Losartan + Amlodipine + Hydrochlorothiazide Pharmacology

Losartan + Amlodipine + Hydrochlorothiazide

About Losartan + Amlodipine + Hydrochlorothiazide
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Mechanism of Action of Losartan + Amlodipine + Hydrochlorothiazide
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Pharmacokinets of Losartan + Amlodipine + Hydrochlorothiazide
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Onset of Action for Losartan + Amlodipine + Hydrochlorothiazide
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Duration of Action for Losartan + Amlodipine + Hydrochlorothiazide
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Half Life of Losartan + Amlodipine + Hydrochlorothiazide
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Side Effects of Losartan + Amlodipine + Hydrochlorothiazide
1.Dizziness
2.Headache
3.Tired feeling
4.Nausea
5.Upset stomach
6.Muscle spasms
7.Back pain
8.Stuffy nose
9.Sore throat.
Contra-indications of Losartan + Amlodipine + Hydrochlorothiazide
Hypersensitivity to any of the component.
Special Precautions while taking Losartan + Amlodipine + Hydrochlorothiazide
1.Avoid drinking alcohol. It can lower your blood pressure and may increase some of the side effects
2.Kidney or liver disease
3.Congestive heart failure
4.Asthma or allergies
5.Low or high blood levels of potassium
6.Gout
7.Lupus
8.Diabetes
Pregnancy Related Information
Contra indicated
Old Age Related Information
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Breast Feeding Related Information
Use with caution
Children Related Information
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Indications for Losartan + Amlodipine + Hydrochlorothiazide
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Interactions for Losartan + Amlodipine + Hydrochlorothiazide
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Typical Dosage for Losartan + Amlodipine + Hydrochlorothiazide
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Schedule of Losartan + Amlodipine + Hydrochlorothiazide
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Storage Requirements for Losartan + Amlodipine + Hydrochlorothiazide
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Effects of Missed Dosage of Losartan + Amlodipine + Hydrochlorothiazide
Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.
Effects of Overdose of Losartan + Amlodipine + Hydrochlorothiazide
Seek emergency medical attention if you think you have used too much of this medicine.
Overdose symptoms may include fast or slow heartbeat, confusion, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling; feeling light-headed, and fainting.

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Amlodipine

About Amlodipine
Calcium Channel Blocker, Anti hypertensive,anti angina.
Mechanism of Action of Amlodipine
Amlodipine is a second generation dihydropyridine Ca channel blocker. It exerts it`s antihypertensive, antianginal actions through blocking the influx of Ca ions through voltage gated L-type Ca channels to the peripheral vascular smooth muscle cells, Coronary smooth muscle cells and to the myocardial cells. Thus causes dilatation of vascular endothelium, decrease peripheral resistance, & reduce myocardial oxygen demand .It markedly relax arterioles and milder effects on veins. They do not compromise haemodynamics and cerebral and renal perfusion.
Pharmacokinets of Amlodipine
Absorption: Well absorbed orally, Distribution: Widely distributed in a protein bound form, Metabolism: Metabolized in liver, but there is no active metabolite.
Onset of Action for Amlodipine
Slow
Duration of Action for Amlodipine
24 hours
Half Life of Amlodipine
N/A
Side Effects of Amlodipine
1.Palpitation
2.Flushing
3.Nausea
4.Vomiting
5.Abdominal pain
6.Edema
7.Headache
8.Dizziness
9.Paresthesia
10.Light headedness
11.Fatigue
12.Aggravates myocardial ischaemia
13.Rashes
Contra-indications of Amlodipine
1.Heart failure
2.Aortic stenosis
3.Hypersensitivity to the drug
4.Unstable angina
5.Hepatic impairment
6.Along with other anti hypertensive drugs.
Special Precautions while taking Amlodipine
1.Cardiovascular disorders: Use cautiously in cardiovascular disorders because it aggravates myocardial ischaemia.
2.Sick sinus syndrome
3.Renal impairment
4.Use cautiously along with other antihypertensive drugs,
Pregnancy Related Information
Contraindicated.
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution.
Children Related Information
Contraindicated
Indications for Amlodipine
1.Hypertension
2.Prinzmetal`s angina
3.Stable angina
Interactions for Amlodipine
ACE inhibitors, Thiazide diuretics: Potentiates effect of these drugs.
Beta Blockers: Best avoided, especially by those with impaired LV function due to depressant effect on myocardial contractibility or AV conduction.
Fentanyl: Severe hypotension or increased fluid volume requirements.
Typical Dosage for Amlodipine
5 mg once daily.
Maximum dose: 10mg/day
Prinzmetal`s angina and Stable angina:
5 to 10mg once daily.
Hypertension: 2.5 to 5mg once daily. Dose may increase up to 10mg once daily as required by the individual needs.
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Schedule of Amlodipine
H
Storage Requirements for Amlodipine
Store at room temperature below 30 degree C. Protect from moisture and light.

