DRUGS & SUPPLEMENTS

Angizaar-AT

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Angizaar-AT uses

Angizaar-AT consists of Atenolol, Losartan Potassium.

Atenolol:


Pharmacological action

Angizaar-AT is a cardioselective beta1-blocker without intrinsic sympathomimetic activity. This medication has antihypertensive, antianginal and antiarrhythmic action. Angizaar-AT (Atenolol) reduces the stimulatory effect on the heart sympathetic innervation and circulating catecholamines.

The hypotensive effect of this drug is associated with a decrease in minute volume of blood, decreased activity of the renin-angiotensin system (has a greater significance for patients with initial hypersecretion of renin), sensitivity of baroreceptors of the aortic arch (not going to enhance their activity in response to decreased blood pressure) and the effect on the CNS; manifested lower both systolic and diastolic blood pressure, decreasing stroke volume and cardiac output. In the medium therapeutic doses it has no effect on the tone of peripheral arteries.

The antianginal effect of Angizaar-AT (Atenolol) is associated with decreased myocardial oxygen demand by decreasing heart rate (lengthening of diastole and improved myocardial perfusion) and contractility, as well as reduced sensitivity to the effects of myocardial sympathetic innervation. Decrease in heart rate occurs at rest and during exercise.

The antiarrhythmic effect of this medicine is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increase of cAMP, hypertension), decrease in the rate of spontaneous excitation of the sinus and ectopic pacemakers and slowing of AV conduction.

The hypotensive effect lasts 24 hours, with regular admission is stabilized by the end of 2 weeks of treatment. The negative chronotropic effect is manifested by 1 h after administration, reaches a maximum after in 2-4 hours and lasts up to 24 hours.

Pharmacokinetics

After oral administration the absorption of Angizaar-AT (Atenolol) from the gastrointestinal tract is 50-60%, its bioavailability is 40-50%. This drug is practically not metabolized in the body; poorly penetrates the BBB. The plasma protein binding is 6-16%. T1/2 is 6-9 h. Angizaar-AT (Atenolol) is primarily excreted by the kidneys in unchanged form. Renal dysfunction accompanied mainly to the increase of T1/2 and cumulation. This medication is excreted during hemodialysis. For elderly patients T1/2 of Angizaar-AT (Atenolol) is increased.

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Why is Angizaar-AT prescribed?

Hypertension, hypertensive crisis, mitral valve prolapse, cardiac hyperkinetic syndrome of functional origin, neurocirculatory dystonia of hypertensive type.

Treatment: coronary artery disease, angina pectoris (stress, rest and unstable).

Treatment and prevention of: myocardial infarction (acute phase in stable hemodynamic parameters, secondary prevention).

Arrhythmias (including at the general anesthesia, congenital syndrome prolongation QT, myocardial infarction without signs of congestive heart failure, thyrotoxicosis), sinus tachycardia, paroxysmal atrial tachycardia, supraventricular and ventricular premature beats, supraventricular and ventricular tachycardia, atrial tachyarrhythmia, atrial flutter.

Essential and senile tremor, agitation and tremors withdrawal syndrome.

In the combined therapy: hypertrophic obstructive cardiomyopathy, pheochromocytoma (only in combination with alpha-blockers), hyperthyroidism; migraine (prophylaxis).

Dosage and administration

The dosing regimen of Angizaar-AT is set individually. The usual dose for adults for oral administration at the beginning of treatment is 25-50 mg 1 time / day. If necessary the dose is increased gradually. If impaired renal function in patients with CC 15-35 ml / min - 50 mg / day; with CC less than 15 ml / min - 50 mg every other day.

The maximum dose for adults for oral administration is 200 mg / day in 1 or 2 doses.

Angizaar-AT (Atenolol) side effects, adverse reactions

Cardiovascular system: in some cases - bradycardia, hypotension, AV-conduction disturbances, symptoms of heart failure.

Digestive system: at the beginning of therapy it is possible nausea, constipation, diarrhea, dry mouth.

CNS and peripheral nervous system: at the beginning of therapy may be fatigue, dizziness, depression, mild headache, sleep disturbances, coldness and paresthesia in extremities, reduced reactivity of the patient, reducing the secretion of tear fluid, conjunctivitis.

Endocrine system: reduced potency, hypoglycemic state in patients with diabetes.

Respiratory system: in predisposed patients - symptoms of bronchial obstruction.

Allergic reactions: itching.

Other: increased sweating, redness of the skin.

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Angizaar-AT contraindications

AV-block II and III degree, sinoatrial block, SSS, bradycardia (HR < 40 bpm), hypotension (in case of myocardial infarction, systolic blood pressure less than 100 mm Hg), cardiogenic shock, congestive heart failure IIB-III stages, acute heart failure, Prinzmetal's angina, lactation, concomitant use of MAO inhibitors, hypersensitivity to Angizaar-AT (Atenolol).

Using during pregnancy and breastfeeding

Angizaar-AT crosses the placental barrier, so use during pregnancy is only possible if the intended benefits to the mother justifies potential risk to the fetus.

Angizaar-AT (Atenolol) is excreted in breast milk, so if you need to use during lactation is recommended to stop breastfeeding.

Category effects on the fetus by FDA - D.

Special instructions

With caution use this medication in hepatic failure.

