circulating blood volume (CBV); water-electrolyte imbalance; bilateral renal artery stenosis or stenosis of the artery of a single kidney; renal failure; liver failure (less than 9 points on the Child-Pugh scale); hyperkalemia; hypertrophic obstructive cardiomyopathy; heart failure with life-threatening arrhythmias; heart failure with concomitant severe renal impairment; cardiac ischemia; cerebrovascular diseases; primary hyperaldosteronism; history of angioedema. Use during pregnancy and breastfeeding The use of losartan during pregnancy is contraindicated. It is known that drugs that directly act on the renin-angiotensin-aldosterone system (RAAS), when used in the second and third trimesters of pregnancy, can cause developmental defects or even death of the developing fetus. Therefore, if pregnancy is diagnosed, losartan should be stopped immediately. It is not known whether losartan is excreted in breast milk. It is not recommended to take losartan during breastfeeding. If taking the drug is necessary during lactation, then breastfeeding must be stopped. METHOD OF APPLICATION AND DOSES Orally, regardless of food intake, frequency of administration - 1 time per day. The tablets are swallowed whole, without chewing, with water. Arterial hypertension For arterial hypertension, the standard initial and maintenance dose for most patients is 50 mg 1 time / day. To achieve a greater therapeutic effect, the dose is increased to a maximum daily dose of 100 mg once a day. Chronic heart failure The initial dose for patients with chronic heart failure is 12.5 mg 1 time per day. Typically, the dose is increased at weekly intervals (i.e., 12.5 mg/day, 25 mg/day, and 50 mg/day) to a mean maintenance dose of 50 mg once daily, depending on patient tolerance. Reducing the risk of developing cardiovascular diseases (including stroke) and mortality in patients with arterial hypertension and left ventricular hypertrophy The initial dose of the drug is 50 mg 1 time / day. In the future, hydrochlorothiazide may be added in low doses or the dose of Losartan may be increased to 100 mg in one or two doses, taking into account the reduction in blood pressure. Kidney protection in patients with type 2 diabetes mellitus and proteinuria Losartan is prescribed at an initial dose of 50 mg once a day with a further increase in dose to 100 mg/day (taking into account the degree of blood pressure reduction) in one or two doses . Special groups of patients: In patients with reduced blood volume (for example, when taking diuretics in high doses), the recommended initial dose of Losartan is 25 mg 1 time / day. Patients with renal failure and patients on dialysis There is no need to adjust the starting dose in patients with renal failure, including patients on dialysis. Elderly Patients No dose adjustment is necessary in elderly patients, although it is recommended to initiate treatment with a dose of 25 mg in patients over 75 years of age. Patients with liver failure For patients with a history of liver disease, it is recommended to prescribe the drug in lower doses. The use of losartan is contraindicated in patients with severe liver failure, since there is no clinical experience with this group of patients (see section “Contraindications”). The safety and effectiveness of the drug in children under 18 years of age has not been established. SIDE EFFECTS Side effects of Losarate are usually transient and do not require discontinuation of the drug. When Losaratne was used for the treatment of essential hypertension in controlled studies, among all side effects, only the incidence of dizziness differed from placebo by more than 1% (4.1% vs. 2.4%). A dose-dependent orthostatic effect, characteristic of antihypertensive drugs, was observed in less than 1% of patients when using losartan. The frequency of adverse reactions was determined according to the following gradation (classification of the World Health Organization): very frequent (≥10%); frequent (≥1%; Prevalence of adverse reactions based on the results of placebo-controlled clinical trials and post-registration surveillance. Arterial hypertension: Nervous system disorders: common: dizziness; uncommon: drowsiness, headache, sleep disturbance. Hearing and labyrinthine disorders disorders: common: vertigo Cardiac disorders: uncommon: palpitations, angina pectoris Vascular disorders: uncommon: (orthostatic) hypotension (including dose-mediated orthostatic effects) (especially in patients with reduced blood volume, e.g. with severe heart failure or patients treated with high doses of diuretics. Gastrointestinal disorders: uncommon: abdominal pain, intestinal obstruction. Skin and subcutaneous tissue disorders: uncommon: rash. General disorders and disorders at the injection site: uncommon: asthenia, weakness, edema.Influence on the results of laboratory and instrumental studies: common: hyperkalemia; rare: