Compatibility «Co-Diroton» and «Losartan»
Between «Co-Diroton» and «Losartan» found 20 dangerous and 18 negative interactions, joint admission is not recommended without consulting a doctor.
Interaction tableCompare |
Losartan |
✘Co-Diroton [Lisinopril and more 1Hydrochlorothiazide] Analogs | |
✘Losartan [Losartan] Analogs |
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Interactions Co-Diroton with Losartan
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Dangerous interactions
- Double blockade of RAAS ARA II, ACE inhibitors or direct renin inhibitors (such as aliskiren) It is associated with an increased risk of hypotension, syncope, hyperkalemia and changes in renal function (including acute renal failure) compared to monotherapy.
- In patients treated with a combination of losartan and lisinopril, there were no additional advantages compared with monotherapy in relation to the combined endpoint of GFR reduction, end-stage renal failure or death, but there was an increased incidence of hyperkalemia and acute kidney damage compared with patients in the monotherapy group.
- In patients with atherosclerotic disease, heart failure or diabetes mellitus with target organ damage, simultaneous therapy with ACE inhibitor and ARA II is associated with a higher incidence of arterial hypotension, syncope, hyperkalemia and deterioration of renal function (including acute renal failure) compared with the use of only one drug that affects the RAAS.
- Concomitant use of ACE inhibitors with ARA II is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.
- With simultaneous use of lisinopril with potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone), potassium preparations or potassium-containing substitutes for table salt and other drugs capable of increasing the potassium content in blood serum (including ARA II, heparin, tacrolimus, cyclosporine; preparations containing co-trimoxazole [trimethoprim + sulfamethoxazole]), the risk of hyperkalemia increases (especially in patients with impaired renal function).
- In some patients with impaired renal function (for example, in elderly patients or patients with dehydration) receiving NSAID therapy (in pm with selective COX-2 inhibitors), the simultaneous use of ACE inhibitors or ARA II may cause further deterioration of renal function, including the development of acute renal failure, and hyperkalemia.
- ACE inhibitors (C09A) + angiotensin ii receptor antagonists => Are associated with an increased risk of arterial hypotension, syncope, hyperkalemia and impaired renal function (in pm acute renal failure) compared with monotherapy.
- Double blockade of RAAS with angiotensin receptor blockers, ACE inhibitors or aliskiren is associated with an increased risk of hypotension, syncope, hyperkalemia and changes in renal function (including acute renal failure) compared to monotherapy.
- Patients receiving losartan in combination with lisinopril did not have any additional advantages compared with monotherapy in relation to the combined endpoint of GFR reduction, end-stage renal failure or death, but among them there was an increased incidence of hyperkalemia and acute kidney injury compared with the monotherapy group.
- There is evidence that the simultaneous use of ACE inhibitors, ARA II or aliskiren increases the risk of arterial hypotension, hyperkalemia and impaired renal function (including acute renal failure) when compared with the use of a single drug affecting RAAS.
- The use of a combination of hydrochlorothiazide + losartan in combination with ACE inhibitors is contraindicated in patients with diabetic nephropathy and is not recommended for other patients (see 'Contraindications').
- It should be used with caution with hypotensive drugs (their effect is potentiated, dose adjustment may be necessary), cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase the toxicity of digitalis), amiodarone (its use simultaneously with thiazide diuretics may lead to an increased risk of arrhythmias associated with hypokalemia), hypoglycemic oral medications (their effectiveness decreases, hyperglycemia may develop), corticosteroids, calcitonin (increase potassium excretion), NSAIDs (may weaken the diuretic and hypotensive effects of thiazides), non-depolarizing muscle relaxants (their effect may be enhanced), amantadine (clearance of amantadine may decrease with hydrochlorothiazide, which leads to an increase in plasma concentration of amantadine and possible toxicity), colestyramine (reduces absorption of hydrochlorothiazide), ethanol, barbiturates and narcotic analgesics, which enhance the effect of orthostatic hypotension.
- In elderly patients with a decrease in the volume of intercellular fluid (including those receiving diuretics) or with impaired renal function, the combined use of NSAIDs, including selective COX-2 inhibitors, with ARA II (including losartan) may lead to deterioration of renal function, including the possible development of acute renal failure.
