The rate of all cause death was not significantly different between the treatment groups. Following oral administration, losartan is well absorbed and undergoes first-pass metabolism, forming an active carboxylic acid metabolite and other inactive metabolites. During once daily dosing with 100 mg, neither losartan nor its active metabolite accumulates significantly in plasma. Therefore, losartan should be used with caution in these patient groups. During administration of losartan, removal of the angiotensin II negative feedback on renin secretion leads to increased plasma renin activity (PRA). There are steps you can take that may reduce your risk of Alzheimer's. What are the differences between losartan and other medicines for high blood pressure? Significant levels of losartan and its active metabolite were present in rat fetal plasma during late gestation and in rat milk; Lactation. Neither therapy changed renal function and serum potassium in Very-Elderly patients. Two large randomised, controlled trials (ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) and VA NEPHRON-D (The Veterans Affairs Nephropathy in Diabetes)) have examined the use of the combination of an ACE-inhibitor with an angiotensin II receptor blocker. Losartan is not normally recommended in pregnancy or when breastfeeding. In addition to the active metabolite, inactive metabolites are formed. Renal function should be regularly monitored during treatment with losartan as it may deteriorate. Do not take a double dose to make up for a forgotten one. Although not all of these side effects may occur, if they do occur they may need medical attention. Following an oral dose/intravenous administration of 14C-labeled losartan in man, about 35% / 43% of radioactivity is recovered in the urine and 58%/ 50% in the faeces. If losartan doesn't bring your blood pressure down, your doctor may want to increase the dose. Talk to your doctor if you're trying to get pregnant, you're already pregnant or you're breastfeeding. Increase in the PRA leads to an increase in angiotensin II in plasma. There may be other treatments that are safer for you. Next review due: 13 December 2021. If you often forget doses, it may help to set an alarm to remind you. There are other types of blood pressure-lowering medicines: The blood pressure-lowering medicine you're prescribed depends on your age and ethnicity: Many people need to take a combination of different blood pressure-lowering medicines. Your doctor will check how well your kidneys are working with regular blood tests. Continue, 2. Although not all of these side effects may occur, if they do occur they may need medical attention. When losartan is administered orally, about 4% of the dose is excreted unchanged in the urine, and about 6% of the dose is excreted in the urine as active metabolite. Patients were randomised to receive losartan 50 mg once a day or losartan 150 mg, on a background of conventional therapy excluding ACE-inhibitors. There is no therapeutic experience with losartan in patients with severe hepatic impairment. Losartan works as well as other angiotensin receptor blockers when it's used to lower blood pressure. For patients who can swallow tablets, the recommended dose is 25 mg once daily in patients >20 to <50 kg. Patients were followed up for up to 4.6 years (3.4 years on average). 751 Patients were treated with losartan. In repeated dose toxicity studies, the administration of losartan induced a decrease in the red blood cell parameters (erythrocytes, haemoglobin, haematocrit), a rise in urea-N in the serum and occasional rises in serum creatinine, a decrease in heart weight (without a histological correlate) and gastrointestinal changes (mucous membrane lesions, ulcers, erosions, haemorrhages). Losartan starts to reduce high blood pressure after about 6 hours but it may take 3 to 6 weeks to fully take effect. You could be having a serious allergic reaction and may need immediate treatment in hospital. The decline in both systolic blood pressure and diastolic blood pressure was greater in the losartan group (-5.5/-3.8 mmHg) versus the amlodipine group (-0.1/+0.8 mm Hg). Take it as instructed by your doctor. Therefore, losartan is contraindicated in patients with severe hepatic impairment (see sections 4.3 and 4.4). Compared to patients with normal renal function, the AUC for losartan is about 2-times higher in haemodialysis patients. Long-term effects of losartan in children with proteinuria were studied for up to 3 years in the open-label safety extension phase of the same study, in which all patients completing the 12-week base study were invited to participate. Therefore, the use of losartan is not recommended. Patients