Angizaar-AT (Atenolol) should be used with caution in diabetes, COPD (including asthma, emphysema), metabolic acidosis, hypoglycemia, allergic reactions, a history of chronic heart failure (compensated), obliterating peripheral arterial disease (intermittent claudication, Raynaud's syndrome), pheochromocytoma, liver failure, chronic renal insufficiency, myasthenia gravis, hyperthyroidism, depression (including in history), psoriasis, pregnancy, elderly patients, in pediatrics (the efficacy and safety are not defined).

While taking Angizaar-AT (Atenolol) it can decrease tear fluid production, which is important for patients who use contact lenses.

Cancellation of this drug after prolonged treatment should be carried out gradually under medical supervision.

Upon the termination of the combined use of Angizaar-AT (Atenolol) and clonidine, clonidine treatment continued for several days after discontinuation of Angizaar-AT (Atenolol), otherwise you may experience severe arterial hypertension.

When the need for inhaled anesthesia in patients receiving Angizaar-AT (Atenolol) Meliapharm, a few days before anesthesia to stop taking Angizaar-AT (Atenolol) or find a medication for anesthesia with minimal negative inotropic effects.

Patients whose work requires high concentration, the question of outpatient use of Angizaar-AT (Atenolol) should be addressed only after an assessment of individual response.

Angizaar-AT drug interactions

Antiarrhythmic and anesthetic facilities increase cardiodepressive action of this drug (increased risk of developing bradycardia, arrhythmia, hypotension, heart failure).

Reserpine, methyldopa, clonidine, guanfacine, cardiac glycosides potentiate the negative chrono-, drome- and bathmotropic effect, insulin and other antidiabetic funds - hypoglycemia.

NSAIDs, estrogens, sympathomimetics, xanthines weaken the anti-hypertensive effect, absorption; sympatholytic, nitroglycerin, hydralazine, and other antihypertensive drugs increase it; antacids slow down this medication absorption.

Cimetidine inhibits the metabolism of Angizaar-AT (Atenolol) Meliapharm.

This medication prolongs the action of anti-depolarizing muscle relaxant, anticoagulant effect of coumarins.

Three / tetracyclic antidepressants, antipsychotics, sedatives, hypnotics and alcohol potentiate CNS depression.

Angizaar-AT (Atenolol) is incompatible with MAO inhibitors.

Angizaar-AT in case of emergency / overdose

Symptoms: bradycardia, AV block II-III degree, heart failure, respiratory failure, hypotension, bronchospasm, hypoglycemia.

Treatment: gastric lavage and the appointment of adsorbing medications; Symptomatic treatment: atropine, isoprenaline, orciprenaline, cardiac glycosides or glucagon, diuretics, pressor agents (dopamine, dobutamine or norepinephrine), selective beta-adrenoceptor agonists, IV glucose solution, installation of an artificial pacemaker. Perhaps dialysis.

Losartan Potassium:


INDICATIONS AND USAGE

Hypertension

Angizaar-AT Tablets, USP is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents, including diuretics.

Hypertensive Patients with Left Ventricular Hypertrophy

Angizaar-AT (Losartan Potassium) Tablets USP is indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, but there is evidence that this benefit does not apply to Black patients. (See PRECAUTIONS , Race and CLINICAL PHARMACOLOGY , Pharmacodynamics and Clinical Effects, Reduction in the Risk of Stroke, Race .)

Nephropathy in Type 2 Diabetic Patients

Angizaar-AT (Losartan Potassium) is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥ 300 mg/g) in patients with type 2 diabetes and a history of hypertension. In this population, Angizaar-AT (Losartan Potassium) reduces the rate of progression of nephropathy as measured by the occurrence of doubling of serum creatinine or end stage renal disease (need for dialysis or renal transplantation) (see CLINICAL PHARMACOLOGY , Pharmacodynamics and Clinical Effects ).

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CONTRAINDICATIONS

Angizaar-AT (Losartan Potassium) Tablets USP is contraindicated in patients who are hypersensitive to any component of this product.

WARNINGS

Fetal/Neonatal Morbidity and Mortality

Drugs that act directly on the renin-angiotensin system can cause fetal and neonatal morbidity and death when administered to pregnant women. Several dozen cases have been reported in the world literature in patients who were taking angiotensin converting enzyme inhibitors. When pregnancy is detected, Angizaar-AT tablets should be discontinued as soon as possible.

The use of drugs that act directly on the renin-angiotensin system during the second and third trimesters of pregnancy has been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased fetal renal function; oligohydramnios in this setting has been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development. Prematurity, intrauterine growth retardation, and patent ductus arteriosus have also been reported, although it is not clear whether these occurrences were due to exposure to the drug.

These adverse effects do not appear to have resulted from intrauterine drug exposure that has been limited to the first trimester.

Mothers whose embryos and fetuses are exposed to an angiotensin II receptor antagonist only during the first trimester should be so informed. Nonetheless, when patients become pregnant, physicians should have the patient discontinue the use of Angizaar-AT (Losartan Potassium) tablets as soon as possible.

Rarely (probably less often than once in every thousand pregnancies), no alternative to an angiotensin II receptor antagonist will be found. In these rare cases, the mothers should be apprised of the potential hazards to their fetuses, and serial ultrasound examinations should be performed to assess the intra-amniotic environment.

If oligohydramnios is observed, Angizaar-AT (Losartan Potassium) tablets should be discontinued unless it is considered life-saving for the mother. Contraction stress testing (CST), a non-stress test (NST), or biophysical profiling (BPP) may be appropriate, depending upon the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury.

