Losartan Brand Name– Cozaar
What is Losartan
Losartan is the first of a unique class of oral antihypertensive agents called angiotensin II (AG II) receptor antagonists.
Losartan and its longer acting active metabolite (E-3174) are specific and selective AT1 receptor antagonists.
Losartan is indicated to treat essential hypertension, diabetic nephropathy, and proteinuria, and has also been used off-label to treat congestive heart failure.
Compared with the angiotensin converting enzyme (ACE) inhibitors (e.g., captopril, enalapril), losartan is associated with a lower incidence of drug-induced cough, rash, and/or taste disturbances.
Because losartan does not inhibit ACE, it does not result in bradykinin accumulation which is theorized to cause the cough and angioedema associated with ACE inhibitors.
However, angioedema has been rarely associated with losartan or other angiotensin II antagonists.
Because AT1 receptors are nearly saturated at the starting dose for most angiotensin II antagonists, the antihypertensive dose-response curve of these drugs are nonlinear, with proportionally small decreases in blood pressure attained with increased dosage; greater antihypertensive efficacy is achieved by adding a small dose of a diuretic.
The LIFE outcome trial (conducted in patients with hypertension and left ventricular hypertrophy) shows that losartan is more effective than atenolol in reducing total mortality and cardiovascular morbidity and mortality, and is associated with less drug-related adverse events.
The results of the long-term (mean 3.4 years) RENAAL study reported that losartan (50—100 mg/day) is renoprotective (endpoints: doubling of serum creatinine, development of end-stage renal disease) in patients with type 2 diabetes and nephropathy.
Although it is not FDA approved for the treatment of heart failure, losartan has been shown to lower all-cause mortality and hospitalization to a greater extent than captopril in elderly patients with chronic heart failure (ELITE I trial).
Losartan (Cozaar®) was approved by the FDA for the treatment of hypertension in April 1995 and for the treatment of nephropathy in patients with type 2 diabetes mellitus in September 2002.
Indications
- diabetic nephropathy
- heart failure
- hypertension
- proteinuria
- stroke prophylaxis
For the treatment of hypertension, either alone or in combination with other antihypertensive agents
Side Effects
- abdominal pain
- alopecia
- anaphylactoid reactions
- anemia
- angina
- angioedema
- anorexia
- anxiety
- arrhythmia exacerbation
- arthralgia
- asthenia
- ataxia
- atrial fibrillation
- AV block
- azotemia
- back pain
- blurred vision
- bradycardia
- chest pain (unspecified)
- confusion
- conjunctivitis
- constipation
- cough
- dental pain
- depression
- diaphoresis
- diarrhea
- dizziness
- drowsiness
- dysgeusia
- dyspepsia
- dyspnea
- ecchymosis
- edema
- elevated hepatic enzymes
- epistaxis
- erythema
- exfoliative dermatitis
- fatigue
- fever
- flatulence
- flushing
- gout
- headache
- hepatitis
- hyperbilirubinemia
- hyperkalemia
- hypoesthesia
- hyponatremia
- hypotension
- impotence (erectile dysfunction)
- increased urinary frequency
- infection
- insomnia
- libido decrease
- malaise
- memory impairment
- migraine
- muscle cramps
- musculoskeletal pain
- myalgia
- myocardial infarction
- nasal congestion
- nausea
- nocturia
- ocular irritation
- oliguria
- orthostatic hypotension
- palpitations
- paresthesias
- peripheral neuropathy
- pharyngitis
- photosensitivity
- pruritus
- purpura
- rash
- renal failure (unspecified)
- rhabdomyolysis
- rhinitis
- sinus tachycardia
- sinusitis
- stroke
- syncope
- teratogenesis
- thrombocytopenia
- tinnitus
- tremor
- urticaria
- vasculitis
- ventricular fibrillation
- ventricular tachycardia
- vertigo
- visual impairment
- vomiting
- weakness
- xerostomia
Interactions
- Acarbose
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Pseudoephedrine
- Acrivastine; Pseudoephedrine
- Aldesleukin, IL-2
