Introduction

Prosan HZ 12.5/50 is a combination of two medicines. It helps to control high blood pressure in different ways. If high blood pressure is not treated it can lead to heart attacks, strokes and kidney failure. You can take Prosan HZ 12.5/50 with or without food. The dose will depend on your condition and how your respond to the medicine. Try to take it at the same time each day. It is important to keep taking this medicine until your doctor tells you not to. It contains a diuretic (water pill) and will make you urinate more so, it is best to avoid taking this medicine within four hours of going to bed. Use this medicine regularly to get the most benefit from it even if you feel well. High blood pressure does not usually have symptoms and if you stop taking it your risk of heart attack or stroke may increase. The most common side effect is dizziness. Other side effects include feeling tired, nausea, diarrhoea, headache, and decreased blood pressure. Frequent urination is not a side effect of this medicine. It is the purpose of hydrochlorothiazide and helps control your blood pressure. You may experience other possible side effects, but most are rare. Make sure you read the leaflet that comes with your medicines and tell your doctor if you are bothered by side effects or they do not go away. It may be possible to adjust your dose or try a different medicine. This medicine is not recommended during pregnancy and you should ask your doctor before taking it if you have kidney or liver disease, heart trouble or diabetes. Drinking alcohol can further lower your blood pressure and may cause side effects.

Uses of Prosan HZ 12.5/50

• Hypertension (high blood pressure)

Side effects of Prosan HZ 12.5/50

• Nausea
• Taste change
• Upset stomach
• Diarrhea
• Headache
• Dizziness
• Weakness
• Decreased blood pressure
• Increased blood uric acid
• Increased blood lipid level
• Glucose intolerance
• Electrolyte imbalance

How to use Prosan HZ 12.5/50

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Prosan HZ 12.5/50 may be taken with or without food, but it is better to take it at a fixed time.

How Prosan HZ 12.5/50 works

Prosan HZ 12.5/50 is a combination of two medicines: Losartan and Hydrochlorothiazide, which lowers the blood pressure effectively. Losartan is an angiotensin receptor blocker (ARB). It works by blocking the hormone angiotensin thereby relaxing blood vessels. This allows the blood to flow more smoothly and the heart to pump more efficiently. Hydrochlorothiazide is a diuretic that removes extra water and certain electrolytes from the body. Over time it also relaxes blood vessels and improves blood flow.

Indication

Hypertension, Stroke, risk reduction of hypertensive or LVH patients

Adult Dose

Hypertension Initial: 50 mg/12.5 mg PO qDay If dose titrated upward, do not to exceed final titration of 100 mg/25 mg PO qDay or 50 mg/12.5 mg PO q12hr Decrease losartan to 25 mg PO qDay initially if volume depleted

Child Dose

Safety and efficacy not established

Renal Dose

Renal impairment CrCl <30 mL/min: Do not use thiazide-containing products; loop diuretic preferred CrCl >30 mL/min: No dosage adjustment required

Contraindication

Pregnancy, lactation; intravascular volume depletion.

Mode of Action

Hydrochlorothiazide increases renal excretion of sodium and chloride and reduces cardiac load. Losartan is an angiotensin II receptor (type AT1) antagonist antihypertensive which acts by blocking the actions of angiotensin II of renin-angiotensin-aldosterone system. The drug and its active metabolite selectively block the vasoconstrictor and aldosterone secreting effects of angiotensin II. The two drugs exert additive effects in hypertension.

Precaution

Existing electrolyte disturbances; hepatic cirrhosis; severe hepatic failure; oedema; elderly (>75 yr); renal impairment; hepatic impairment; diabetes, gout, hyperlipidaemia; hyperuricaemia; ECG: LVH and/or ventricular ectopics extrasystoles); volume depleted patients; patients on diuretics and salt restriction; renal artery stenosis; aortic and mitral stenosis. Monitor potassium concentration. Discontinue before performing tests for parathyroid function. Lactation: Discontinue drug or do not nurse

Side Effect

>10% Losartan Fatigue (14%),Hypoglycemia (14%),Chest pain (12%),Cough, incidence higher in previous cough related to ACE therapy (3-11%) 1-10% Losartan Diarrhea (2-10%),URI (8%),Hypotension (7%),Dizziness (4%),Nausea (2%) Hydrochlorothiazide Hypotension,Anorexia,Epigastric distress,Hypokalemia,Phototoxicity,Thrombocytopenia Potentially Fatal: Hypersensitivity reactions; hemolytic anaemia; toxic epidermal necrolysis.

Interaction

Reduced excretion of lithium; effect of diuretic, natriuretic & other antihypertensive w/ NSAIDs including selective COX-2 inhibitors. Do not co-administer w/ aliskiren in patients w/ diabetes & renal impairment. Losartan: Rifampin & fluconazole. Increased serum potassium w/ K-sparing diuretics (eg spironolactone, triamterene, amiloride), K supplements or salt substitutes containing K. Hydrochlorothiazide: Potentiate orthostatic hypotension w/ alcohol, barbiturates or narcotics. Antidiabetic drugs (oral agents, insulin), other antihypertensive drugs. Impaired absorption w/ cholestyramine & colestipol resins. Intensified electrolyte depletion w/ corticosteroids, ACTH, glycyrrhizin (liquorice). Possible decreased response to pressor amines (eg adrenaline); increased response to nondepolarizing skeletal muscle relaxants (eg tubocurarine). May interfere w/ parathyroid function test.