Infants with histories of in utero exposure to an angiotensin II receptor antagonist should be closely observed for hypotension, oliguria, and hyperkalemia. If oliguria occurs, attention should be directed toward support of blood pressure and renal perfusion. Exchange transfusion or dialysis may be required as means of reversing hypotension and/or substituting for disordered renal function.

Angizaar-AT (Losartan Potassium) has been shown to produce adverse effects in rat fetuses and neonates, including decreased body weight, delayed physical and behavioral development, mortality and renal toxicity. With the exception of neonatal weight gain (which was affected at doses as low as 10 mg/kg/day), doses associated with these effects exceeded 25 mg/kg/day (approximately three times the maximum recommended human dose of 100 mg on a mg/m2 basis). These findings are attributed to drug exposure in late gestation and during lactation. Significant levels of losartan and its active metabolite were shown to be present in rat fetal plasma during late gestation and in rat milk.

Hypotension - Volume-Depleted Patients

In patients who are intravascularly volume-depleted (e.g., those treated with diuretics), symptomatic hypotension may occur after initiation of therapy with Angizaar-AT (Losartan Potassium). These conditions should be corrected prior to administration of Angizaar-AT (Losartan Potassium) tablets, or a lower starting dose should be used (see DOSAGE AND ADMINISTRATION ).

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PRECAUTIONS

General

Hypersensitivity: Angioedema.

See ADVERSE REACTIONS , Post-Marketing Experience.

Impaired Hepatic Function

Based on pharmacokinetic data which demonstrate significantly increased plasma concentrations of losartan in cirrhotic patients, a lower dose should be considered for patients with impaired liver function.

Impaired Renal Function

As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function have been reported in susceptible individuals treated with Angizaar-AT (Losartan Potassium); in some patients, these changes in renal function were reversible upon discontinuation of therapy.

In patients whose renal function may depend on the activity of the renin-angiotensin-aldosterone system (e.g., patients with severe congestive heart failure), treatment with angiotensin converting enzyme inhibitors has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. Similar outcomes have been reported with Angizaar-AT (Losartan Potassium).

In studies of ACE inhibitors in patients with unilateral or bilateral renal artery stenosis, increases in serum creatinine or blood urea nitrogen (BUN) have been reported. Similar effects have been reported with Angizaar-AT (Losartan Potassium); in some patients, these effects were reversible upon discontinuation of therapy.

Electrolyte Imbalance

Electrolyte imbalances are common in patients with renal impairment, with or without diabetes, and should be addressed. In a clinical study conducted in type 2 diabetic patients with proteinuria, the incidence of hyperkalemia was higher in the group treated with Angizaar-AT as compared to the placebo group; however, few patients discontinued therapy due to hyperkalemia (see ADVERSE REACTIONS ).

Information for Patients

Pregnancy: Female patients of childbearing age should be told about the consequences of second-and third-trimester exposure to drugs that act on the renin-angiotensin system, and they should also be told that these consequences do not appear to have resulted from intrauterine drug exposure that has been limited to the first trimester. These patients should be asked to report pregnancies to their physicians as soon as possible.

Potassium Supplements: A patient receiving Angizaar-AT (Losartan Potassium) tablets should be told not to use potassium supplements or salt substitutes containing potassium without consulting the prescribing physician (see PRECAUTIONS , Drug Interactions ).

Drug Interactions: No significant drug-drug pharmacokinetic interactions have been found in interaction studies with hydrochlorothiazide, digoxin, warfarin, cimetidine and phenobarbital. Rifampin, an inducer of drug metabolism, decreased the concentrations of losartan and its active metabolite. (See CLINICAL PHARMACOLOGY , Drug Interactions .) In humans, two inhibitors of P450 3A4 have been studied. Ketoconazole did not affect the conversion of losartan to the active metabolite after intravenous administration of losartan, and erythromycin had no clinically significant effect after oral administration. Fluconazole, an inhibitor of P450 2C9, decreased active metabolite concentration and increased losartan concentration. The pharmacodynamic consequences of concomitant use of losartan and inhibitors of P450 2C9 have not been examined. Subjects who do not metabolize losartan to active metabolite have been shown to have a specific, rare defect in cytochrome P450 2C9. These data suggest that the conversion of losartan to its active metabolite is mediated primarily by P450 2C9 and not P450 3A4.

As with other drugs that block angiotensin II or its effects, concomitant use of potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium.

Lithium: As with other drugs which affect the excretion of sodium, lithium excretion may be reduced. Therefore, serum lithium levels should be monitored carefully if lithium salts are to be co-administered with angiotensin II receptor antagonists.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) including Selective Cyclooxygenase-2 Inhibitors(COX-2Inhibitors): In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function co-administration of NSAIDS, including selective COX-2 inhibitors, with angiotensin II receptor antagonists (including losartan) may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving losartan and NSAID therapy.

The antihypertensive effect of angiotensin II receptor antagonists, including losartan may be attenuated by NSAIDs, including selective COX-2 inhibitors.

Dual blockade of the renin-angiotensin-aldosterone system: Dual blockade of the renin-angiotensin-aldosterone system is associated with increased risk of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure). Closely monitor blood pressure, renal function, and electrolytes in patients on Angizaar-AT (Losartan Potassium) Tablets and ACE inhibitors.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Angizaar-AT was not carcinogenic when administered at maximally tolerated dosages to rats and mice for 105 and 92 weeks, respectively. Female rats given the highest dose (270 mg/kg/day) had a slightly higher incidence of pancreatic acinar adenoma. The maximally tolerated dosages (270 mg/kg/day in rats, 200 mg/kg/day in mice) provided systemic exposures for losartan and its pharmacologically active metabolite that were approximately 160- and 90-times (rats) and 30- and 15-times (mice) the exposure of a 50 kg human given 100 mg per day.