- The simultaneous use of ARA II or diuretics and NSAIDs may cause an increased risk of deterioration of renal function, in pm acute renal failure and increased potassium content in blood plasma, especially in patients with initial renal impairment.
- Metformin should be used with caution due to the risk of lactic acidosis caused by possible functional renal failure associated with the use of hydrochlorothiazide.
- Diuretics reduce the renal clearance of lithium and significantly increase the risk of its toxic effects.
- It is recommended to avoid simultaneous use of hydrochlorothiazide with lithium preparations.
- In the case of high doses of salicylates, hydrochlorothiazide may enhance their toxic effect on the central nervous system.
- Hypokalemia or hypomagnesemia caused by thiazide diuretics may contribute to the development of arrhythmias induced by cardiac glycosides.
- In the case of dehydration caused by the use of diuretics, the risk of acute renal failure increases, especially when taking high doses of iodine preparations.
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Negative interactions
- The possibility of hypotensive effects when taking lisinopril can be minimized by reducing or stopping the diuretic or increasing salt intake before starting treatment with lisinopril.
- Double blockade (for example, when combining an ACE inhibitor with ARA II) should be limited to individual cases with careful monitoring of renal function, potassium content and regular blood pressure monitoring.
- Other antihypertensive drugs.
- When used simultaneously with vasodilators, beta-blockers, BMCC, diuretics and other antihypertensive drugs, the severity of the antihypertensive effect of lisinopril increases.
- Blood pressure should be carefully monitored and, if necessary, the dose of antihypertensive drugs should be adjusted.
- The VA NEPHRON-D study included 1,448 patients with type 2 diabetes, an increased ratio of albumin to creatinine in urine and a reduced calculated GFR (from 30 to 89.9 ml/min); they were randomized into groups receiving lisinopril or placebo on the background of losartan therapy, the follow-up lasted an average of 2.2 years.
- Other antihypertensive agents.
- It may be necessary to adjust the dose of simultaneously prescribed antihypertensive drugs.
- When taken simultaneously with thiazide diuretics, interaction with the following drugs may be observed.
- In the presence of ion exchange resins, the absorption of hydrochlorothiazide is impaired.
- Taking a single dose of colestyramine or colestipol leads to the binding of hydrochlorothiazide and a decrease in its absorption from the gastrointestinal tract by 85 and 43%, respectively.
- It may be necessary to adjust the dose of anti-gouty drugs, since hydrochlorothiazide can increase the concentration of uric acid in blood plasma.
- Concomitant use with thiazides may increase the incidence of hypersensitivity reactions to allopurinol.
- It is possible to increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility and the rate of gastric emptying.
- Thiazide diuretics can inhibit the excretion of cytotoxic drugs through the kidneys and enhance their myelosuppressive effect.
- Isolated cases of hemolytic anemia have been described in patients receiving hydrochlorothiazide and methyldopa at the same time.
- Thiazide diuretics can increase the calcium content in blood plasma by reducing the excretion of calcium by the kidneys.
- Hydrochlorothiazide can cause the development of electrolyte deficiency, especially hypokalemia.
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Unclear interactions
- Losartan + Hydrochlorothiazide analgin and citramon are used together in 20 preparations.
- Hydrochlorothiazide.
- Treatment with thiazide diuretics may affect glucose tolerance.
- Due to the effect on calcium metabolism, thiazides can distort the results of tests to assess the function of the parathyroid glands.
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Dangerous interactions
Decoding the colors of interactions and contraindications
Dangerous | — | a pronounced negative interaction or contraindication. |
Negative | — | negative interaction or side effect that may reduce effectiveness. |
Positive | — | the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication of the drug. |
No | — | the drugs do NOT interact, which is separately indicated in the instructions. |
Unclear | — | the system failed to pre-assess the danger. |
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Additional information
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- Why do I need to
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- The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
- The article is written: artificial intelligence Kiberis
- Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
- Total analyzed: 169,985,306 possible combinations of drugs and their components were found 412,521 interacting combinations.
- Medicine section: Standard evidence-based medicine
- The date of the last update of the interaction database: 2024-09-05
Category - medicine