increased activity of alanine aminotransphrase (usually resolves after discontinuation of treatment). Patients with arterial hypertension and left ventricular hypertrophy: Nervous system disorders: common: dizziness. Hearing and labyrinthine disorders: common: vertigo. General disorders and disorders at the injection site: common: asthenia, weakness. Chronic heart failure: Blood and lymphatic system disorders: common: anemia. Nervous system disorders: common: dizziness; uncommon: headache; rare: paresthesia. Cardiac disorders: rare: fainting, atrial fibrillation, acute cerebrovascular accident. Vascular disorders: Common: (orthostatic) hypotension (including dose-mediated orthostatic effects) (especially in patients with reduced blood volume, such as patients with severe heart failure or patients treated with high doses of diuretics). Respiratory, thoracic and mediastinal disorders: uncommon: shortness of breath, cough. Gastrointestinal disorders: uncommon: diarrhea, nausea, vomiting. Skin and subcutaneous tissue disorders: uncommon: urticaria, itching, rash. Musculoskeletal and connective tissue disorders: uncommon: muscle spasm. Renal and urinary tract disorders: common: renal dysfunction, renal failure. General disorders and administration site disorders: uncommon: asthenia, weakness. Impact on the results of laboratory and instrumental studies: frequent: increased concentrations of urea, creatinine and potassium in the blood plasma; uncommon: hyperkalemia (often observed in patients taking losartan at a dose of 150 mg per day instead of 50 mg per day). Arterial hypertension and type 2 diabetes mellitus with impaired renal function: Nervous system disorders: common: dizziness. Vascular disorders: Common: (orthostatic) hypotension (including dose-mediated orthostatic effects) (especially in patients with reduced blood volume, such as patients with severe heart failure or patients treated with high doses of diuretics). General disorders and disorders at the injection site: common: asthenia, weakness. Impact on the results of laboratory and instrumental studies: common: hyperkalemia (in a clinical study conducted in patients with type 2 diabetes mellitus and nephropathy, hyperkalemia >5.5 mmol/l developed in 9.9% of patients taking losartan tablets, and in 3.4% of patients taking placebo), hypoglycemia. Post-registration surveillance: Disorders of the blood and lymphatic system: frequency unknown: anemia, thrombocytopenia. Immune system disorders: rare: allergic reactions, anaphylactic reactions, angioedema (including swelling of the larynx, vocal folds, face, lips, pharynx and/or tongue (resulting in airway obstruction); in some of these patients Quincke's edema has been noted previously in connection with the prescription of other drugs including ACE inhibitors), vasculitis (including hemorrhagic vasculitis (Henoch-Schönlein disease)). Mental disorders: frequency unknown: depression. Nervous system disorders: frequency unknown: migraine, taste disturbance. Hearing and labyrinthine disorders: frequency unknown: tinnitus. Respiratory, thoracic and mediastinal disorders: frequency unknown: cough. Gastrointestinal disorders: frequency unknown: diarrhea. Disorders of the liver and biliary tract: rare: hepatitis; frequency unknown: liver dysfunction, pancreatitis. Skin and subcutaneous tissue disorders: frequency unknown: urticaria, pruritus, rash, photosensitivity. Musculoskeletal and connective tissue disorders: frequency unknown: myalgia, arthralgia, rhabdomyolysis. Genital and breast disorders: frequency unknown: erectile dysfunction/impotence. General disorders and administration site disorders: frequency unknown: malaise. Impact on the results of laboratory and instrumental studies: frequency unknown: hyponatremia. The following additional adverse reactions were reported more frequently in patients receiving losartan than in patients receiving placebo (precise incidence unknown): back pain, urinary tract infections, and flu-like symptoms. Renal and urinary tract disorders As a consequence of RAAS inhibition, renal dysfunction, including acute renal failure, has been reported in patients at risk. These changes in renal function may be reversible if treatment is discontinued in a timely manner. OVERDOSE Symptoms: marked decrease in blood pressure and tachycardia; bradycardia may occur due to parasympathetic stimulation. Treatment: forced diuresis, symptomatic therapy; losartan and its active metabolite are not removed from the bloodstream by hemodialysis. INTERACTIONS WITH OTHER MEDICINES There are no clinically significant interactions between losartan and hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole and erythromycin. Rifampicin and fluconazole have been reported to reduce plasma concentrations of the active metabolite. The clinical significance of these interactions is currently unknown. As with the use