Angizaar-AT (Losartan Potassium) was negative in the microbial mutagenesis and V-79 mammalian cell mutagenesis assays and in the in vitro alkaline elution and in vitro and in vivo chromosomal aberration assays. In addition, the active metabolite showed no evidence of genotoxicity in the microbial mutagenesis, in vitro alkaline elution, and in vitro chromosomal aberration assays.

Fertility and reproductive performance were not affected in studies with male rats given oral doses of Angizaar-AT (Losartan Potassium) up to approximately 150 mg/kg/day. The administration of toxic dosage levels in females (300/200 mg/kg/day) was associated with a significant (p<0.05) decrease in the number of corpora lutea/female, implants/female, and live fetuses/female at C-section. At 100 mg/kg/day only a decrease in the number of corpora lutea/female was observed. The relationship of these findings to drug-treatment is uncertain since there was no effect at these dosage levels on implants/pregnant female, percent post-implantation loss, or live animals/litter at parturition. In nonpregnant rats dosed at 135 mg/kg/day for 7 days, systemic exposure (AUCs) for losartan and its active metabolite were approximately 66 and 26 times the exposure achieved in man at the maximum recommended human daily dosage (100 mg).

Pregnancy

Pregnancy Categories C (first trimester) and D (second and third trimesters). See WARNING , Fetal/Neonatal Morbidity and Mortality .

Nursing Mothers

It is not known whether losartan is excreted in human milk, but significant levels of losartan and its active metabolite were shown to be present in rat milk. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Antihypertensive effects of Angizaar-AT have been established in hypertensive pediatric patients aged 6 to 16 years. There are no data on the effect of Angizaar-AT (Losartan Potassium) on blood pressure in pediatric patients under the age of 6 or in pediatric patients with glomerular filtration rate <30 mL/min/1.73 m2 (see CLINICAL PHARMACOLOGY , Pharmacokinetics, Special Populations and Pharmacodynamics and Clinical Effects and DOSAGE AND ADMINISTRATION).

Geriatric Use

Of the total number of patients receiving Angizaar-AT (Losartan Potassium) in controlled clinical studies for hypertension, 391 patients (19%) were 65 years and over, while 37 patients (2%) were 75 years and over. In a controlled clinical study for renal protection in type 2 diabetic patients with proteinuria, 248 patients (33%) were 65 years and over. In a controlled clinical study for the reduction in the combined risk of cardiovascular death, stroke and myocardial infarction in hypertensive patients with left ventricular hypertrophy, 2857 patients (62%) were 65 years and over, while 808 patients (18%) were 75 years and over. No overall differences in effectiveness or safety were observed between these patients and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

Race

In the LIFE study, Black patients with hypertension and left ventricular hypertrophy had a lower risk of stroke on atenolol than on Angizaar-AT (Losartan Potassium). Given the difficulty in interpreting subset differences in large trials, it cannot be known whether the observed difference is the result of chance. However, the LIFE study does not provide evidence that the benefits of Angizaar-AT (Losartan Potassium) on reducing the risk of cardiovascular events in hypertensive patients with left ventricular hypertrophy apply to Black patients. (See CLINICAL PHARMACOLOGY , Pharmacodynamics and Clinical Effects ; Reduction in the Risk of Stroke .)

ADVERSE REACTIONS

Hypertension

Angizaar-AT has been evaluated for safety in more than 3300 adult patients treated for essential hypertension and 4058 patients/subjects overall. Over 1200 patients were treated for over 6 months and more than 800 for over one year. In general, treatment with Angizaar-AT (Losartan Potassium) was well-tolerated. The overall incidence of adverse experiences reported with Angizaar-AT (Losartan Potassium) was similar to placebo.

In controlled clinical trials, discontinuation of therapy due to clinical adverse experiences was required in 2.3 percent of patients treated with Angizaar-AT (Losartan Potassium) and 3.7 percent of patients given placebo.

The following table of adverse events is based on four 6- to 12-week, placebo-controlled trials involving over 1000 patients on various doses (10-150 mg) of losartan and over 300 patients given placebo. All doses of losartan are grouped because none of the adverse events appeared to have a dose-related frequency. The adverse experiences reported in ≥1% of patients treated with Angizaar-AT (Losartan Potassium) and more commonly than placebo are shown in the table below.

Losartan

(n=1075)

Incidence

%

Placebo

(n=334)

Incidence

%



Musculoskeletal

Cramp, muscle

Pain, back

Pain, leg


1

2

1


0

1

0

Nervous System/Psychiatric

Dizziness


3


2

Respiratory

Congestion, nasal

Infection, upper respiratory

Sinusitis


2

8

1


1

7

0


The following adverse events were also reported at a rate of 1% or greater in patients treated with losartan, but were as, or more frequent, in the placebo group: asthenia/fatigue, edema/swelling, abdominal pain, chest pain, nausea, headache, pharyngitis, diarrhea, dyspepsia, myalgia, insomnia, cough, sinus disorder.

Adverse events occurred at about the same rates in men and women, older and younger patients, and Black and non-Black patients.