- Alemtuzumab
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alogliptin; Metformin
- Alpha-glucosidase Inhibitors
- Alprostadil
- Amifostine
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Amiodarone
- Amobarbital
- Amphetamine; Dextroamphetamine Salts
- Amyl Nitrite
- Angiotensin II
- Angiotensin-converting enzyme inhibitors
- Apomorphine
- Apraclonidine
- Aprepitant, Fosaprepitant
- Aripiprazole
- Asenapine
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Baclofen
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benzphetamine
- Boceprevir
- Bosentan
- Brexpiprazole
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Cabergoline
- Calcium Phosphate, Supersaturated
- Canagliflozin; Metformin
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloroprocaine
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Clozapine
- Co-Enzyme Q10, Ubiquinone
- Cobicistat
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Conivaptan
- Cyclosporine
- Dabrafenib
- Dapagliflozin; Metformin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Desloratadine; Pseudoephedrine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Quinidine
- Diazoxide
- Diethylpropion
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Dronedarone
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Duloxetine
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Elexacaftor; tezacaftor; ivacaftor
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enflurane
- Ephedrine
- Eplerenone
- Epoprostenol
- Ertugliflozin; Metformin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Etomidate
- Fenofibric Acid
- Fexofenadine; Pseudoephedrine
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluvoxamine
- Fosphenytoin
- Fospropofol
- General anesthetics
- Glipizide; Metformin
- Glyburide; Metformin
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Haloperidol
- Halothane
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Ibritumomab Tiuxetan
- Ibuprofen; Pseudoephedrine
- Idelalisib
- Iloperidone
- Iloprost
- Imatinib
- Incretin Mimetics
- Indapamide
- Insulins
- Intravenous Lipid Emulsions
- Isavuconazonium
- Isocarboxazid
- Isoflurane
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isoproterenol
- Isosorbide Dinitrate, ISDN
- Isosorbide Mononitrate
- Ivacaftor
- Ketamine
- Levodopa
- Linagliptin; Metformin
- Lisdexamfetamine
- Lithium
- Loop diuretics
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lovastatin; Niacin
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Lurasidone
- Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
- Meglitinides
- Mestranol; Norethindrone
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methamphetamine
- Methohexital
- Methylphenidate
- Miglitol
- Milrinone
- Mitotane
- Naproxen; Pseudoephedrine
- Nateglinide
- Nefazodone
- Nesiritide, BNP
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nitrates
- Nitroglycerin
- Nitroprusside
- Nonsteroidal antiinflammatory drugs
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Oxymetazoline
- Paliperidone
- Pazopanib
- Pentoxifylline
- Phenelzine
- Phenobarbital
- Phenylephrine
- Phenylephrine; Promethazine
- Phenytoin
- Polyethylene Glycol; Electrolytes
- Polyethylene Glycol; Electrolytes; Ascorbic Acid
- Potassium
- Potassium Phosphate
- Potassium Phosphate; Sodium Phosphate
- Pramlintide
- Prazosin
- Procainamide
- Procaine
- Propofol
- Pseudoephedrine
- Quinidine
- Rasagiline
- Repaglinide
- Rifampin
- Risperidone
- Ritonavir
- Selegiline
- Sevoflurane
- SGLT2 Inhibitors
- Silodosin
- Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Spironolactone
- St. John’s Wort, Hypericum perforatum
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfonamides
- Sulfonylureas
- Telotristat Ethyl
- Tetracaine
- Tezacaftor; Ivacaftor
- Thiazolidinediones
- Thiopental
- Thiothixene
- Tizanidine
- Tolvaptan
- Tranylcypromine
- Trazodone
- Triamterene
- Trimethoprim
- Vemurafenib
- Vigabatrin
- Voriconazole
- Yohimbine
- Zafirlukast
- Ziprasidone