Losartan Substitute for Losartan HCTZ, is It OK?

Losartan and losartan HCTZ are prescription antihypertensive medications. Both drugs are angiotensin II antagonists. These two are usually taken once a day and can be in combination therapy with other antihypertensive drug such as amlodepine. Losartan HCTZ is expensive than the ordinary losartan. But, can the plain losartan replace losartan HCTZ for awhile?

Angiotensin II antagonists or angiotensin II blockers like losartan potassium work by preventing the protein angiotensin from binding to the blood vessel.  Angiotensin causes constriction within the vein that causes hypertension. With the use of ARBs agent (angiotensin receptor blockers) like losartan, blood vessels are dilated making the blood circulation free flowing and blood pressure is diminished.

Losartan potassium is a prescription antihypertensive drug.  It can be given in single or in combination with other antihypertensive medication. Amlodepine, a calcium antagonist is the usual combination with losartan. These two drugs are not generally taken at a time though. Prescribers usually give losartan in the morning then amlodepine in the evening for control of hypertension.  However, if the condition cannot be controlled by such combination, losartan plain is usually switched to losartan with the HCTZ or hydrochlorothiazide. 

Dispensing error may happen and sometimes patients try cheaper alternatives. In the case of losartan and losartan HCTZ, won’t there be any problem if losartan plain is taken instead of a losartan HCTZ?

Losartan facts

Bepsar (Nabiqasim), Cozaar (Merck Sharp & Dohme) and Lifezar (Therapharma) are some popular tradenames of losartan potassium. It is generally indicated for hypertension that can be given alone or with other antihypertensive drugs.

Losartan potassum is available in 50 and 100mg tablet. It can be taken in full or empty stomach and usually given in 50mg strength during the initial treatment. Depending on the body’s response, or if the patient has liver or kidney problem, losartan’s maintenance dosing can range to 25, 50 to 100mg strength. It can be taken once or twice a day.

  • Contraindications

Losartan is contraindicated in pregnancy.

  • Special precautions

Losartan should be used in precaution for breast feeding mothers, children, elderly people and for individuals with liver and kidney problems.

  • Side effects

Losartan may cause allergic symptoms like cough, respiratory congestion and utricaria. It can cause dizziness, fatigue, UTI, diarrhea or constipation. Hyperkalemia, cardiac arrythmia and hypotension are also cited.

  • Drug interactions

Phenobarbital and ketoconazolecan reduce the effect of losartan. Cimetidine on the other hand, can increase the effect of losartan.  Potassium supplements, potassium sparing diuretics like amiloride and canrenone may increase risk of hyperkalemia with losartan potassium.  Losartan with NSAIDs (e.g. indomethacin, piroxicam, and mefenamic) may increase liver impairment especially in elderly people.

Hydrocholorothiazide facts

HCTZ or hydrochorothiazide is a thiazide diuretic. In combination with losartan potassium, its strength is generally 12.5mg. But used alone, hydrocholorothiazide can be taken in 25 to 100mg potency.

Some brand names of hydrochlorothiazide in single form are Diuzid (Hizon), Hytaz (Therapharma) and Hydrax (Lloyd). HCTZ with losartan brandnames include Hextan Plus (Pasteur Pharma), Getzar Plus (Hizon) and Accuzide (Pfizer).

Hydrochlorothiazide is generally taken once a day in the morning and should be taken in full stomach. As a diuretic, HCTZ is indicated for edema linked to heart failure and in liver or kidney disorders. It works by enhancing urine production, expelling the excess salt and water from the body.

In hypertension, blood pressure is also reduced whenever fluids are released from the system. Medical specialist would compare hypertension to a full-blown balloon that needs to be dealt carefully to prevent it from popping. By liberating the air slowly and bit by bit, this balloon won’t go off – the same case with high blood pressure and urinating.

Hydrochlorothiazide in combination with losartan is usually given once a day in the morning. Alone, HCTZ is indicated for hypertension 25 to 50mg daily.

  • Contraindications

Hydrocholorothiazide is not recommended in pregnancy and breastfeeding mothers. Not only that HCTZ is in category C concerning pregnancy which may be risky for the fetus, this medication may also reduce milk production.

  • Precautions

Hydrocholorothiazide is to be used in precaution in elderly people, individuals who have liver or kidney problems and those with severe heart failure. 

