Losartan and hydrochlorothiazide side effects
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Common Side Effects of Losartan and Hydrochlorothiazide Combination
The combination of losartan and hydrochlorothiazide is widely used to treat hypertension and has been shown to be generally well tolerated. The most frequently reported side effects include headache, fatigue (asthenia), dizziness, sinusitis, and upper respiratory infections. These side effects occur slightly more often than with placebo, but are usually mild in nature 1248.
Electrolyte and Metabolic Effects
Hydrochlorothiazide, as a thiazide diuretic, can affect electrolyte balance. Studies have shown that the combination with losartan can increase urinary zinc excretion, leading to a decrease in serum zinc levels, which may result in zinc deficiency over time. However, magnesium and nitric oxide metabolism are not significantly affected by this combination . Additionally, unlike some other antihypertensive combinations, losartan with hydrochlorothiazide does not significantly increase serum uric acid levels, which is beneficial for patients at risk of gout .
Rare and Serious Adverse Reactions
Although rare, hydrochlorothiazide has been associated with noncardiogenic pulmonary edema, a potentially serious condition. This reaction is considered idiosyncratic and can occur acutely after ingestion. Prompt discontinuation of the medication and supportive care are necessary if this occurs .
Cough and Respiratory Symptoms
The incidence of cough with losartan and hydrochlorothiazide is low and similar to that seen with hydrochlorothiazide alone. This is in contrast to ACE inhibitors, which are more likely to cause cough. For patients who have experienced cough with ACE inhibitors, switching to losartan or hydrochlorothiazide is less likely to result in this side effect 29.
Renal and Cardiovascular Safety
The combination of losartan and hydrochlorothiazide is considered safe for kidney function, with no significant changes in creatinine levels observed. Both drugs together can help reduce microalbuminuria, which is beneficial for cardiovascular and renal protection 710. In elderly patients and those with congestive heart failure, the combination is effective and associated with few adverse effects 58.
Comparison with Other Antihypertensive Therapies
Compared to other antihypertensive regimens, losartan plus hydrochlorothiazide offers improved blood pressure control and a reduction in therapy-related symptoms, especially cough. It also has a better safety profile than some alternatives, such as high-dose amlodipine, which is more likely to cause flushing and lower extremity edema 210.
Conclusion
Losartan and hydrochlorothiazide, when used together, are effective for blood pressure control and generally well tolerated. Most side effects are mild, with rare but serious reactions like pulmonary edema possible. The combination is less likely to cause cough than ACE inhibitors and does not significantly impact kidney function or uric acid levels. Regular monitoring for electrolyte changes, especially zinc, is recommended during long-term therapy.
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