Losartan with Clonixin Interaction Details
Brand Names Associated with Losartan
- Cozaar®
- Hyzaar® (as a combination product containing Hydrochlorothiazide, Losartan)
- Losartan
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 05, 2023
Interaction Effect
Reduced antihypertensive effect and renal dysfunction and/or increased blood pressure
Interaction Summary
NSAIDs may decrease the antihypertensive and natriuretic effect of ACE inhibitors or angiotensin receptor blockers (ARBs). Additionally, coadministration may result in deterioration of renal function, including possible acute renal failure, in some patients. When concomitant use is required, determine the need to monitor renal function at initiation of treatment, monitor for antihypertensive efficacy, and assess renal function periodically for signs of renal deterioration or failure, especially in patients who are elderly, during treatment initiation, in the volume-depleted, or those with preexisting renal dysfunction. Ensure that patients are adequately hydrated.
Severity
Moderate
Onset
Unspecified
Evidence
Established
How To Manage Interaction
NSAIDs may decrease the antihypertensive and natriuretic effect of ACE inhibitors or angiotensin receptor blockers (ARBs). Additionally, coadministration may result in deterioration of renal function, including possible acute renal failure, in some patients. When concomitant use is required, determine the need to monitor renal function at initiation of treatment, monitor for antihypertensive efficacy, and assess renal function periodically for signs of renal deterioration or failure, especially in patients who are elderly, during treatment initiation, in the volume-depleted, or those with preexisting renal dysfunction. Ensure that patients are adequately hydrated.
Mechanism Of Interaction
Additive effects on renal function; decreased renal prostaglandin production
Literature Reports
A) Four days after initiation of indomethacin 100 mg/day for gout, a 48-year-old man with hypertension who was previously well-controlled with enalapril 10 mg/day experienced severe hypertension, psychosis, disorientation, and generalized anasarca . Hypertension was not controlled with an enalapril dose increase to 20 mg/day, and indomethacin was discontinued. One day later, the patient experienced rapid diuresis and significant weight loss. The enalapril dose was then reduced to 10 mg/day with good control of hypertension and no residual psychosis .
B) Indomethacin antagonized the antihypertensive effect of captopril in a randomized, double-blind, parallel-design multicenter study involving 141 hypertensive patients. One week of concomitant therapy with indomethacin and captopril increased 24-hour systolic blood pressure by 4.6 mmHg and diastolic by 2.7 mmHg (p less than 0.001). Overall, ambulatory diastolic blood pressure rose in 67% of patients treated with captopril during indomethacin treatment .
C) Hypertension worsened in a 59-year-old man treated for 5 years with lisinopril 10 mg/day after rofecoxib 25/day for arthritic pain was initiated. After 5 weeks, blood pressure increased from 130 to 135/80 to 85 to 168/98. Rofecoxib was withdrawn. Blood pressure declined over the following 18 days (average, 127/78 mmHg). Rofecoxib was restarted at 25 mg/day due to increased joint pain. After 2 days of therapy, blood pressure increased, and over the next 2 weeks it averaged 143/89 mmHg. Lisinopril was increased to 20 mg/day, resulting in an average blood pressure of 121/81 mmHg over the next 21 days .
D) Celecoxib did not attenuate the antihypertensive effect of lisinopril in 178 hypertensive patients in a double-blind, placebo-controlled, parallel-group trial. Patients received celecoxib 200 mg twice daily or placebo in addition to their usual lisinopril therapy (10 to 40 mg daily) for 4 weeks. Changes from baseline in the 24-hour systolic and diastolic blood pressure (BP) were nonsignificant. The proportion of patients whose 24-hour BP increased by at least 5, 10, 15, or 20 mmHg were also similar on celecoxib and placebo. The placebo-subtracted changes observed in 24-hour BP (1.6/1.2 mmHg) were less than what has been reported for NSAIDs in ACE inhibitor-treated patients .
Losartan Overview
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Losartan is used alone or in combination with other medications to treat high blood pressure. Losartan is also used to decrease the risk of stroke in people who have high blood pressure and a heart condition called left ventricular hypertrophy (enlargement of the walls of the left side of the heart). Losartan may not decrease the risk of stroke in African Americans who have these conditions. This medication is also used to treat kidney disease in people who have type 2 diabetes (condition in which the body does not use insulin normally and therefore cannot control the amount of sugar in the blood) and high blood pressure. Losartan is in a class of medications called angiotensin II receptor antagonists. It works by blocking the action of certain natural substances that tighten the blood vessels, allowing the blood to flow more smoothly and the heart to pump more efficiently.
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High blood pressure is a common condition, and when not treated it can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.