Xelotan Plus

Introduction
Xelotan Plus 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 Xelotan Plus 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.

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Uses of Xelotan Plus
Hypertension (high blood pressure)
Side effects of Xelotan Plus
Common
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 Xelotan Plus
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. Xelotan Plus may be taken with or without food, but it is better to take it at a fixed time.
How Xelotan Plus works
Xelotan Plus 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.
Quick Tips
You have been prescribed Xelotan Plus for the treatment of high blood pressure.
It can be taken with or without food.
Xelotan Plus may cause dehydration. Drink plenty of fluids and inform your doctor if you develop extreme thirst, very dry mouth or muscle weakness.
It may cause dizziness. Get up slowly when rising from a sitting or lying position.
Use of Xelotan Plus during pregnancy or breastfeeding is unsafe.
It may also decrease the risk of stroke and heart attacks.
Brief Description
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

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Child Dose
Safety and efficacy not established

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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

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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

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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.

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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.

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