  • Side effects

Some side effects of HCTZ are fluid loss, muscle cramps, weakness and thirst. There are also reported allergic reactions such as rash, swelling and breathing difficulty. Headache, stomach pains and dizziness can also be experienced.

  • Drug interactions

The effect of HCTZ may be decreased by cholesthyramine and colestipol – both cholesterol lowering drugs. HCTZ can potentiate the effects of antidiabetic medications and may increase arrythmias therefore it should not be taken with digoxin.  Care should be exercised upon using hydrochlorothiazidewith other antihypertensive drugs to avoid hypotension. Finally, HCTZ can also increase lithium levels.

Losartan potassium for losartan potassium with HCTZ, is it OK?

In 2008, a hypertensive patient bought ten pieces of losartan plain instead of losartan with hydrochlorothiazide. She took this wrong medication with her amlodepine and aspirin for ten days. It was during the next refill when the pharmacy aid found out about the dispensing error. Fortunately, nothing bad happened to the patient. 

Since, the patient was also taking another antihypertensive drug which was amlodepine; losartan plain may have not created a problem. More to this, losartan even without the hydrocholorothiazide is still an antihypertensive medication.

Image by the author

Losartan HCTZ is more potent than the ordinary losartan because of its diuretic content. But, as cited, hypertension can be controlled. With lifestyle improvement (proper diet and exercise) along with the losartan-amlodepine combination maintenance, highblood pressure can be managed. Physicians tend to adjust the medication into a lesser degree when blood pressure begins to drop. 

Losartan plain for losartan HCTZ may seem OK at least for awhile, when there are no other alternatives. However, cases vary and it is not wise when a patient decides to change his antihypertensive drug without the advice of his doctor.

Losartan HCTZ for the plain losartan?

The real danger is when a patient accidentally took a losartan with a hydrochlorothiazide instead of a losartan plain. As losartan HCTZ is more powerful than the plain losartan, hypotension or a drop of blood pressure can be immediate. This won’t also be good for the patient if he is already taking other diuretics as loss of potassium and other electrolytes can harm the body.

© Phoenix Montoya @ September 5, 2012

References:

  1. http://mims.com/
  2. Medications and Mothers’ Milk by Thomas W. Hale Ph.D.

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Quadriderm cream

Quadriderm cream or ointment contains betamethasone as 17 - valerate (0.05%), gentamicin sulfate (0.1%), Tolnaftate (1%) and clioquinol (1%).

Quadriderm cream or ointment - Tubes with 20 grams.

What is Quadriderm cream used for?

Quadriderm ointment or cream is a topical dermatological preparation highly effective in treating many skin disorders.

Quadriderm cream or ointment should be stored in a cool place and protected from light and moisture.

The validity of Quadriderm ointment or cream is 36 months, and is recorded on the outer packaging, in case of expiration render the product unusable.

Tell your doctor the occurrence of pregnancy during treatment or after its termination. Inform your doctor if you are breastfeeding. Follow the advice of your doctor, always respecting the schedules, doses and duration of treatment. Do not stop treatment without the knowledge of your doctor. Tell your doctor the appearance of unpleasant reactions such as burning, itching, irritation and dry skin. Tell your doctor about any medication you are using before the start or during treatment.

Quadriderm ointment or cream is not suitable for ophthalmic use.

TECHNICAL INFORMATION - Quadriderm

Quadriderm cream or ointment is a topical dermatological preparation highly effective in treating many skin disorders. Quadriderm ensures greater safety of therapeutic success, especially when the causative agent cannot be readily identified.

Because it is a composition of four agents with different pharmacological effects, Quadriderm provides anti-inflammatory, antibacterial and antifungal in the treatment of inflammatory and allergic skin disorders complicated by some types of bacteria or fungi, including Candida.

Quadriderm cream uses

Quadriderm is indicated for topical use in dermatoses caused, complicated or threatened by some types dde bacterial or fungal infection, including candidiasis. It is indicated for the prevention and treatment of infections caused by bacteria or fungi in a variety of eczema and other allergic and inflammatory dermatoses. It has been used successfully to treat acne inguinal, chronic dermatoses of the extremities, erythrasma the external ear otitis, balanoposthitis, herpes zoster, dermatitis, eczema, contact dermatitis, dermatitis microbial follicular dermatitis, dyshidrosis, paronychia (candida) anal pruritus, intertrigo, seborrheic eczema, parakeratosis, pustular acne, impetigo of the scalp, neurodermatitis, angular stomatitis, seborrheic dermatitis, occipital area, photosensitivity dermatitis, lichenified and groin ringworm ringworm infections, like tinea cruris, tinea pedis, and tinea corporis.

