Losartan
COZAAR
What it isAT1 receptor antagonist for hypertension and diabetic nephropathy.
Why this oneIts uricosuric effect distinguishes it from other ARBs and can help when gout coexists.
What limits itCheck potassium and creatinine; avoid in pregnancy. CYP2C9 inhibition or poor metabolism can blunt formation of its more potent metabolite.
FDA-approved for
- hypertension (1995)
- diabetic nephropathy (2002)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 50 mg QD (25 mg if volume-depleted) | 100 mg/day | |
| Hypertension | Peds ≥6 yr | 0.7 mg/kg QD (up to 50 mg) | 1.4 mg/kg or 100 mg/day | |
| Hypertension with left ventricular hypertrophy | Adults | 50 mg QD | add HCTZ 12.5 mg and/or increase to 100 mg, then HCTZ 25 mg | |
| Nephropathy in type 2 diabetes | Adults | 50 mg QD | 100 mg QD if further BP response needed |
Renal No adjustment needed (unless volume-depleted); not recommended if GFR <30 mL/min/1.73 m² (peds)
Hepatic Mild–moderate: 25 mg QD; not studied in severe impairment
Instructions
- Correct volume or salt depletion before starting
- Oral suspension (2.5 mg/mL) may be compounded from tablets for pediatric use
Contraindications
- Coadministration with aliskiren in patients with diabetes
Cautions
- Fetal toxicity
- Hypotension in volume- or salt-depleted patients
- Renal function deterioration (esp. renal artery stenosis, CKD, severe HF)
- Hyperkalemia
Adverse reactions
- Dizziness
- Upper respiratory infection
- Nasal congestion
- Back pain
- Angioedema (postmarketing)
Pregnancy Can cause fetal harm (oligohydramnios, fetal/neonatal renal failure, death); discontinue when pregnancy detected
Lactation Unknown whether excreted in human milk; decide whether to discontinue nursing or the drug
⚠ BOXED WARNING
- Fetal toxicity; discontinue as soon as pregnancy is detected
Principal riskHyperkalemia and acute kidney injury
Cost, est. cash$4–$80/month
Generic entry2010
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityHyperkalemia, kidney injury, fetal toxicity and increased lithium exposure.
Active metabolites
Mechanism of action: Losartan ballicule
Open Losartan in the interactive console ↗
Memory aids: mascots and interaction avatars
Arby’s for ARB
Satan for sartan
Bananas in bunches → ↑ serum potassium