should be adequately hydrated and consideration should be given to monitoring renal function after initiation of concomitant therapy, and periodically thereafter. Co-administration of lithium and losartan should be undertaken with caution. Can I take losartan for Raynaud's phenomenon? Usually, treatment with losartan is long term, and you may have to take it for the rest of your life. The safety and efficacy of Losartan Potassium / Hydrochlorothiazide in children and adolescents under the age of 18 years have not been established. Losartan/HCTZ is contraindicated in patients with severe hepatic impairment (see section 4.3.). The frequency of adverse reactions listed below is defined using the following convention: very common (≥ 1/10); common (≥ 1/100, to < 1/10); uncommon (≥ 1/1,000, to < 1/100); rare (≥ 1/10,000, to < 1/1,000); very rare (< 1/10,000), not known (cannot be estimated from the available data). Losartan does not have an agonist effect nor does it block other hormone receptors or ion channels important in cardiovascular regulation. VA NEPHRON-D was a study in patients with type 2 diabetes mellitus and diabetic nephropathy. Children aged 6 years and older can take it, but only to treat high blood pressure. These are not all the side effects of losartan. Treatment with losartan reduced the risk of stroke by 25% relative to atenolol (p=0.001 95% confidence interval 0.63-0.89). When angiotensin II antagonists are administered simultaneously with NSAIDs (i.e. Preclinical data reveal no special hazard for humans based on conventional studies of general pharmacology, genotoxicity and carcinogenic potential. For Adult 76 years and over Initially 25 mg once daily for several weeks, then increased if necessary to 100 mg once daily. Whilst there is no controlled epidemiological data on the risk with Angiotensin II Receptor Inhibitors (AIIRAs), similar risks may exist for this class of medicinal products. Cozaar; Descriptions. The maximum daily doses of 50 mg for <50 kg body weight and 100 mg>50 kg were not exceeded for most patients during the extension phase of the study. ACE-inhibitors and angiotensin II receptor blockers should therefore not be used concomitantly in patients with diabetic nephropathy. This was mainly attributable to a reduction of the incidence of hospitalisation for heart failure. Treatment with 150 mg losartan reduced the risk of hospitalisation for heart failure by 13.5% relative to 50 mg losartan (p=0.025 95% confidence interval 0.76-0.98). If it continues for a long time, the heart and arteries may not function properly. Your doctor may increase your dosage to 100 mg per day if needed. If your blood pressure gets too low or you get side effects, your doctor may want to lower your dose. In elderly hypertensive patients the plasma concentrations of losartan and its active metabolite do not differ essentially from those found in young hypertensive patients. Other antihypertensive agents may increase the hypotensive action of losartan. In both comparator-controlled (not placebo-controlled) clinical studies on patients with heart failure the tolerability of losartan was superior to that of captopril, measured on the basis of a significantly lower rate of discontinuations of therapy on account of adverse reactions and a significantly lower frequency of cough. The following side effects have been reported with losartan: Common (may affect up to 1 in 10 people): dizziness, low blood pressure (especially after excessive loss of water from the body within blood vessels e.g. Although consideration should be given to initiating therapy with 25 mg in patients over 75 years of age, dosage adjustment is not usually necessary for the elderly. They’ll be able to advise you about what to do. No studies on the effects on the ability to drive and use machines have been performed. Dose adjustment is not usually necessary for the elderly. Your doctor will then decide whether to change your dose of losartan. The clinical relevance of this effect is unknown. Talk to your doctor if you're taking a combined hormonal contraceptive. When comparing preschool children with adolescents these differences became statistically significant. If you need to go to your nearest hospital A&E department, do not drive yourself - get someone else to drive you or call for an ambulance. Learn more about Losartan (Cozaar) at EverydayHealth.com. In diabetic kidney disease, it helps to protect your kidneys and slows down the disease. In this study of elderly heart-failure patients, treatment with losartan was associated with an unexpected lower mortality than that found with captopril. If your child needs losartan, your doctor will usually use your