CONTRAINDICATIONS - Quadriderm

Quadriderm cream or ointment is contraindicated in patients with a history of hypersensitivity to any of its components. It is also contraindicated in cases of tuberculous lesions of the skin, acute herpes simplex, vaccinia and varicella.

WARNINGS - Quadriderm

any adverse effects reported to the systemic application of corticosteroids, which include adrenal suppression, may also take place with topical corticosteroids, especially in children and newborns.

The absorption of Quadriderm cream or ointment will be larger if wide body surface are treated or if the occlusive method is used. Possible safety measures ought to be taken in advance in these situations or when it is prolonged use of the product, particularly in young children.

Prolonged use of topical antibiotics may occasionally result in growth of non-susceptible organisms. If this occurs, or if irritation, sensitization or super infections are present, treatment with Quadriderm cream or ointment should be discontinued and appropriate therapy should be instituted.

The ferric chloride test for phenylketonuria may yield false positive if clioquinol is present in the urine.

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Ascof and Solmux: A Comparison of Two Cough Remedies

A comparison between the herbal medicine Ascof and the synthetic cough cure Solmux – two popular cough remedy the Philippines. Is Ascof better than Solmux?

In the Philippines, most cough remedies are considered as OTC or Over-The- Counter medications. Customers usually choose a product based on  drug popularity. The more they see or hear about it from the media, the more they feel secure in purchasing the product for their loved ones or for themselves.

 Ascof and Solmux are two common cough cures. While Ascof is known as a herbal remedy, Solmux as a carbocisteine is also notorious for being in the market for 50 years as a mucoregulator in respiratory diseases  since the 1960s. Both claim efficacy and safety, but which of the two is really better?

Ascof

 

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Manufactured by Pascual/ Altermed, Ascof (Lagundi) is from a herbal source. It is indicated for bronchospasm in acute bronchial asthma, chronic bronchitis and other bronco pulmonary disorder.

Contraindication: No known contraindication.

Precaution: Pregnancy and lactation.

Side-effect: Itchiness, nausea and vomiting, tachycardia, diarrhea, drowsiness and body malaise.

Solmux 

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Solmux (Carbocisteine) is a derivative of cysteine which is an amino acid. It is manufactured by Westmont/ Unilab Consumer Health and its primary use is to reduce the viscosity of pulmonary secretions in patients. It is for wet productive coughs, to help eliminate phlegm.

Contraindication: Peptic ulcer.

Side-effect: GI disturbance, GI bleeding, headache, skin rash.

Ascof and Solmux comparison

  • Formulation

Ascof and Solmux have different formulations. Ascof is available in 300mg tablet, 600mg caplet and in 300mg syrup drug form. It contains powdered Lagundi leaves (Vitex negundo linne family Verbenaceae). Ascof is for mild to moderate cough usually associated with common colds.

Solmux is available in 500mg capsule and in suspension forms. It has a mucolytic property. It is more beneficial in eliminating excessive mucous in the lungs.

  • Relief

Solmux in its encapsulated form has faster effect than Ascof tablet. Capsule forms of medications have greater dissolution compared to tablets thus they have faster relief. On the other hand, syrup has faster effect than suspension types. This means, Ascof syrup has a much faster effect than Solmux suspension.

  • Safety

Ascof reveals some mild side effects on few patients like itchiness, vomiting etc. These adverse reactions as they claim were reported without prevailing complaint with similar frequency on the placebo control. Solmux’s adverse effect involves gastric upsets. This drug is also used in precaution with old people with severe respiratory insufficiency or asthmatic patients.

Ascof VS Solmux

Considering the formulation, Ascof is more attractive for most consumers because of its herbal origin.  As for relief, liquid forms of medication have faster action and both Solmux and Lagundi have these dosage forms. Although, in terms of solid preparations, Solmux capsule is better than Ascof tablet.

