артериальная гипертензия;хроническая сердечная недостаточность (в составе комбинированной терапии, при непереносимости или неэффективности терапии ингибиторами АПФ);снижение риска развития сердечно-сосудистых заболеваний (в т.ч. инсульта) и смертности у пациентов с артериальной гипертензией и гипертрофией левого желудочка;диабетическая нефропатия при ...
повышенная чувствительность к компонентам препарата;одновременное применение с алискиреном у пациентов с сахарным диабетом и пациентов с почечной недостаточностью (Cl креатинина менее 60 мл/мин);тяжелые нарушения функции печени (более 9 баллов по шкале Чайлд-Пью— опыт применения отсутствует);беременность;период лактации;возраст до 18 лет (эффективность ...
Таблетки 12,5 мг: белые или почти белые, продолговатые, двояковыпуклые, покрытые пленочной оболочкой.Таблетки 50 мг: белые или почти белые, продолговатые, двояковыпуклые, покрытые пленочной оболочкой, с риской с обеих сторон.Таблетки 100 мг: белые или почти белые, продолговатые, двояковыпуклые, покрытые пленочной оболочкой, с риской с обеих сторон.
Фармакологические свойства
Фармакологическое действие — гипотензивное.
Показания к применению
артериальная гипертензия;хроническая сердечная недостаточность (в составе комбинированной терапии, при непереносимости или неэффективности терапии ингибиторами АПФ);снижение риска развития сердечно-сосудистых заболеваний (в т.ч. инсульта) и смертности у пациентов с артериальной гипертензией и гипертрофией левого желудочка;диабетическая нефропатия при гиперкреатининемии и протеинурии (соотношение альбумина мочи и креатинина >300 мг/г) у пациентов с сахарным диабетом типа 2 и сопутствующей артериальной гипертензией (снижение прогрессирования диабетической нефропатии до терминальной стадии хронической почечной недостаточности).
Противопоказания
повышенная чувствительность к компонентам препарата;одновременное применение с алискиреном у пациентов с сахарным диабетом и пациентов с почечной недостаточностью (Cl креатинина менее 60 мл/мин);тяжелые нарушения функции печени (более 9 баллов по шкале Чайлд-Пью— опыт применения отсутствует);беременность;период лактации;возраст до 18 лет (эффективность и безопасность не установлены).С осторожностью: артериальная гипотензия; сердечная недостаточность с сопутствующей тяжелой почечной недостаточностью; тяжелая хроническая сердечная недостаточность IV функционального класса по классификации NYHA; сердечная недостаточность с угрожающими жизни аритмиями; ишемическая болезнь сердца; цереброваскулярные заболевания; гиперкалиемия, возраст старше 75 лет; применение у представителей негроидной расы; сниженный ОЦК, нарушения водно-электролитного баланса, двусторонний стеноз почечных артерий или стеноз артерии единственной почки; почечная/печеночная недостаточность; состояние после трансплантации почки (отсутствует опыт применения); аортальный и митральный стеноз; ангионевротический отек в анамнезе; первичный гиперальдостеронизм; гипертрофическая обструктивная кардиомиопатия.
Применение при беременности и в период грудного вскармливания
Применение препарата Лозап® в I триместре беременности не рекомендуется; во II и III триместрах— противопоказано.Эпидемиологические данные о риске тератогенного действия ингибиторов АПФ в I триместре беременности недостаточно убедительны, однако полностью риск для плода все же нельзя исключить. Несмотря на то что контролируемых эпидемиологических исследований с применением антагонистов рецепторов ангиотензина II не проводилось, для данного класса препаратов могут быть характерны аналогичные риски. За исключением случаев, когда продолжение лечения с применением АРАII считается необходимым, пациенток, планирующих беременность, следует переводить на другие виды гипотензивной терапии, безопасность которых подтверждена результатами клинических исследований. При подтверждении факта беременности лечение препаратом Лозап® следует немедленно прекратить и при необходимости назначить другое лечение.Известно, что применение АРАII во II и III триместрах беременности оказывает токсическое действие на организм плода (снижение функции почек, развитие олигогидрамниона, замедление оссификации костей черепа) и новорожденного (почечная недостаточность, артериальная гипотензия, гиперкалиемия). Если по каким-то причинам женщина принимала препарат Лозап® во II триместре или на более поздних сроках беременности, рекомендуется проведение УЗИ плода для контроля функции почек и состояния костей черепа.Дети, чьи матери принимали препарат Лозап® во время беременности, должны находиться под тщательным наблюдением педиатра из-за риска развития артериальной гипотензии.Неизвестно, выделяется ли лозартан в грудное молоко. Поскольку никакой информации о применении лозартана в период кормления грудью не получено, от назначения препарата Лозап® кормящим женщинам следует воздержаться, отдавая предпочтение альтернативным видам лечения с более изученным профилем безопасности, особенно при вскармливании новорожденного или недоношенного ребенка. При необходимости применения в период лактации, грудное вскармливание необходимо прекратить.