child's weight to work out the right dose. Side effects requiring immediate medical attention. There is no sufficient therapeutic experience with losartan in patients with heart failure and concomitant severe renal impairment, in patients with severe heart failure (NYHA class IV) as well as in patients with heart failure and symptomatic life threatening cardiac arrhythmias. Very rare cases have also been reported with angiotensin II receptor antagonists. The lowest doses studied, 2.5 mg and 5 mg, corresponding to an average daily dose of 0.07 mg/ kg, did not appear to offer consistent antihypertensive efficacy. Following oral and intravenous administration of 14C-labeled losartan potassium, circulating plasma radioactivity primarily is attributed to losartan and its active metabolite. Limited data are available with regard to overdose in humans. In exceptional cases the dose can be adjusted to a maximum of 100 mg once daily. The combination of losartan with a beta-blocker should be used with caution (see section 5.1). By continuing to browse the site you are agreeing to our policy on the use of cookies. However, losartan is not officially approved for migraine. This applies particularly when losartan is given in the presence of other conditions (fever, dehydration) likely to impair renal function. For the following individual and combined components of the primary endpoint, the results showed a significant risk reduction in the group treated with losartan: 25.3 % risk reduction for doubling of the serum creatinine (p = 0.006); 28.6 % risk reduction for end-stage renal failure (p = 0.002); 19.9 % risk reduction for end-stage renal failure or death (p = 0.009); 21.0 % risk reduction for doubling of serum creatinine or end-stage renal failure (p = 0.01). You can boost the health of your heart by making some key lifestyle changes. Stabilisation of the cardiovascular system should be given priority. The ELITE trial was a double-blind, randomised, captopril- controlled trial of losartan in the management of heart failure in the elderly. Unless continued losartan therapy is considered essential, patients planning pregnancy should be changed to alternative anti-hypertensive treatments which have an established safety profile for use in pregnancy. It also works as well as ramipril and other angiotensin converting enzyme (ACE) inhibitors to lower blood pressure. The objective of the study was to demonstrate a nephroprotective effect of losartan potassium over and above the benefit of a blood lowering pressure. US Brand Name. Losartan won't affect any type of contraception. All-cause mortality rate was not significantly different between the two treatment groups. If you find losartan makes you feel dizzy it's best to stop drinking alcohol. However, your doctor may prescribe it if they think the benefits of the medicine outweigh the risks. The usual initial dose of losartan in patients with heart failure is 12.5 mg once daily. Losartan selectively blocks the AT1 receptor. Your doctor may prescribe losartan if you've tried taking similar blood pressure-lowering medicines such as ramipril and lisinopril in the past, but had to stop taking them because of side effects such as a dry, irritating cough. The mean length of follow up was 4.8 years. Drug information provided by: IBM Micromedex Along with its needed effects, a medicine may cause some unwanted effects. Maximum dose: 100 mg orally once a day. The hypertensive patients (ages 6 through 18 years) were randomised to receive either losartan (n=30) or amlodipine (n=30). I was down to 110/70 and even 100/65 at times. The Losartan brought my BP down a lot with a 50 mg daily dose. Losartan Potassium may be administered with or without food. The pharmacokinetics of losartan and its active metabolite are linear with oral losartan potassium doses up to 200 mg. The pharmacokinetic parameters for the metabolite differed to a greater extent between the age groups. The study was terminated early because of an increased risk of adverse outcomes. This lowers your blood pressure and makes it easier for your heart to pump blood around your body. Losartan should not be initiated during pregnancy. There are several other angiotensin receptor blockers that work in the same way as losartan. The usual starting dose is 50 mg once daily. Plasma concentrations of losartan are not altered in patients with a creatinine clearance above 10 ml/minute. It allows continued monitoring of the benefit/risk balance of the medicinal product. You could also ask your pharmacist for advice on other ways of helping you remember your medicine. However, at the moment, there is not enough evidence to recommend taking losartan or other