Drug Interactions between Cozaar and vosoritide

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

MONITOR: Grapefruit juice may modestly decrease and delay the conversion of losartan to its active metabolite, E3174. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The clinical significance is unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.

MANAGEMENT: Patients who regularly consume grapefruits and grapefruit juice should be monitored for altered efficacy of losartan. Grapefruits and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact.

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MONITOR: Vosoritide may cause transient decreases in blood pressure. In clinical trials, 13% of patients treated with vosoritide experienced a transient decrease in blood pressure compared to 5% of patients on placebo. The median time to onset from injection was 31 (18 to 120) minutes with resolution within 31 (5 to 90) minutes. Two out of 60 (3%) vosoritide-treated patients each had one symptomatic episode of decreased blood pressure with vomiting and/or dizziness compared to 0 of 61 (0%) patients on placebo.

MANAGEMENT: To reduce the risk of low blood pressure and its associated signs and symptoms, patients should have adequate food intake before vosoritide administration and should drink approximately 240 to 300 mL of fluid within the hour prior to vosoritide administration. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their doctor if they experience fatigue, nausea, dizziness, or lightheadedness.

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