Побочное действие
Побочные эффекты лозартана обычно преходящие и не требуют отмены препарата. При применении лозартана для лечения эссенциальной гипертензии в контролируемых исследованиях среди всех побочных эффектов только частота развития головокружения отличалась от плацебо более чем на 1% (4,1 против 2,4%).Дозозависимое ортостатическое действие, характерное для гипотензивных средств, при применении лозартана отмечалось менее чем у 1% пациентов.Частота побочных реакций определялась соответственно следующей градации (классификация ВОЗ): очень часто— ≥1/10; часто— от ≥1/100 до <1/10; нечасто— от ≥1/1000 до <1/100; редко— от ≥1/10000 до <1/1000; очень редкие, включая отдельные сообщения— от <1/10000; неизвестной частоты (при невозможности оценки по имеющимся данным).ТаблицаРаспространенность побочных реакций по результатам плацебо-контролируемых клинических исследований и пострегистрационного наблюдения Побочная реакция Распространенность побочных реакций по показаниям к применению Другое Артериальная гипертензия Пациенты с артериальной гипертензией и гипертрофией левого желудочка Хроническая сердечная недостаточность Артериальная гипертензия и сазарный диабет типа 2 с нарушением функции почек Пострегистрационное наблюдение Со стороны крови и лимфатической системы анемия часто частота неизвестна тромбоцитопения частота неизвестна Со стороны иммунной системы аллергические реакции, анафилактические ракции, отек Квинке1, васкулит2 редко Нарушения психики депрессия частота неизвестна Со стороны нервной системы головокружение часто часто часто часто сонливость нечасто головная боль нечасто нечасто нарушение сна нечасто парестезия редко мигрень частота неизвестна нарушение вкуса частота неизвестна Со стороны органа слуха и лабиринтные нарушения вертиго нечасто часто шум в ушах частота неизвестна Со стороны сердца ощущение сердцебиения нечасто стенокардия нечасто обмороки редко мерцательная аритмия редко острое нарушение мозгового кровообращения редко Со стороны сосудов (ортостатическая) нечасто часто часто выраженное снижение АД (включая дозозависимые ортостатические эффекты)3 Со стороны дыхательной системы, грудной клетки и средостения одышка нечасто кашель нечасто частота неизвестна Со стороны ЖКТ боли в животе нечасто кишечная непроходимость нечасто диарея нечасто частота неизвестна тошнота нечасто рвота нечасто Со стороны печени и желчевыводящих путей панкреатит частота неизвестна гепатит редко нарушения функции печени частота неизвестна Со стороны кожи и подкожных тканей крапивница нечасто частота неизвестна кожный зуд нечасто частота неизвестна сыпь нечасто нечасто частота неизвестна фотосенсибилизация частота неизвестна Со стороны скелетно-мышечной и соединительной ткани миалгия частота неизвестна артралгия частота неизвестна рабдомиолиз частота неизвестна спазм мышц нечасто Со стороны почек и мочевыводящих путей нарушение функции почек часто почечная недостаточность часто Со стороны половых органов и молочных желез эректильная дисфункция/импотенция частота неизвестна Общие расстройства и нарушения в месте введения астения нечасто часто нечасто часто слабость нечасто часто нечасто часто отеки нечасто частота неизвестна недомогание частота неизвестна Влияние на результаты лабораторных и инструментальных исследований гиперкалиемия часто нечасто4 часто5 повышение активности АЛТ6 редко повышение концентраций мочевины, креатинина и калия в плазме крови часто гипонатриемия частота неизвестна гипогликемия часто 1 Включая отек гортани, голосовых складок, лица, губ и/или языка (что приводит к нарушению проходимости дыхательных путей); у некоторых пациентов отек Квинке отмечался ранее, в связи с назначением других препаратов, включая ингибиторы АПФ.2 Включая геморрагический васкулит (болезнь Шенлейна-Геноха).3 Особенно у пациентов с гиповолемией, например с тяжелой сердечной недостаточностью или получающих диуретики в высоких дозах.4 Часто отмечается у пациентов, получавших лозартан в дозе 150 вместо 50 мг.5 В клиническом исследовании, проведенном с участием пациентов с сахарным диабетом типа 2 и нефропатией, гиперкалиемия >5,5 ммоль/л развилась у 9,9% пациентов, получавших лозартан в таблетках, и у 3,4% пациентов, получавших плацебо.6 Обычно проходит после отмены лечения.Следующие дополнительные нежелательные реакции чаще отмечались у пациентов, получавших лозартан, чем у пациентов, получавших плацебо (точные показатели частоты неизвестны): боли в спине, инфекции мочевых путей и гриппоподобные симптомы.Со стороны почек и мочевыводящих путей: как следствие ингибирования РААС у пациентов из группы риска отмечались нарушения функции почек, включая острую почечную недостаточность. Эти изменения со стороны функции почек могут носить обратимый характер в случае своевременной отмены лечения.
