From the FDA Drug Label
There is no apparent rebound effect after abrupt withdrawal of losartan. The FDA drug label for losartan does not directly address the combination of losartan and Hydrochlorothiazide (HCTZ). However, for losartan, there is no apparent rebound effect after abrupt withdrawal.
- No rebound effect is noted for losartan. It is essential to consider that the information provided is for losartan alone and may not be directly applicable to the combination of losartan and HCTZ. However, based on the available information for losartan, it can be inferred that holding losartan for one day in the setting of hypotension is unlikely to cause an immediate rebound effect 1.
From the Research
No, there is typically no immediate rebound effect from holding hydrochlorothiazide and losartan for one day in the setting of hypotension. It is generally safe and appropriate to temporarily withhold these medications when a patient is experiencing hypotension. The provided evidence does not directly address the issue of rebound effect after holding hydrochlorothiazide and losartan for one day in the setting of hypotension, but based on the pharmacokinetics of these medications,
- Hydrochlorothiazide has a half-life of 6-15 hours and its antihypertensive effects gradually diminish over 24-48 hours after discontinuation.
- Losartan has a half-life of about 2 hours, though its active metabolite has a longer half-life of 6-9 hours, with effects typically waning within 24 hours. When blood pressure has stabilized and returned to an acceptable range, these medications can usually be safely restarted at their previous doses. However, if hypotension was severe or recurrent, consider restarting at lower doses or reassessing the need for both medications. It's essential to identify and address the underlying cause of the hypotension, which could include volume depletion, infection, or other medications, as discussed in various studies 2, 3, 4, 5, 6. Regular blood pressure monitoring is crucial when restarting these medications to ensure an appropriate response. The most recent and highest quality study, although not directly addressing rebound effects, supports the safety and efficacy of losartan and hydrochlorothiazide combination therapy in managing hypertension 6.