A patient with known hypersensitivity to aspirin and penicillin, when treated with Angizaar-AT (Losartan Potassium), was withdrawn from study due to swelling of the lips and eyelids and facial rash, reported as angioedema, which returned to normal 5 days after therapy was discontinued.

Superficial peeling of palms and hemolysis were reported in one subject.

In addition to the adverse events above, potentially important events that occurred in at least two patients/subjects exposed to losartan or other adverse events that occurred in <1% of patients in clinical studies are listed below. It cannot be determined whether these events were causally related to losartan: Body as a Whole: facial edema, fever, orthostatic effects, syncope; Cardiovascular: angina pectoris, second degree AV block, CVA, hypotension, myocardial infarction, arrhythmias including atrial fibrillation, palpitation, sinus bradycardia, tachycardia, ventricular tachycardia, ventricular fibrillation; Digestive: anorexia, constipation, dental pain, dry mouth, flatulence, gastritis, vomiting; Hematologic: anemia; Metabolic: gout; Musculoskeletal: arm pain, hip pain, joint swelling, knee pain, musculoskeletal pain, shoulder pain, stiffness, arthralgia, arthritis, fibromyalgia, muscle weakness; Nervous System/Psychiatric: anxiety, anxiety disorder, ataxia, confusion, depression, dream abnormality, hypesthesia, decreased libido, memory impairment, migraine, nervousness, paresthesia, peripheral neuropathy, panic disorder, sleep disorder, somnolence, tremor, vertigo; Respiratory: dyspnea, bronchitis, pharyngeal discomfort, epistaxis, rhinitis, respiratory congestion; Skin: alopecia, dermatitis, dry skin, ecchymosis, erythema, flushing, photosensitivity, pruritus, rash, sweating, urticaria; Special Senses: blurred vision, burning/stinging in the eye, conjunctivitis, taste perversion, tinnitus, decrease in visual acuity; Urogenital: impotence, nocturia, urinary frequency, urinary tract infection.

Persistent dry cough (with an incidence of a few percent) has been associated with ACE-inhibitor use and in practice can be a cause of discontinuation of ACE-inhibitor therapy. Two prospective, parallel-group, double-blind, randomized, controlled trials were conducted to assess the effects of losartan on the incidence of cough in hypertensive patients who had experienced cough while receiving ACE-inhibitor therapy. Patients who had typical ACE-inhibitor cough when challenged with lisinopril, whose cough disappeared on placebo, were randomized to losartan 50 mg, lisinopril 20 mg, or either placebo (one study, n=97) or 25 mg hydrochlorothiazide (n=135). The double-blind treatment period lasted up to 8 weeks. The incidence of cough is shown below.

Study 1† HCTZ Losartan Lisinopril
Cough 25% 17% 69%
Study 2†† Placebo Losartan Lisinopril
Cough 35% 29% 62%

† Demographics = (89% caucasian, 64% female)

†† Demographics = (90% caucasian, 51% female)

These studies demonstrate that the incidence of cough associated with losartan therapy, in a population that all had cough associated with ACE-inhibitor therapy, is similar to that associated with hydrochlorothiazide or placebo therapy.

Cases of cough, including positive re-challenges, have been reported with the use of losartan in post-marketing experience.

Pediatric Patients: No relevant differences between the adverse experience profile for pediatric patients and that previously reported for adult patients were identified.

Hypertensive Patients with Left Ventricular Hypertrophy

In the LIFE study, adverse events with Angizaar-AT (Losartan Potassium) were similar to those reported previously for patients with hypertension.

Nephropathy in Type 2 Diabetic Patients

In the RENAAL study involving 1513 patients treated with Angizaar-AT tablets or placebo, the overall incidences of reported adverse experiences were similar for the two groups. Angizaar-AT (Losartan Potassium) tablets was generally well tolerated as evidenced by a similar incidence of discontinuations due to side effects compared to placebo (19% for Angizaar-AT (Losartan Potassium) tablets, 24% for placebo). The adverse experiences, regardless of drug relationship, reported with an incidence of ≥4% of patients treated with Angizaar-AT (Losartan Potassium) tablets and occurring more commonly than placebo, on a background of conventional antihypertensive therapy, are shown in the table below.

Losartan

and Conventional

Antihypertensive

Therapy

Incidence

%

(n=751)

Placebo

and Conventional

Antihypertensive

Therapy

Incidence

%

(n=762)

Body as a Whole

Asthenia/Fatigue

Chest Pain

Fever

Infection

Influenza-like disease

Trauma


14

12

4

5

10

4


10

8

3

4

9

3

Cardiovascular

Hypotension

Orthostatic hypotension


7

4


3

1

Digestive

Diarrhea

Dyspepsia

Gastritis


15

4

5


10

3

4

Endocrine

Diabetic neuropathy

Diabetic vascular disease


4

10


3

9

Eyes, Ears, Nose and Throat

Cataract

Sinusitis


7

6


5

5

Hemic

Anemia


14


11

Metabolic and Nutrition

Hyperkalemia

Hypoglycemia

Weight gain


7

14

4


3

10

3

Musculoskeletal

Back pain

Leg pain

Knee pain

Muscular weakness


12

5

5

7


10

4

4

4

Nervous System

Hypesthesia


5


4

Respiratory

Bronchitis

Cough


10

11


9

10

Skin

Cellulitis


7


6

Urogenital

Urinary tract infection


16


13

Post-Marketing Experience

The following additional adverse reactions have been reported in post-marketing experience:

Digestive: Hepatitis (reported rarely).