Взаимодействие с другими лекарственными средствами
Применение препарата Лозап® с алискиреном у пациентов с сахарным диабетом противопоказано. Следует исключить применение препарата Лозап® с алискиреном у пациентов с почечной недостаточностью (Cl креатинина <60 мл/мин).Может назначаться с другими гипотензивными средствами. Взаимно усиливает эффект β-адреноблокаторов и симпатолитиков. Совместное применение лозартана с диуретиками оказывает аддитивный эффект.Сочетанное применение с другими препаратами, способными вызывать развитие артериальной гипотензии как нежелательной реакции (например трициклические антидепрессанты, антипсихотические препараты, баклофен и амифостин), может повышать риск развития артериальной гипотензии.Не отмечено фармакокинетических взаимодействий лозартана с гидрохлоротиазидом, дигоксином, варфарином, циметидином, фенобарбиталом, кетоконазолом, эритромицином.Лозартан преимущественно метаболизируется под действием изофермента CYP2C9 системы цитохрома P450 с образованием активного метаболита карбоксильной кислоты. В клиническом исследовании было показано, что флуконазол (ингибитор изофермента CYP2C9) уменьшает образование активного метаболита примерно на 50%. Установлено, что сочетанное применение лозартана с рифампицином (индуктор метаболических ферментов) приводит к увеличению концентрации активного метаболита на 40% в плазме крови. Клиническое значение данного эффекта остается неясным.При сочетанном назначении препарата с флувастатином (слабый ингибитор изофермента CYP2C9) изменение концентрации метаболита не отмечалось.Опыт применения других ЛС, действующих на РААС, показывает, что сопутствующая терапия калийсберегающими диуретиками (спиронолактон и его производное эплеренон; триамтерен, амилорид), препаратами калия, заменителями соли, содержащих калий, и другими средствами, которые могут повышать содержание калия в плазме крови (например гепарин), может приводить к развитию гиперкалиемии. Антигипертензивный эффект препарата может быть ослаблен при совместном применении с НПВС, в т.ч. селективными ингибиторами ЦОГ-2.Как и в слу
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При необходимости применения в период лактации, грудное вскармливание необходимо прекратить."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Побочные эффекты лозартана обычно преходящие и не требуют отмены препарата. 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артериальной гипертензией и \t\tгипертрофией левого желудочка\t\tХроническая сердечная недостаточность\t\tАртериальная гипертензия и сазарный диабет \t\tтипа 2 с нарушением функции почек\t\tПострегистрационное наблюдение\t\t\t\tСо стороны крови и \t\tлимфатической системы\t\t\t\tанемия\t\t\t\t\t\tчасто\t\t\t\tчастота неизвестна\t\t\t\tтромбоцитопения\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tСо стороны иммунной системы\t\t\t\tаллергические реакции, \t\tанафилактические ракции, отек Квинке1, васкулит2\t\t\t\t\t\t\t\t\t\tредко\t\t\t\tНарушения психики\t\t\t\tдепрессия\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tСо стороны нервной системы\t\t\t\tголовокружение\t\tчасто\t\tчасто\t\tчасто\t\tчасто\t\t\t\t\t\tсонливость\t\tнечасто\t\t\t\t\t\t\t\t\t\t\t\tголовная боль\t\tнечасто\t\t\t\tнечасто\t\t\t\t\t\t\t\tнарушение сна\t\tнечасто\t\t\t\t\t\t\t\t\t\t\t\tпарестезия\t\t\t\t\t\tредко\t\t\t\t\t\t\t\tмигрень\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tнарушение вкуса\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tСо стороны органа слуха и \t\tлабиринтные