of other drugs that inhibit the formation of angiotensin II or its action, the simultaneous use of losartan with potassium-sparing diuretics (for example, spironolactone, triamterene, amiloride), potassium preparations, salts containing potassium increases the risk of hyperkalemia. Nonsteroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 (COX-2) inhibitors, may reduce the effect of diuretics and other antihypertensive agents. Therefore, the antihypertensive effect of angiotensin II receptor antagonists (APA II) or ACE inhibitors may be weakened when used concomitantly with NSAIDs, including selective COX-2 inhibitors. In some patients with impaired renal function (for example, elderly patients and patients with reduced circulating blood volume (BCV), including those taking diuretics) who were treated with NSAIDs, including selective COX-2 inhibitors, concomitant use of ARB II or inhibitors ACE can cause further deterioration of kidney function up to the development of acute renal failure. Usually this effect is reversible. Therefore, concomitant therapy with NSAIDs should be used with caution in patients with impaired renal function. Dual blockade of the RAAS using ARA II receptor antagonists, ACE inhibitors or aliskiren (renin inhibitor) is associated with an increased risk of arterial hypotension, hyperkalemia and renal dysfunction (including the development of acute renal failure) compared with monotherapy. Monitoring of blood pressure, renal function and blood electrolyte levels is necessary in patients taking losartan and other drugs that affect the RAAS. Losartan should not be used concomitantly with aliskiren in patients with diabetes mellitus. The simultaneous use of losartan and aliskiren should be avoided in patients with impaired renal function (glomerular filtration rate less than 60 ml/min). With simultaneous use of APA II and lithium, an increase in the concentration of lithium in the blood plasma is possible. Given this, it is necessary to weigh the benefits and risks of combined use of losartan with lithium preparations. If it is necessary to use drugs simultaneously, it is necessary to regularly monitor the concentration of lithium in the blood plasma. Fluconazole, an inhibitor of the cytochrome P450 2C9 isoenzyme, reduces plasma concentrations of the active metabolite and increases the concentrations of losartan, however, the pharmacodynamic significance of this phenomenon has not been established. It has been shown that patients who do not metabolize losartan into the active metabolite have a very rare and specific defect in the P450 2C9 isoenzyme. SPECIAL INSTRUCTIONS In patients with reduced blood volume (for example, those receiving treatment with high doses of diuretics), symptomatic arterial hypotension may occur at the beginning of treatment with losartan (it is necessary to correct blood volume before prescribing losartan or start treatment with a lower dose). Violation of water and electrolyte balance is typical for patients with impaired renal function with or without diabetes mellitus, so careful monitoring of these patients is necessary. During therapy with losartan, patients should not take potassium supplements or potassium supplements without prior approval from their physician. In patients with liver cirrhosis, the concentration of losartan in the blood plasma increases significantly, and therefore, in the presence of a history of liver disease, it should be prescribed in lower doses. During the treatment period, potassium levels in the blood should be regularly monitored, especially in elderly patients with impaired renal function. Drugs that affect the RAAS may increase blood urea and serum creatinine concentrations in patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney. The safety and effectiveness of the drug in children under 18 years of age have not been established. Effect on the ability to drive vehicles and operate equipment. No special clinical studies have been conducted to evaluate the effect of the drug on the ability to drive vehicles and operate equipment. The possibility of drowsiness and dizziness should be borne in mind, so care must be taken when performing work that requires increased attention, especially at the beginning of treatment, when increasing the dose of the drug and when driving. RELEASE FORM Film-coated tablets, 12.5 mg, 25 mg and 50 mg. 7 or 10 tablets per blister pack. 1, 2, 3 or 4 blister packs along with instructions for use in a cardboard pack. STORAGE CONDITIONS Protected from light, at a temperature not exceeding 25 °C. Keep out of the reach of children. SHELF LIFE 4 years. Do not use after expiration date. CONDITIONS OF DISCHARGE FROM PHARMACIES Dispensed with a doctor's prescription. MANUFACTURER CJSC "Biocom", Russia, 355016, Stavropol, Chapaevsky proezd, 54 Tel., 36-53-54, fax Consumer complaints should be sent to the manufacturer.