Effects of Missed Dosage of Amlodipine
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Amlodipine
Monitor &support cardiac and respiratory functions. Measure the BP. Give cardiovascular support by elevating the limbs and maintaining fluid balance. Administer vasopressers like nor epinephrine and Calcium gluconate if required.

Hydrochlorothiazide

About Hydrochlorothiazide
Thiazide derivatibve, Diuretic.
Mechanism of Action of Hydrochlorothiazide
It is thiazide diuretic which exerts its action by acting at site-3(central dilating segment of early distal tubule). It binds to Na+Cl- symporter and inhibits Na+Cl- symport at the luminal membrane. It has additional carbonic anhydrase inhibitory actions in proximal tubules. It increases natriuresis, kaliuresis and diuresis. It decreases Ca2+ excretion and increases Mg2+excretion. It also has minor carbonic anhydrase inhibitory action. It also causes direct arteriolar vasodilatation and decreases total peripheral resistance. The antihypertensive actions of the drug may be attributable to depletion of sodium and subsequent reduction in plasma volume and a decrease in peripheral resistance. Decrease in peripheral resistance is due to either the loss of sodium from the arteriolar wall or a direct action on the vascular bed. It is an effective drug in edema associated with congestive heart failure.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure

Pharmacokinets of Hydrochlorothiazide
Absorption: It is absorbed after oral administration.
Metabolism: It is not metabolized in the body.
Excretion: Excreted unchanged in urine.

Onset of Action for Hydrochlorothiazide
1 to 3 hours
Duration of Action for Hydrochlorothiazide
12 to 16 hours
Half Life of Hydrochlorothiazide
5 to 15 hours
Side Effects of Hydrochlorothiazide
1. Dizziness
2. Blurred vision
3. Confusion
4. Tingling fingers
5. Dry mouth
6. Nausea
7. Diarrhoea
8. Constipation
9. Vomiting
10. Weakness
11. Hypokalaemia
12. Hyponatraemia
13. Hyperuricaemia
14. Elevated levels of glucose, calcium and lipids
15. Gastro intestinal disturbances
16. Polyuria
17. Electrolyte imbalance
18. Jaundice
19. Rashes
20. Photosensitivity
21. Fever
22. Itching
23. Myalgia
24. Muscle cramps
25. Arthralgia
26. Blood dyscrasias
27. Ototoxicity

Contra-indications of Hydrochlorothiazide
1. Hyper uricaemia
2. Hyper calcaemia
3. Renal impairment
4. Hepatic impairment
5. Anuria
6. Hypersensitivity to the drug
7. Hyper sensitivity to sulfonamides
8. Fluid and electrolyte imbalance

Special Precautions while taking Hydrochlorothiazide
1. Gout
2. Diabetes mellitus
3. Renal impairment
4. Hepatic impairment
5. Monitor and correct Fluid and electrolyte imbalance
6. Hyper parathyroidism
7. Cirrhosis

Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
May be used
Indications for Hydrochlorothiazide
1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Diabetes insipidus
5. Idiopathic hypercalciurea.
6. Vertigo
Interactions for Hydrochlorothiazide
Cholestyramine & Colestipol: decrease absorption of hydrochlorothiazide.
Diazoxide: Additive action - may cause hyperglycemia, hyperuricaemia and hypotension.
Digitalis: Diuretics induced hypokalaemia may precipitate digitalis toxicity.
Lithium: Hydrochlorothiazide potentiates therapeutic and toxic effects by increasing its renal excretion.
Frusemide: Synergy leading to profound diuresis and greater than predicted electrolyte loss.
Non-depolarizing muscle relaxants: Diuretics induced hypokalaemia enhances efficacy.
Sulfonylureas: Efficacy decreased due to hydrochlorothiazide induced glucose intolerance.
Chlorpropamide: Hypokalaemia.
Propantheline: Bioavailability of hydrochlorothiazide increased.
Metoclopramide: Bioavailability of hydrochlorothiazide decreased.
NSAIDs: Natriuretic effect of hydrochlorothiazide decreased.
Typical Dosage for Hydrochlorothiazide
Adults:
Hypertension: 25mg once daily or in divided doses. Increased to 50mg if required; depending up on the patient`s response.
Children: 1mg/kg single daily dose.
Oedema:
Adults:
Starts with 25 to 50mg. Increased the dose until desired response is obtained.
Maximum dose: 200mg/day
Maintenance dosage: 25 to 100mg daily or on alternate days.
Children: 1mg/kg single daily dose or 1 to 3mg/kg/day in two divided doses



Schedule of Hydrochlorothiazide
G
Storage Requirements for Hydrochlorothiazide
Store at room temperature in a well closed container and protected from light.
Effects of Missed Dosage of Hydrochlorothiazide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Hydrochlorothiazide
Treatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and assist respiratory, cardiovascular, and renal function as indicated. Monitor and support fluid and electrolyte balance.

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