нарушения\t\t\t\tвертиго\t\tнечасто\t\tчасто\t\t\t\t\t\t\t\t\t\tшум в ушах\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tСо стороны сердца\t\t\t\tощущение сердцебиения\t\tнечасто\t\t\t\t\t\t\t\t\t\t\t\tстенокардия\t\tнечасто\t\t\t\t\t\t\t\t\t\t\t\tобмороки\t\t\t\t\t\tредко\t\t\t\t\t\t\t\tмерцательная аритмия\t\t\t\t\t\tредко\t\t\t\t\t\t\t\tострое нарушение мозгового \t\tкровообращения\t\t\t\t\t\tредко\t\t\t\t\t\t\t\tСо стороны сосудов\t\t\t\t(ортостатическая)\t\tнечасто\t\t\t\tчасто\t\tчасто\t\t\t\t\t\tвыраженное снижение АД (включая \t\tдозозависимые ортостатические эффекты)3\t\t\t\t\t\t\t\t\t\t\t\t\t\tСо стороны дыхательной \t\tсистемы, грудной клетки и средостения\t\t\t\tодышка\t\t\t\t\t\tнечасто\t\t\t\t\t\t\t\tкашель\t\t\t\t\t\tнечасто\t\t\t\tчастота неизвестна\t\t\t\tСо стороны ЖКТ\t\t\t\tболи в животе\t\tнечасто\t\t\t\t\t\t\t\t\t\t\t\tкишечная непроходимость\t\tнечасто\t\t\t\t\t\t\t\t\t\t\t\tдиарея\t\t\t\t\t\tнечасто\t\t\t\tчастота неизвестна\t\t\t\tтошнота\t\t\t\t\t\tнечасто\t\t\t\t\t\t\t\tрвота\t\t\t\t\t\tнечасто\t\t\t\t\t\t\t\tСо стороны печени и \t\tжелчевыводящих путей\t\t\t\tпанкреатит\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tгепатит\t\t\t\t\t\t\t\t\t\tредко\t\t\t\tнарушения функции печени\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tСо стороны кожи и подкожных \t\tтканей\t\t\t\tкрапивница\t\t\t\t\t\tнечасто\t\t\t\tчастота неизвестна\t\t\t\tкожный зуд\t\t\t\t\t\tнечасто\t\t\t\tчастота неизвестна\t\t\t\tсыпь\t\tнечасто\t\t\t\tнечасто\t\t\t\tчастота неизвестна\t\t\t\tфотосенсибилизация\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tСо стороны скелетно-мышечной \t\tи соединительной ткани\t\t\t\tмиалгия\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tартралгия\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tрабдомиолиз\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tспазм мышц\t\t\t\t\t\tнечасто\t\t\t\t\t\t\t\tСо стороны почек и \t\tмочевыводящих путей\t\t\t\tнарушение функции почек\t\t\t\t\t\tчасто\t\t\t\t\t\t\t\tпочечная недостаточность\t\t\t\t\t\tчасто\t\t\t\t\t\t\t\tСо стороны половых органов и \t\tмолочных желез\t\t\t\tэректильная дисфункция/импотенция\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tОбщие расстройства и \t\tнарушения в месте введения\t\t\t\tастения\t\tнечасто\t\tчасто\t\tнечасто\t\tчасто\t\t\t\t\t\tслабость \t\tнечасто\t\tчасто\t\tнечасто\t\tчасто\t\t\t\t\t\tотеки\t\tнечасто\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tнедомогание\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tВлияние на результаты \t\tлабораторных и инструментальных исследований\t\t\t\tгиперкалиемия\t\tчасто\t\t\t\tнечасто4\t\tчасто5\t\t\t\t\t\tповышение активности \t\tАЛТ6\t\tредко\t\t\t\t\t\t\t\t\t\t\t\tповышение концентраций мочевины, \t\tкреатинина и калия в плазме крови\t\t\t\t\t\tчасто\t\t\t\t\t\t\t\tгипонатриемия\t\t\t\t\t\t\t\t\t\tчастота неизвестна\t\t\t\tгипогликемия\t\t\t\t\t\t\t\tчасто\t\t\t1 Включая отек гортани, голосовых складок, лица, губ и/или языка (что приводит к нарушению проходимости дыхательных путей); у некоторых пациентов отек Квинке отмечался ранее, в связи с назначением других препаратов, включая ингибиторы АПФ.2 Включая геморрагический васкулит (болезнь Шенлейна-Геноха).3 Особенно у пациентов с гиповолемией, например с тяжелой сердечной недостаточностью или получающих диуретики в высоких дозах.4 Часто отмечается у пациентов, получавших лозартан в дозе 150 вместо 50 мг.5 В клиническом исследовании, проведенном с участием пациентов с сахарным диабетом типа 2 и нефропатией, гиперкалиемия \u003e5,5 ммоль/л развилась у 9,9% пациентов, получавших лозартан в таблетках, и у 3,4% пациентов, получавших плацебо.6 Обычно проходит после отмены лечения.