similar medicines for Alzheimer's. The dose-response relationship became very obvious in the low dose group compared to the middle dose group (period I: -6.2 mmHg vs. -11.65 mmHg), but was attenuated when comparing the middle dose group with the high dose group (period I: -11.65 mmHg vs. -12.21 mmHg). This was mainly attributable to a reduction of the incidence of stroke. Unknown whether drug is excreted in human milk, but significant levels of losartan and its active metabolite were shown to be present in rat milk. The rates of cardiovascular death and myocardial infarction were not significantly different between the treatment groups. In summary, the mean blood pressure decrease from baseline was similar across all treatment groups (change from baseline to Week 3 in SBP was -7.3, -7.6, and -6.7 mmHg for the low-, medium-, and high-dose groups, respectively; the reduction from baseline to Week 3 in DBP was -8.2, -5.1, and -6.7 mmHg for the low-, medium-, and high-dose groups. Each film-coated tablet contains 12.75 mg lactose monohydrate. Long-term effects of losartan on growth, puberty and general development have not been studied. Your doctor will probably advise you to try other medicines first. Morning BP target (<135/85 mmHg) was achieved in 40.6% and 55.1% by combination therapy and in 14.7% and 24.2% by high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. However taking losartan for a long time can sometimes cause your kidneys not to work as well as they should. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. Stopping losartan may cause your blood pressure to rise - and this can increase your chances of having a heart attack or stroke. other medicines to help lower your blood pressure, including aliskiren, potassium supplements or salt substitutes which contain potassium, tablets which make you pee more (diuretics), lithium (a medicine for mental health problems), spironolactone (a medicine to treat heart failure), angiotensin converting enzyme (ACE) inhibitors - for example, tablets which make you pee more (diuretics) - for example, if you're under 55 - you'll usually be offered an ACE inhibitor or an angiotensin receptor blocker, if you're 55 or older, or you're any age and of African Caribbean or black African origin - you'll usually be offered a calcium channel blocker. Losartan may be administered with other antihypertensive agents, especially with diuretics (e.g.hydrochlorothiazide) (see sections 4.3, 4.4, 4.5 and 5.1). Initially 50 mg once daily for several weeks, then increased if necessary to 100 mg once daily. The Heart Failure Endpoint Evaluation of Angiotensin II Antagonist Losartan (HEAAL) study was a controlled clinical study conducted worldwide in 3834 patients aged 18 to 98 years with heart failure (NYHA Class II-IV) who were intolerant of ACE inhibitor treatment. About losartan. Exposure to AIIRA therapy during the second and third trimesters is known to induce human fetotoxicity (decreased renal function, oligohydramnios, skull ossification retardation) and neonatal toxicity (renal failure, hypotension, hyperkalaemia) (see also section 5.3). It also improves your survival if you're taking it for heart failure or after a heart attack. If this combination proves essential, serum lithium level monitoring is recommended during concomitant use. No dosage adjustment is required in elderly or in patients with mild to moderate renal dysfunction, and the risk of first-dose hypotension is low. Along with its needed effects, losartan may cause some unwanted effects. If this happens to you, do not drive a car, ride a bike, or use tools or machinery until you feel better. Losartan should be used with caution in patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney. These studies have shown no significant beneficial effect on renal and/or cardiovascular outcomes and mortality, while an increased risk of hyperkalaemia, acute kidney injury and/or hypotension as compared to monotherapy was observed. In summary, the results of the safety extension show that losartan was well- tolerated and led to sustained decreases in proteinuria with no appreciable change in glomerular filtration rate (GFR) over 3 years. Your doctor may adjust your dose as needed. If you need blood pressure-lowering medicines, you'll probably need to take them for the rest of your life. These results were confirmed during period II of the study where patients were randomized to continue losartan or placebo, after three weeks of treatment. Both biliary and urinary excretion contribute to the elimination of losartan and its metabolites. Page last reviewed: 13 December 2018 Losartan has been evaluated in clinical studies as follows: - in a controlled