Indications for use

This drug is prescribed to patients who have:

• Hypertension, that is, high blood pressure.
• Reducing the risk of groups of diseases of the cardiovascular system and mortality statistics in those who have been diagnosed with hypertension, enlargement of the left ventricle, the symptom of which is a decrease in mortality due to heart disease, rates of cerebral hemorrhages and ruptures of the heart muscles.
• Kidney safety in type 2 diabetes mellitus with slow progression of renal failure. Its symptom is a decrease in the frequency of hypercreatininemia, the formation of the final phase of chronic renal failure, which requires cleansing or kidney transplantation, mortality statistics and a decrease in proteinuria.
• Long-term heart failure due to improper therapy with ACE paralyzers.

Before prescribing treatment, the doctor must carefully examine the patient’s medical history to ensure that no negative consequences arise after the simultaneous use of several medications.

Loss of pressure

• 1 Composition and release form
• 2 How does it work?
• 3 Indications and contraindications
• 4 Instructions for use of “Lozap”
• 5 Side effects
• 6 During pregnancy and pregnancy
• 7 Overdose
• 8 Compatibility
• 9 What to replace: analogues of the drug

The drug "Lozap" is designed to help with high blood pressure, namely, to reduce and control its level. The medication should be used only after its instructions for use have been studied, which describe possible side effects, symptoms of overdose and other treatment features. In addition, before starting to use Lozap, each patient is required to visit a specialized doctor and undergo the necessary diagnostic examination. Only if you follow your doctor’s recommendations can you achieve the desired results from taking an antihypertensive drug.

Composition and release form

A medicine for high blood pressure called “Lozap” is available in the form of film-coated tablets. The pills are placed in blister packs of 10 pieces, each cardboard pack contains 3, 6 or 9 plates. Each tablet contains losartan potassium as the active substance, and the auxiliary components are:

• MCC;
• low molecular weight medical polyvinylpyrrolidone;
• hexahydric alcohol;
• crystalline substance;
• food additive E572;
• primellose;
• polyethylene glycol;
• food additive E110;
• liquid silicone;
• hypromellose.

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How does it work?

The action of the drug is aimed at reducing pressure on the heart muscle.

The pharmaceutical drug "Lozap" relieves peripheral vascular resistance, and thereby reduces blood pressure. In addition, the described medication reduces the load on the heart muscle, which is important in case of its dysfunction, and exhibits a diuretic effect, due to which excess fluid is not retained in the body. An antihypertensive drug acts both as a kind of prevention of changes in the size of the cavities of the heart, and as a drug that improves blood supply to the heart muscle.

After taking the dose, Lozap will reduce blood pressure to normal levels after 6 hours. The medication keeps blood pressure at a normal level throughout the day, gradually reducing its main effect. The maximum therapeutic effect when using the drug “Lozap” to lower blood pressure is observed after completing a 3-week therapeutic course.

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Indications and contraindications

The drug "Lozap" helps to quickly and effectively cope with various heart pathologies. However, not everyone is allowed to take it for blood pressure. The table shows the main purposes and restrictions for taking Lozap:

Instructions for use of "Lozap"

You cannot independently violate the dose of the drug prescribed by your doctor.

Lozap is prescribed for the treatment of persistent and prolonged increases in blood pressure at a dose of 0.05 g mg once a day for a long period of time. If it is necessary to achieve greater severity of the therapeutic effect, then the dosage is doubled. “Lozap” 100 is recommended to be taken once a day, but you can take it 2 times a day, but only by dividing the dose into 50 mg. The drug is taken regardless of the meal, the tablet is not crushed or crushed, but is swallowed whole, washed down with a small amount of purified still water. It is optimal to take the medicine at the same time every day, preferably in the evening.

Patients receiving high doses of diuretics are prescribed Lozap 0.25 g per day. For people with impaired liver function, it is better to start taking the drug with the lowest doses. Elderly patients and those with impaired renal function do not need to adjust the initial dose of Lozap. The maximum hypertensive effect occurs 3.5-5 weeks after the start of treatment.

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Side effects

While taking the pharmaceutical drug Lozap, the following negative effects may develop:

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• flatulence;
• tinnitus;
• atrial fibrillation;
• stool disorders;
• decrease in heart rate;
• toothache;
• arteritis;
• nose bleed;
• pain in the center of the chest;
• myocardial infarction;
• dry mouth;
• a sharp decrease in body weight;
• gagging;
• liver dysfunction;
• drying of the skin;
• hyperhidrosis;
• allergies in the form of itching, skin rash;
• decreased libido;
• anemia;
• conjunctivitis;
• memory disorders;
• gout;
• fainting;
• feeling of anxiety;
• migraine;
• taste disorders;
• impotence;
• joint pain;
• tremor;
• visual impairment;
• depressive states;
• increase in the number of eosinophils.

