losartan (Rx)Brand and Other Names:Cozaar

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg
more...

Hypertension

50 mg/day PO (25 mg/day in patients with possible intravascular depletion or receiving diuretics)

Dosage range: 25-100 mg/day PO in 1 or 2 daily doses

Diabetic Nephropathy

Type 2 diabetes and hypertension: 50-100 mg PO qDay

Hypertension and Left Ventricular Hypertrophy

50 mg PO qDay initially; may increase to 100 mg PO qDay; may use in combination with a thiazide diuretic

Marfan Syndrome (Orphan)

Orphan designation for treatment of Marfan syndrome

Orphan sponsor

  • National Marfan Foundation, 22 Manhasset Ave, Port Washington, NY 11050

Dosing Considerations

Generally, adjust dosage monthly; adjust more aggressively in high-risk patients

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg
more...

Hypertension

<6 years: Safety and efficacy not established

≥6 years: 0.7 mg/kg/day (up to 50 mg/day) PO initially; not to exceed 1.4 mg/kg/day (or 100 mg/day) 

Oral suspension may be used

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Interactions

Interaction Checker

losartan and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Fatigue (14%)

            Hypoglycemia (14%)

            Anemia (14%)

            Urinary tract infection (UTI) (13%)

            Chest pain (12%)

            Weakness (14%)

            Diarrhea (2-15%)

            Cough; incidence higher in previous cough related to angiotensin-converting enzyme (ACE) inhibitor therapy (3-11%)

            1-10%

            Upper respiratory tract infection (8%)

            Hypotension (7%)

            Dizziness (4%)

            Cellulitis (7%)

            Gastritis (5%)

            Nausea (2%)

            Frequency Not Defined

            Angioedema

            Edema/swelling

            Hypotension in hypovolemic or diuretic-using patients

            Asthenia

            Headache

            Malaise

            Nausea

            Abdominal pain

            Hyperkalemia

            Back pain

            Worsening renal failure

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            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; drug affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury or death (see Pregnancy & Lactation)

            Contraindications

            Hypersensitivity

            Coadministration with aliskiren in patients with diabetes mellitus

            Cautions

            Angioedema, volume-depletion, severe congestive heart failure (CHF), hepatic or renal impairment

            Correct volume or salt depletion prior to administration

            Increases risks of hypotension; hyperkalemia

            Monitor renal function and potassium in susceptible patients

            Discontinue immediately if patient is pregnant; potential risk of congenital malformations

            Use with caution in renal artery stenosis; avoid in bilateral renal artery stenosis

            Renal impairment reported

            Increased heart failure-related morbidity in patients receiving ACE inhibitors and beta blockers concomitantly; such combination therapy is not recommended

            Dual blockade of the renin-angiotensin-aldosterone system (ie, an angiotensin-receptor blocker [ARB] plus an ACE inhibitor) in patients with established atherosclerotic disease, heart failure, or diabetes with end-organ damage is associated with a higher frequency of hypotension, syncope, hyperkalemia, and altered renal function (including acute renal failure) in comparison with use of a single renin-angiotensin-aldosterone system agent; limit dual blockade to individually defined cases with close monitoring of renal function; closely monitor blood pressure

            Risk of anaphylactic reactions or angioedema

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            Pregnancy & Lactation

            Pregnancy category: D

            Use of drugs that act on the renin-angiotensin system during the 2nd and 3rd trimesters of pregnancy reduces renal function and increases fetal and neonatal morbidity and death

            Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations

            Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death

            When pregnancy is detected, discontinue as soon as possible

            Lactation: Unknown if excreted in milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Blocks binding of angiotensin II to type 1 angiotensin II receptors; blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II

            Absorption

            Bioavailability: 25%

            Onset: 6 hr

            Duration: 24 hr

            Peak plasma time: 1-1.5 hr

            Distribution

            Protein bound: Losartan, 98.7%; E-3174, 99.8%

            Vd: Losartan, 34 L; E-3174, 12 L

            Metabolism

            Metabolized by hepatic P450 enzyme CYP2C9

            Metabolites: 5-Carboxylic acid (E-3174) (active metabolite; 40 times as potent as losartan in angiotensin II-blocking activity)

            Elimination

            Half-life: Losartan, 1.5-2 hr; E-3174, 6-9 hr; increased in end-stage renal failure or CHF

            Dialyzable: HD, no; PD, no

            Renal clearance: Losartan, 43-75 mL/min; E-3174, 18-25 mL/min

            Total plasma clearance: Losartan, 600 mL/min; E-3174, 50 mL/min

            Excretion: Urine (4%)

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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