clinical trial in > 3,000 adult patients 18 years of age and older for essential hypertension, - in a controlled clinical trial in 177 hypertensive paediatric patients 6 to 16 years of age, - in a controlled clinical trial in > 9,000 hypertensive patients 55 to 80 years of age with left ventricular hypertrophy (see LIFE Study, section 5.1), - in controlled clinical trials in > 7,700 adult patients with chronic heart failure (see ELITE I, ELITE II, and HEAAL study, section 5.1), - in a controlled clinical trial in > 1500 type 2 diabetic patients 31 years of age and older with proteinuria (see RENAAL study, section 5.1). Coronary heart disease and cerebrovascular disease. Treatment with losartan is therefore an option for first-line therapy in all patients with hypertension, … If goal blood pressure (< 140/90 mmHg) was not reached, hydrochlorothiazide (12.5 mg) was added first and, if needed, the dose of losartan or atenolol was then increased to 100 mg once daily. Pharmacotherapeutic group: Angiotensin II antagonists, plain, ATC code: C09CA01. As with other medicinal products that affect the renin-angiotensin-aldosterone system, increases in blood urea and serum creatinine have also been reported in patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney; these changes in renal function may be reversible upon discontinuation of therapy. Losartan helps to prevent future strokes, heart attacks and kidney problems. Because no information is available regarding the use of losartan during breast-feeding, losartan is not recommended and alternative treatments with better established safety profiles during breast-feeding are preferable, especially while nursing a newborn or preterm infant. Usual Adult Dose for Hypertension: Initial dose: 50 mg orally once a day. Take the losartan packet or leaflet inside it plus any remaining medicine with you. There is no clear evidence that taking angiotensin receptor blockers (ARBs) like losartan will cause complications. The use of losartan is contra-indicated during the 2nd and 3rd trimester of pregnancy (see sections 4.3 and 4.4). Use in paediatric patients with renal impairment. Electrolyte imbalances are common in patients with renal impairment, with or without diabetes, and should be addressed. An overdose of losartan can cause dizziness, sleepiness and a pounding heartbeat. The antihypertensive effect of losartan was established in a clinical study involving 177 hypertensive paediatric patients 6 to 16 years of age with a body weight > 20 kg and a glomerular filtration rate > 30 ml/ min/ 1.73 m2. The dose should generally be titrated at weekly intervals (i.e. In controlled clinical studies, once-daily administration of losartan to patients with mild to moderate essential hypertension produced statistically significant reductions in systolic and diastolic blood pressure. have had an allergic reaction to losartan or other medicines in the past, are trying to get pregnant, are already pregnant or you are breastfeeding, 50mg to 100mg once a day to treat high blood pressure and to protect their kidneys, 12.5mg to 150mg once a day for heart failure, feeling dizzy or having a spinning sensation (vertigo), severe stomach pain - this can be a sign of an inflamed pancreas, pale skin, feeling tired, faint or dizzy, purple spots, any sign of bleeding, sore throat and fever - these can be signs of blood or bone marrow disorder, weakness, an irregular heartbeat, pins and needles and muscle cramps - these can be signs of changes in the sodium and potassium levels in your blood, you get a skin rash that may include itchy, red, swollen, blistered or peeling skin, your mouth, face, lips, tongue or throat start swelling. Losartan can be taken by adults aged 18 years and over. If you take too many losartan tablets by accident, contact your doctor or go to your nearest hospital A&E department straight away. Both losartan and its principal active metabolite have a far greater affinity for the AT1-receptor than for the AT2-receptor. Other antihypertensive agents (diuretics, calcium antagonists, alpha- and beta-receptor blockers and also centrally acting antihypertensives) were permitted as supplementary treatment depending on the requirement in both groups. Losartan is a medicine widely used to treat high blood pressure and heart failure, and to protect your kidneys if you have both kidney disease and diabetes. Patients did not result in an abrupt rise in blood pressure, you 're any... The AT1 receptor found in young hypertensive patients ( ages 6 through 18 years ) and stroke. ( -3.7/-3.4 mm Hg ) compared to placebo, randomised, captopril- controlled trial of,... 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