Losartan is an Angiotensin II Receptor Blocker (ARB) primarily used to treat hypertension, heart failure, and diabetic nephropathy. This medication works by blocking the effects of angiotensin II, causing vasodilation, lowering blood pressure, and reducing cardiac workload, thereby improving cardiac and renal functions. It is also used to slow the progression of diabetic kidney disease, especially when patients have increased urinary albumin levels.
Losartan's mechanism of action differs from other similar drugs; it does not affect angiotensin-converting enzyme (ACE), thus avoiding specific side effects such as cough. This feature makes it an alternative for patients who cannot tolerate ACE inhibitors. Clinical trials have shown that long-term use can reduce the risk of myocardial infarction and improve survival rates in patients with chronic heart failure.
The generic name of losartan is Losartan. Common brand names include:
Different countries or regions may have different brand names; patients should confirm the medication information provided by their pharmacist.
This medication is available in various formulations, including tablets and oral suspensions, with dosages typically ranging from 25 mg to 100 mg. Combination formulations may be used with diuretics, but require physician evaluation before prescribing.
Losartan is classified as an Angiotensin II Receptor Blocker (ARB), a second-line drug for hypertension treatment. These drugs primarily act on the renin-angiotensin-aldosterone system (RAAS), with a mechanism different from ACE inhibitors but similar in blood pressure control effects.
In the field of cardiology, ARB drugs are considered key medications for heart failure treatment. The choice of this class depends on individual patient history; for example, patients with a history of chronic cough may prefer ARBs over ACE inhibitors.
Main indications include:
In diabetic nephropathy, it may be used to reduce proteinuria and delay renal function decline even if blood pressure is normal.
It can also be used for primary prevention in high-risk patients, such as hypertensive patients with concomitant cardiac disease. Physicians may adjust the medication strategy based on indicators like left ventricular hypertrophy or metabolic syndrome.
Mild side effects include:
These usually diminish gradually with continued use.
Serious but less common side effects include:
If muscle weakness, decreased urination, or difficulty breathing occurs, immediate medical attention is required.
Contraindications: Pregnant women in the second and third trimesters should not use this medication, as it may cause fetal harm or death. Patients with severe renal impairment need dose adjustments, as it may exacerbate hyperkalemia.
Special precautions include:
Doctors will adjust the medication plan based on the patient's liver and kidney function.
Use of NSAIDs may reduce the antihypertensive effect and increase the risk of renal impairment. Combining with potassium-sparing diuretics (e.g., spironolactone) may increase the risk of hyperkalemia by more than threefold.
Concurrent use with lithium may lead to lithium toxicity; blood levels should be monitored. Certain antibiotics (e.g., tetracyclines) may affect metabolism due to changes in renal function, requiring dose adjustments. All prescribed, over-the-counter, or herbal medicines should be disclosed to the healthcare provider.
The initial adult dose for hypertension is usually 50 mg once daily, adjustable up to 100 mg daily based on blood pressure response. For heart failure, the starting dose is 25 mg twice daily, gradually increased based on tolerability. It should be taken at a fixed time, with or without food.
Patients with renal impairment (creatinine clearance below 30 mL/min) should reduce the dose to 25-50 mg daily. Avoid abrupt discontinuation; dose should be tapered to prevent rebound hypertension.
If a dose is missed, take it as soon as remembered. If less than 6 hours remain before the next dose, skip the missed dose and resume the regular schedule. Do not take a double dose to make up for a missed one, as this may increase the risk of hypotension.
Repeated missed doses should prompt consultation with a healthcare provider for dose adjustment. Pharmacists can provide medication organizers or reminders to help establish a regular medication routine.
Acute overdose may cause severe hypotension, dizziness, or syncope. If overdose is suspected, seek immediate medical attention; supportive treatments such as IV fluids or vasopressors may be necessary. Symptoms can develop within hours, so close monitoring of blood pressure and urine output is essential.
Chronic overdose may lead to persistent hyperkalemia; blood tests and medication adjustments are required. Symptoms like muscle weakness, palpitations, or abnormal ECG should be treated as emergencies.
Yes. Losartan can affect potassium metabolism; regular monitoring of blood potassium levels is recommended. Avoid excessive intake of high-potassium foods (such as bananas and spinach) or potassium supplements, especially when combined with potassium-sparing diuretics. Patients with impaired renal function should follow medical advice on diet adjustments.
Dizziness is a common early side effect, usually alleviated within a few weeks as the body adapts. It is recommended to move slowly when standing up or changing positions to prevent falls. If symptoms are severe or persistent, contact a healthcare provider; dose adjustment or increased fluid intake may improve blood pressure regulation.
Combining with diuretics (such as thiazides) can enhance blood pressure reduction but may increase the risk of hyperkalemia. Avoid combining with ACE inhibitors (such as enalapril) to prevent increased risk of renal dysfunction or hyperkalemia. Doctors will adjust doses and monitor relevant parameters based on the patient's condition.
Pregnant women in the second and third trimesters should not use Losartan, as it may cause fetal injury or death. Women planning pregnancy should inform their doctor in advance and switch to safer alternatives. Women of childbearing age should use effective contraception during medication and regularly monitor pregnancy status.
Regular blood tests including complete blood count, serum creatinine, and potassium levels are recommended, especially for patients with renal impairment. If muscle pain, decreased urine output, or unexplained fatigue occurs, stop medication immediately and seek medical attention to rule out rhabdomyolysis or acute kidney injury.
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