General Disorders and Administration Site Conditions : Malaise.

Hemic: Thrombocytopenia (reported rarely).

Hypersensitivity: Angioedema, including swelling of the larynx and glottis, causing airway obstruction and/or swelling of the face, lips, pharynx, and/or tongue has been reported rarely in patients treated with losartan; some of these patients previously experienced angioedema with other drugs including ACE inhibitors. Vasculitis, including Henoch-Schönlein purpura, has been reported. Anaphylactic reactions have been reported.

Metabolic and Nutrition: Hyperkalemia, hyponatremia have been reported with losartan.

Musculoskeletal: Rare cases of rhabdomyolysis have been reported in patients receiving angiotensin II receptor blockers.

Nervous system disorders: Dysgeusia

Respiratory: Dry cough.

Skin: Erythroderma

Laboratory Test Findings

In controlled clinical trials, clinically important changes in standard laboratory parameters were rarely associated with administration of Angizaar-AT (Losartan Potassium).

Creatinine, Blood Urea Nitrogen: Minor increases in blood urea nitrogen (BUN) or serum creatinine were observed in less than 0.1 percent of patients with essential hypertension treated with Angizaar-AT (Losartan Potassium) alone (see PRECAUTIONS , Impaired Renal Function ).

Hemoglobin and Hematocrit: Small decreases in hemoglobin and hematocrit (mean decreases of approximately 0.11 grams percent and 0.09 volume percent, respectively) occurred frequently in patients treated with Angizaar-AT (Losartan Potassium) alone, but were rarely of clinical importance. No patients were discontinued due to anemia.

Liver Function Tests: Occasional elevations of liver enzymes and/or serum bilirubin have occurred. In patients with essential hypertension treated with Angizaar-AT (Losartan Potassium) alone, one patient (<0.1%) was discontinued due to these laboratory adverse experiences.

OVERDOSAGE

Significant lethality was observed in mice and rats after oral administration of 1000 mg/kg and 2000 mg/kg, respectively, about 44 and 170 times the maximum recommended human dose on a mg/m2 basis.

Limited data are available in regard to overdosage in humans. The most likely manifestation of overdosage would be hypotension and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation. If symptomatic hypotension should occur, supportive treatment should be instituted.

Neither losartan nor its active metabolite can be removed by hemodialysis.

DOSAGE AND ADMINISTRATION

Adult Hypertensive Patients

Angizaar-AT tablets may be administered with other antihypertensive agents, and with or without food.

Dosing must be individualized. The usual starting dose of Angizaar-AT (Losartan Potassium) tablets is 50 mg once daily, with 25 mg used in patients with possible depletion of intravascular volume (e.g., patients treated with diuretics) (see WARNINGS , Hypotension - Volume-Depleted Patients ) and patients with a history of hepatic impairment (see PRECAUTIONS , General ). Angizaar-AT (Losartan Potassium) tablets can be administered once or twice daily with total daily doses ranging from 25 mg to 100 mg.

If the antihypertensive effect measured at trough using once-a-day dosing is inadequate, a twice-a-day regimen at the same total daily dose or an increase in dose may give a more satisfactory response. The effect of losartan is substantially present within one week but in some studies the maximal effect occurred in 3-6 weeks (see CLINICAL PHARMACOLOGY , Pharmacodynamics and Clinical Effects, Hypertension).

If blood pressure is not controlled by Angizaar-AT (Losartan Potassium) alone, a low dose of a diuretic may be added. Hydrochlorothiazide has been shown to have an additive effect (see CLINICAL PHARMACOLOGY , Pharmacodynamics and Clinical Effects, Hypertension ).

No initial dosage adjustment is necessary for elderly patients or for patients with renal impairment, including patients on dialysis.

Pediatric Hypertensive Patients ≥ 6 years of age

The usual recommended starting dose is 0.7 mg/kg once daily (up to 50 mg total) administered as a tablet or a suspension (see Preparation of Suspension). Dosage should be adjusted according to blood pressure response. Doses above 1.4 mg/kg (or in excess of 100 mg) daily have not been studied in pediatric patients. (See CLINICAL PHARMACOLOGY , Pharmacokinetics, Special Populations and Pharmacodynamics and Clinical Effects , and WARNINGS , Hypotension - Volume-Depleted Patients .)

Angizaar-AT (Losartan Potassium) is not recommended in pediatric patients <6 years of age or in pediatric patients with glomerular filtration rate <30 mL/min/1.73 m2 (see CLINICAL PHARMACOLOGY , Pharmacokinetics, Special Populations and Pharmacodynamics and Clinical Effects , and PRECAUTIONS ).

Preparation of Suspension

Add 10 mL of Purified Water USP to an 8 ounce (240 mL) amber polyethylene terephthalate (PET) bottle containing ten 50 mg Angizaar-AT (Losartan Potassium) tablets. Immediately shake for at least 2 minutes. Let the concentrate stand for 1 hour and then shake for 1 minute to disperse the tablet contents. Separately prepare a 50/50 volumetric mixture of Ora-Plus ** and Ora-Sweet SF **. Add 190 mL of the 50/50 Ora-Plus /Ora-Sweet SF mixture to the tablet and water slurry in the PET bottle and shake for 1 minute to disperse the ingredients. The suspension should be refrigerated at 2-8°C (36-46°F) and can be stored for up to 4 weeks. Shake the suspension prior to each use and return promptly to the refrigerator.

