Losarite Drug Interactions

Losartan potassium: Lithium: Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists. Monitor serum lithium levels during concomitant use.
Potassium-sparing diuretics/supplements/salt substitutes: As with other medicines that block angiotensin II or its effect, concomitant use of potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium supplements, salt substitutes containing potassium, or other medicines that may increase serum potassium (e.g., trimethoprim-containing products) may lead to increases in serum potassium. Concomitant use is not recommended.
Nonsteroidal anti-inflammatory drugs (NSAIDs) including selective cyclooxygenase-2 (COX-2) inhibitors: The antihypertensive effect of angiotensin II receptor antagonists may be reduced when coadministered with NSAIDs such as selective COX-2 inhibitors and nonselective NSAIDs.
Concurrent administration of angiotensin II receptor antagonists with NSAIDs may result in an increased risk of worsening of renal function (including possible acute renal failure) and an increase in serum potassium, particularly in patients with poor pre-existing renal function. The combination should be administered with caution, especially in the elderly. Patients should be adequately hydrated and renal function monitored after initiation of therapy and periodically thereafter.
Dual blockade of the renin-angiotensin-aldosterone system (RAAS): Dual blockade of the RAAS with angiotensin II receptor antagonists, ACE inhibitors or aliskiren is associated with increased risk of hypotension, hyperkalemia and changes in renal function (including acute renal failure) compared with monotherapy. Closely monitor blood pressure, renal function and electrolytes in patients on losartan and other agents that affect the RAAS.
Do not coadminister losartan with aliskiren in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m²). Avoid concomitant use of angiotensin II receptor antagonists and ACE inhibitors in patients with diabetic nephropathy.
Tricyclic antidepressants, antipsychotics, baclofene, amifostine: Concomitant use with these drugs that may induce hypotension as an adverse effect; may increase the risk of hypotension.
Other drugs: In studies, coadministration of losartan with other drugs such as hydrochlorothiazide, digoxin, warfarin, cimetidine, phenobarbital, ketoconazole, and erythromycin showed no significant drug interactions. Rifampicin and fluconazole decreased the concentrations of losartan and its active metabolite.
Hydrochlorothiazide: Alcohol, barbiturates, or narcotics: Potentiation of orthostatic hypotension.
Amantadine: Increased risk of adverse effects.
Aminoglycoside antibiotics: Diuretic-induced volume depletion can potentiate aminoglycoside nephrotoxicity.
Anticholinergic agents (e.g., atropine, biperidine): May increase availability of thiazide diuretics by decreasing gastrointestinal motility and stomach emptying rate.
Antidiabetic agents (e.g., insulin, hypoglycemic agents): Dosage adjustment of the antidiabetic agent may be necessary as thiazides may impair glucose tolerance.
Diazoxide: May enhance the hyperglycemic effect of diazoxide.
Antigout (e.g., probenecid, sulfinpyrazone, allopurinol): Dosage adjustment of the antigout medication may be necessary as HCTZ may raise level of serum uric acid; may increase hypersensitivity reaction with allopurinol.
Calcium salts, Vitamin D supplements: Increased serum calcium levels due to decreased excretion.
Carbamazepine: Symptomatic hyponatremia may occur. Monitor electrolytes during concomitant use.
Cardiac glycosides (e.g., digitalis): Thiazide-induced hypokalemia or hypomagnesemia may favor the onset of digitalis-induced cardiac arrhythmias.
Cholestyramine and colestipol resins: HCTZ absorption is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind HCTZ and reduce its absorption from the gastrointestinal tract by up to 85% and 43%, respectively.
Corticosteroids, ACTH, amphotericin B (parenteral), stimulant laxative, or glycyrrhizin (found in licorice): Intensified electrolyte depletion/electrolyte imbalance, particularly hypokalemia.
Cytotoxic agents (e.g., cyclophosphamide, methotrexate): Decreased renal excretion; increased myelosuppressive effects.
Ciclosporin: May increase the risk of hyperuricemia and gout-type complications.
Lithium: Increased serum lithium concentrations and increased risk of lithium toxicity. Monitor serum lithium levels during concomitant use.
Pressor amines (e.g., epinephrine): Possible decreased response to pressor amines but not sufficient to prevent their use.
NSAIDs including COX-2 inhibitors: May reduce the diuretic, natriuretic and antihypertensive effects of diuretics in some patients.
Skeletal muscle relaxants, nondepolarizing (e.g., tubocurarine): Possible increased responsiveness to the muscle relaxant.
Selective serotonin reuptake inhibitors (e.g., citalopram, escitalopram, sertraline): May potentiate hyponatremia.
Topiramate: May increase topiramate serum concentrations; additive hypokalemia.
Iodinated contrast media: Increased risk of acute renal failure particularly when large doses of iodinated media are used.
Other antihypertensive agents: Additive effect.