Следующие дополнительные нежелательные реакции чаще отмечались у пациентов, получавших лозартан, чем у пациентов, получавших плацебо (точные показатели частоты неизвестны): боли в спине, инфекции мочевых путей и гриппоподобные симптомы.Со стороны почек и мочевыводящих путей: как следствие ингибирования РААС у пациентов из группы риска отмечались нарушения функции почек, включая острую почечную недостаточность. Эти изменения со стороны функции почек могут носить обратимый характер в случае своевременной отмены лечения."}}]},{"id":8,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Применение препарата Лозап® с алискиреном у пациентов с сахарным диабетом противопоказано. Следует исключить применение препарата Лозап® с алискиреном у пациентов с почечной недостаточностью (Cl креатинина \u003c60 мл/мин).Может назначаться с другими гипотензивными средствами. Взаимно усиливает эффект β-адреноблокаторов и симпатолитиков. Совместное применение лозартана с диуретиками оказывает аддитивный эффект.Сочетанное применение с другими препаратами, способными вызывать развитие артериальной гипотензии как нежелательной реакции (например трициклические антидепрессанты, антипсихотические препараты, баклофен и амифостин), может повышать риск развития артериальной гипотензии.Не отмечено фармакокинетических взаимодействий лозартана с гидрохлоротиазидом, дигоксином, варфарином, циметидином, фенобарбиталом, кетоконазолом, эритромицином.Лозартан преимущественно метаболизируется под действием изофермента CYP2C9 системы цитохрома P450 с образованием активного метаболита карбоксильной кислоты. В клиническом исследовании было показано, что флуконазол (ингибитор изофермента CYP2C9) уменьшает образование активного метаболита примерно на 50%. Установлено, что сочетанное применение лозартана с рифампицином (индуктор метаболических ферментов) приводит к увеличению концентрации активного метаболита на 40% в плазме крови. Клиническое значение данного эффекта остается неясным.При сочетанном назначении препарата с флувастатином (слабый ингибитор изофермента CYP2C9) изменение концентрации метаболита не отмечалось.Опыт применения других ЛС, действующих на РААС, показывает, что сопутствующая терапия калийсберегающими диуретиками (спиронолактон и его производное эплеренон; триамтерен, амилорид), препаратами калия, заменителями соли, содержащих калий, и другими средствами, которые могут повышать содержание калия в плазме крови (например гепарин), может приводить к развитию гиперкалиемии. Антигипертензивный эффект препарата может быть ослаблен при совместном применении с НПВС, в т.ч. селективными ингибиторами ЦОГ-2.Как и в слу"}}]}],"source":{"title":"ЭркаФарм","url":"https://erkapharm.com"}},"description_toggle":false,"short_description":"Фармакологическое действие — гипотензивное.","substance":[{"id":98,"title":"Лозартан","title_latin":"Losartanum","slug":"lozartan_98"},{"id":715,"title":"Гидрохлоротиазид","title_latin":"Hydrochlorothiazidum","slug":"gidrohlorotiazid_715"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":{"count":4,"url":"/review/3633-lozap_plus/"},"image_alt":"Лозап плюс - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/22128/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/22128/share_default/"}},"diseases":[{"id":"717","title":"Эссенциальная [первичная] 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