Hypertensive Patients with Left Ventricular Hypertrophy

The usual starting dose is 50 mg of Angizaar-AT (Losartan Potassium) tablets once daily. Hydrochlorothiazide 12.5 mg daily should be added and/or the dose of Angizaar-AT (Losartan Potassium) should be increased to 100 mg once daily followed by an increase in hydrochlorothiazide to 25 mg once daily based on blood pressure response (see CLINICAL PHARMACOLOGY , Pharmacodynamics and Clinical Effects, Reduction in the Risk of Stroke ).

Nephropathy in Type 2 Diabetic Patients

The usual starting dose is 50 mg once daily. The dose should be increased to 100 mg once daily based on blood pressure response (see CLINICAL PHARMACOLOGY, Pharmacodynamics and Clinical Effects, Nephropathy in Type 2 Diabetic Patients). Angizaar-AT (Losartan Potassium) may be administered with insulin and other commonly used hypoglycemic agents (e.g., sulfonylureas, glitazones and glucosidase inhibitors).

HOW SUPPLIED

Angizaar-AT Tablets USP 25 mg

White, round, biconvex film-coated tablets with “APO” debossed on one side and “LS” over “25” on the other side. Supplied in the following presentations

Bottles of 30 (NDC 60505-3160-3)

Bottles of 90 (NDC 60505-3160-9)

Bottles of 1000 (NDC 60505-3160-8)

Unit dose Blisters of 100 (10x10s) (NDC 60505-3160-0)

Angizaar-AT (Losartan Potassium) Tablets USP 50 mg

White to off white, round, biconvex, film-coated, scored tablets debossed “APO” on one side and “LS” bisect “50” on the other side. Supplied in the following presentations

Bottles of 30 (NDC 60505-3161-3)

Bottles of 90 (NDC 60505-3161-9)

Bottles of 1000 (NDC 60505-3161-8)

Unit dose Blisters of 100 (10x10s) (NDC 60505-3161-0)

Angizaar-AT (Losartan Potassium) Tablets USP 100 mg

White, oval, biconvex film-coated tablets with “APO” debossed on one side and “LS100” on the other side. Supplied in the following presentations

Bottles of 30 (NDC 60505-3162-3)

Bottles of 90 (NDC 60505-3162-9)

Bottles of 1000 (NDC 60505-3162-8)

Unit dose Blisters of 100 (10x10s) (NDC 60505-3162-0)

Storage

Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F). Dispense in a tight, light resistant container.

** Trademark of Paddock Laboratories, Inc

APOTEX CORP.

Angizaar-AT (Losartan Potassium) TABLETS USP

25 mg, 50 mg and 100 mg

Manufactured by:
Apotex Research Pvt. Ltd.
Bangalore – 560 099
India

Manufactured by:
Apotex Inc.
Toronto, Ontario
Canada

Manufactured for:
Apotex Corp.
Weston, Florida
33326

Revised: May 2012

PATIENT INFORMATION

Angizaar-AT Tablets USP

25 mg, 50 mg, 100 mg

Read the Patient Information that comes with Angizaar-AT (Losartan Potassium) Tablets before you start taking it and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your condition and treatment.

What is the most important information I should know about Angizaar-AT (Losartan Potassium) Tablets?

Do not take Angizaar-AT (Losartan Potassium) Tablets if you are pregnant or plan to become pregnant. Angizaar-AT (Losartan Potassium) Tablets can harm your unborn baby causing injury and even death. Stop taking Angizaar-AT (Losartan Potassium) Tablets if you become pregnant and call your doctor right away. If you plan to become pregnant, talk to your doctor about other treatment options before taking Angizaar-AT (Losartan Potassium) Tablets.

What is Angizaar-AT Tablets?

Angizaar-AT (Losartan Potassium) Tablets is a prescription medicine called an angiotensin receptor blocker (ARB). It is used:

  • Alone or with other blood pressure medicines to lower high blood pressure (hypertension).
  • To lower the chance of stroke in patients with high blood pressure and a heart problem called left ventricular hypertrophy. Angizaar-AT (Losartan Potassium) Tablets may not help Black patients with this problem.
  • To slow the worsening of diabetic kidney disease (nephropathy) in patients with type 2 diabetes who have or had high blood pressure.

Angizaar-AT (Losartan Potassium) Tablets has not been studied in children less than 6 years old or in children with certain kidney problems.

High Blood Pressure (hypertension). Blood pressure is the force in your blood vessels when your heart beats and when your heart rests. You have high blood pressure when the force is too much. Angizaar-AT (Losartan Potassium) Tablets can help your blood vessels relax so your blood pressure is lower.

Left Ventricular Hypertrophy (LVH). is an enlargement of the walls of the left chamber of the heart (the heart’s main pumping chamber). LVH can happen from several things. High blood pressure is the most common cause of LVH.

Type 2 Diabetes with Nephropathy. Type 2 diabetes is a type of diabetes that happens mainly in adults. If you have diabetic nephropathy it means that your kidneys do not work properly because of damage from the diabetes.

Who should not take Angizaar-AT Tablets?


  • Do not take Angizaar-AT (Losartan Potassium) Tablets if you are allergic to any of the ingredients in Angizaar-AT (Losartan Potassium) Tablets. See the end of this leaflet for a complete list of ingredients in Angizaar-AT (Losartan Potassium) Tablets.

What should I tell my doctor before taking Angizaar-AT Tablets?

