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When angiotensin II antagonists are administered simultaneously with NSAIDsi.eselective COX-2 inhibitorsacetylsalicylic acid at anti-inflammatory doses and non-selective NSAIDsattenuation of the antihypertensive effect may occurConcomitant use of angiotensin II antagonists or diuretics and NSAIDs may lead to an increased risk of worsening of renal functionincluding possible acute renal failureand an increase in serum potassiumespecially in patients with poor pre-existing renal functionThe combination should be administered with cautionespecially in the elderlyPatients should be adequately hydrated and consideration should be given to monitoring renal function after initiation of concomitant therapyand periodically thereafter.
A lower dose should be considered for patients with a history of hepatic impairmentThere is no therapeutic experience in patients with severe hepatic impairmentThereforelosartan is contraindicated in patients with severe hepatic impairmentsee sections 4.3 and 4.4
Clinical trial data have shown that dual blockade of the renin-angiotensin-aldosterone systemRAASthrough the combined use of ACE-inhibitorsangiotensin II receptor blockers or aliskiren is associated with a higher frequency of adverse events such as hypotensionhyperkalaemiaand decreased renal functionincluding acute renal failurecompared to the use of a single RAAS-acting agentsee sections 4.34.4and 5.1
You may also need to avoid taking Cozaar with aliskiren if you have kidney disease.
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