Regarding safety, Ascof has no known contraindications and has mild adverse reactions that are reported rarely. However like most drugs, it is used in precaution with pregnant women and in lactation. Solmux on the other hand, causes stomach upsets, thus strictly contraindicated to people with peptic ulcer. More to this, it is also to be used in precaution with old people with weak lungs or asthmatic patients.

So which is better?

Summing it up, Ascof may have all the advantages over Solmux. But, these drugs possess dissimilar modes of action. Solmux is a mucolytic while Ascof is a simple cough formula with an anti-asthma effect. Ascof won’t be effective enough if the cough will be involving too much phlegm in the lungs. On the contrary, Solmux will not be also suitable for a simple cough with asthma involved.

References:

MIMS online

Dovepress

Wilson and Gisvold’s Textbook of Organic Medicinal and Pharmaceutical Chemistry 9th edition

LS BL: Antifungal Corticosteroid Cream

LS BL cream seems to be an improved form of Chinese BL - a popular antifungal agent more recognized for its whitening effect. Contrary to this, LS BL has the same content as Chinese BL cream. With the recent research of the author, it has been found out that Chinese BL not only possesses ketoconazole but clobetasole as well. In the Philippines, LS BL cream is a registered form of Chinese BL cream. Interestingly, similar to Chinese BL, LS BL cream can also be bought anywhere. This is a review about LS BL cream and some warnings.

In the Philippines, LS BL cream is imported and distributed by Manxing Enterprise Corporation from Shanghai Baolong Pharmaceutical Co. Ltd in China. LS BL cream is legal as it is registered in the Food and Drug Authority (FDA).  Unfortunately, like the unregistered Chinese BL, there are also counterfeit LS BL creams.

LS BL cream facts

Similar to the Chinese BL cream, LS BL has ketoconazole with the corticosteroid clobetasol. LS BL is a combination of a 10mg/g ketoconazole and a 500mcg/g clobetasol. Like the Chinese BL, LS BL is a 7g cream contained in a maroon jar.

LS BL is a prescription topical preparation indicated for fungal infections including tinea cruris (jock itch), tinea corporis (ringworm), tinea pedis (athlete’s foot) etc. Because it also contains clobetasol, LS BL can be a lot helpful when the itching and inflammation are severe.

More to this, LS BL is cited to be effective for dermatitis like seborrhoeic dermatitis, atopic dermatitis or eczema and psoriasis.

LS BL is applied one to two times daily.

Dangers

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Infants and children are apt to have LS BL cream into the bloodstream because they have larger skin area to body weight ratio in comparison to the adults. Newborns or premature babies can also absorb high quantities of clobetasole because of the incomplete development of the stratus corneum – the outermost layer of the skin.

With ketoconazole alone, any topical agent with this active constituent is an OTC or over-the-counter product. But, because LS BL cream contains clobetasole it is categorized as a prescription medicine.

Clobetasole is a corticosteroid and as a steroid it can cause cushing syndrome, intracranial hypertension and growth retardation in children.  More to this, prolonged use of a potent topical corticosteroid like clobetasole or a preparation containing this active constituent can cause cataract, diabetes mellitus, glaucoma and tuberculosis.

Whitening effect?

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Recommendations and warnings

As mentioned LS BL cream is more legal than the Chinese BL cream in the Philippines. LS BL cream was registered in the FDA (Food and Drug Authority) Philippines since December 2012 under the DR number DR-XY40466.

However, because LS BL is also popular like the Chinese BL, it is usually imitated. The photo of LS BL cream above was a purchase of the author from a grocery store. Interestingly, the clerk was selling it for its whitening benefits, unmindful that LS BL cream is a prescription drug.

LS BL cream, similar to the Chinese BL has clobetasole. A topical preparation containing corticosteroid should not be used for over two weeks. It is frightening that some women use LS BL cream as a beauty lotion. LS BL like Chinese BL is primarily for fungal infections. As LS BL cream contains clobetasole propionate, an advice from a registered physician is essential.

Finally, since LS BL cream is FDA approved. Consumers should only buy this product in registered drug outlets to avoid a counterfeit or fake LS BL cream.

© Phoenix Montoya @ January 28, 2013

References:

  1. LS BL cream leaflet
  2. Clobetasole leaflet
  3. http://www.fda.gov.ph/database/k.pdf
  4. http://www.mayoclinic.com/health/seborrheic-dermatitis/DS00984/DSECTION=causes

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