Tell your doctor about all of your medical conditions including if you:


  • Are pregnant or planning to become pregnant. See "What is the most important information I should know about Angizaar-AT (Losartan Potassium) Tablets?”


  • Are breast-feeding. It is not known if Angizaar-AT (Losartan Potassium) Tablets passes into your breast milk. You should choose either to take Angizaar-AT (Losartan Potassium) Tablets or breast-feed, but not both.


  • are vomiting a lot or having a lot of diarrhea


  • have liver problems


  • have kidney problems

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Angizaar-AT Tablets and certain other medicines may interact with each other. Especially tell your doctor if you are taking:


  • potassium supplements


  • salt substitutes containing potassium


  • water pills (diuretics)


  • Medicines used to treat pain and arthritis, called non-steroidal anti-inflammatory drugs NSAIDs including COX-2 inhibitors.

  • other medicines to reduce blood pressure.

How should I take Angizaar-AT (Losartan Potassium) Tablets?


  • Take Angizaar-AT (Losartan Potassium) Tablets exactly as prescribed by your doctor. Your doctor may change your dose if needed.

  • Angizaar-AT (Losartan Potassium) Tablets

    can be taken with or without food.


  • If you miss a dose, take it as soon as you remember. If it is close to your next dose, donot take the missed dose. Just take the next dose at your regular time.


  • If you take too much Angizaar-AT (Losartan Potassium) Tablets, call your doctor or Poison Control Center, or go to the nearest hospital emergency room right away.

What are the possible side effects of Angizaar-AT Tablets?

Angizaar-AT (Losartan Potassium) Tablets may cause the following side effects that may be serious:


  • Injury or death of unborn babies. See "What is the most important information I should know about Angizaar-AT (Losartan Potassium) Tablets?”


  • Allergic reaction. Symptoms of an allergic reaction are swelling of the face, lips, throat or tongue. Get emergency medical help right away and stop taking Angizaar-AT (Losartan Potassium) Tablets.

  • Low blood pressure (hypotension). Low blood pressure may cause you to feel faint or dizzy. Lie down if you feel faint or dizzy. Call your doctor right away.

  • For people who already have kidney problems, you may see a worsening in how well your kidneys work. Call your doctor if you get swelling in your feet, ankles, or hands, or unexplained weight gain.

The most common side effects of Angizaar-AT Tablets in people with high blood pressure are:

  • “colds” (upper respiratory infection)
  • dizziness
  • stuffy nose
  • back pain

The most common side effects of Angizaar-AT (Losartan Potassium) Tablets in people with type 2 diabetes with diabetic kidney disease are:


  • diarrhea
  • tiredness
  • low blood sugar
  • chest pain
  • high blood potassium
  • low blood pressure

Tell your doctor if you get any side effect that bothers you or that won’t go away.

This is not a complete list of side effects. For a complete list, ask your doctor or pharmacist.

How do I store Angizaar-AT Tablets?


  • Store Angizaar-AT (Losartan Potassium) Tablets at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F), Dispense in a tight; light – resistant container.


  • Keep Angizaar-AT (Losartan Potassium) Tablets in a tightly closed container that protects the medicine from light.


  • Keep Angizaar-AT (Losartan Potassium) Tablets and all medicines out of the reach of children.

General information about Angizaar-AT Tablets

Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use Angizaar-AT (Losartan Potassium) Tablets for a condition for which it was not prescribed. Do not give Angizaar-AT (Losartan Potassium) Tablets to other people, even if they have the same symptoms that you have. It may harm them.

This leaflet summarizes the most important information about Angizaar-AT (Losartan Potassium) Tablets. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Angizaar-AT (Losartan Potassium) Tablets that is written for health professionals.

What are the ingredients in Angizaar-AT Tablets?

Active ingredients: Angizaar-AT (Losartan Potassium)

Inactive ingredients: Lactose monohydrate, microcrystalline cellulose, pregelatinised starch, magnesium stearate, hypromellose 6 cp, hydroxy propyl cellulose, titanium dioxide and carnauba wax.

Rx only


APOTEX CORP.

Angizaar-AT (Losartan Potassium) TABLETS USP

25 mg, 50 mg and 100 mg

Manufactured by:
Apotex Research Pvt. Ltd.
Bangalore – 560 099
India

Manufactured by:
Apotex Inc.
Toronto, Ontario
Canada

Manufactured for:
Apotex Corp.
Weston, Florida
33326

Revised: May 2012

Angizaar-AT (Losartan Potassium) 25mg Tablet

Angizaar-AT pharmaceutical active ingredients containing related brand and generic drugs:

infoActive ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Angizaar-AT available forms, composition, doses:

infoForm of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Angizaar-AT destination | category:

infoDestination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Angizaar-AT Anatomical Therapeutic Chemical codes:

infoA medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Angizaar-AT pharmaceutical companies:

infoPharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


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References

  1. Dailymed."ATENOLOL TABLET [LAKE ERIE MEDICAL & SURGICAL SUPPLY DBA QUALITY CARE PRODUCTS LLC]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. Dailymed."LOSARTAN POTASSIUM TABLET, FILM COATED [BRYANT RANCH PREPACK]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  3. Dailymed."LOSARTAN POTASSIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Angizaar-AT?

Depending on the reaction of the Angizaar-AT after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Angizaar-AT not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Angizaar-AT addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

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Review

sDrugs.com conducted a study on Angizaar-AT, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Angizaar-AT consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Arunabha Ray, MD Pharmacology

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