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During pregnancy and pregnancy

Treatment with the drug during pregnancy is contraindicated.

There is no data on the use of Lozap during pregnancy. It is known that the pharmaceutical drug can provoke a developmental defect or even cardiac arrest of the fetus when taken in the 2nd and 3rd trimesters. Therefore, it is extremely important to immediately stop using Lozap after conceiving a baby. If you need to use antihypertensive tablets "Lozap" during the lactation period, you must stop breastfeeding or take the medication.

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Overdose

Taking Lozap in high doses, a patient may experience an overdose, which manifests itself in the form of arrhythmia, painful palpitations and a decrease in heart rate. A special antidote to the described drug has not been identified, so treatment of overdose is symptomatic. However, before this, the patient undergoes gastric lavage to remove the toxic substances of the drug from the body.

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Compatibility

Before using the drug Lozap to treat arterial hypertension, you should study its interaction with other medications. Thus, the combination of Lozap with fluconazole reduces the content of the active metabolite in the blood. The described medicine enhances the effect of other antihypertensive drugs, which is dangerous due to overdose and increased side effects. "Lozap" in tandem with potassium-sparing drugs, as well as diuretic medications containing the element K, increases the risk of developing hyperkalemia. The hypotensive effect worsens when taken simultaneously with indomethacin.

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Overdose

Losartan

Symptoms: marked decrease in blood pressure, tachycardia. Bradycardia may occur due to parasympathetic (vagal) stimulation.

Treatment: forced diuresis, symptomatic therapy. Hemodialysis is not effective.

Hydrochlorothiazide

Symptoms: The most common symptoms are the result of electrolyte deficiency (hypokalemia, hypochloremia, hyponatremia) and dehydration due to excessive diuresis. When taking cardiac glycosides simultaneously, hypokalemia may aggravate the course of arrhythmias. Treatment: symptomatic.

Losartan Canon tablets are taken every morning at the same time (for example, 8.00), regardless of food, crushed and washed down with the required amount of liquid. To normalize blood pressure with a persistent increase in blood pressure, 50 mg of losartan potassium is prescribed 1 time per day, increasing the dose to 100 mg if the initial dose was not enough.

If this option does not allow you to achieve the required level of pressure, it can be divided into two (take the first half of the dose in the morning, and the second at night). For people with hypertension and thickening of the walls of the left ventricle, the initial daily dose is also 50 mg.

The reaction to taking the medication should be monitored by a doctor and, depending on the decrease in blood pressure, the dosage can be doubled, divided into 2 doses, or kept at the same level with the addition of small doses of hydrochlorothiazide.

For patients with CHF, the initial daily dose is 12.5 mg. Taking into account the body's response to losartan, the dosage can be doubled every week to reach a maximum of 50 mg. In patients with non-insulin-dependent diabetes and elevated levels of protein in the urine, the initial daily dosage should not exceed 50 mg.

Considering the effectiveness in lowering blood pressure, it can be increased to 100 mg. A decrease in the amount of circulating blood requires the administration of Losartan Canon in a daily dose of 25 mg. For elderly people with partial loss of the kidneys' ability to form/excrete urine, the recommended dosage is no different from the dosage for younger patients.

At any age, with CC in the range of 20 - 30 ml/min, the medicine is used in the same dose as in other categories of patients. In case of insufficient liver function and artificial blood filtration, people over the age of 75 are initially prescribed 25 mg of losartan daily, with the dose increasing as needed.

If the liver dysfunction is severe, the use of Losartan Canon is not recommended in the instructions for use, due to the small amount of information about its benefits and safety for patients with this disease.

Exceeding the recommended dose of the drug can cause a significant decrease in blood pressure and an increase in heart rate from 90 beats per minute. Stimulation of the vagus nerve can cause the heart rate to slow down to 59 beats. per minute and below.

In case of an overdose, the patient’s blood pressure drops sharply and severely, he feels all the characteristic symptoms from dizziness to weakness and nausea, and the number of heartbeats also increases. Cold sweat may break out on your body.

In this case, it is necessary to do a gastric lavage, then take “Activated carbon” and take a position in which the hypertensive patient will not feel dizzy. After an overdose, you should stop taking the medication and consult your doctor.