What is ?
Losartan is a medication belonging to a class of drugs called angiotensin II receptor blockers (ARBs). It was the first ARB approved for use and remains one of the most commonly prescribed medications for high blood pressure and kidney protection.
How Does Losartan Work?
Losartan works by blocking the action of angiotensin II, a powerful chemical in the body that causes blood vessels to constrict:
- Blocks angiotensin II type 1 (AT1) receptors
- Prevents blood vessels from narrowing
- Lowers blood pressure
- Reduces workload on the heart
- Protects kidneys from damage
- Decreases aldosterone secretion (reduces sodium and water retention)
- May have uric acid-lowering effects
Unlike ACE inhibitors, losartan does not cause the buildup of bradykinin, which means it typically does not cause the persistent dry cough common with ACE inhibitors.
Common Uses
Losartan is prescribed for several conditions:
- Hypertension: First-line treatment for high blood pressure, used alone or with other medications
- Diabetic Nephropathy: Slows progression of kidney disease in type 2 diabetics with elevated creatinine and proteinuria
- Stroke Prevention: Reduces stroke risk in patients with hypertension and left ventricular hypertrophy
- Heart Failure: Alternative to ACE inhibitors for patients who develop cough
- Marfan Syndrome: May slow aortic root dilation (off-label use)
- Chronic Kidney Disease: Provides renoprotection
Dosage and Administration
Losartan is typically taken once or twice daily:
For Hypertension:
- Starting dose: 50 mg once daily
- May increase to 100 mg once daily
- Can be divided into twice-daily dosing
For Diabetic Nephropathy:
- Starting dose: 50 mg once daily
- Target dose: 100 mg once daily
Administration tips:
- Can be taken with or without food
- Take at the same time each day
- Continue taking even if you feel well
- May take 3-6 weeks for full blood pressure-lowering effect
- Can be used alone or combined with other blood pressure medications
Important Safety Information
Who Should Not Take Losartan?
Do not take losartan if you:
- Are allergic to losartan or any ARB
- Are pregnant (especially second and third trimesters)
- Are taking aliskiren (Tekturna) and have diabetes
- Have severe liver impairment
Drug Interactions
Inform your doctor about all medications, especially:
- Potassium supplements or salt substitutes containing potassium
- Other blood pressure medications
- NSAIDs (ibuprofen, naproxen) - may reduce effectiveness and harm kidneys
- Lithium - losartan may increase lithium levels
- Diuretics - especially potassium-sparing types
- Aliskiren - avoid combination in diabetics or kidney disease
- Rifampin - may decrease losartan effectiveness
Pregnancy Warning
⚠️ CRITICAL: Losartan can cause serious harm or death to an unborn baby if taken during the second or third trimester of pregnancy. If you become pregnant, stop taking losartan immediately and contact your doctor. Women of childbearing potential should use effective contraception.
Breastfeeding
It is not known if losartan passes into breast milk. Discuss with your doctor whether to discontinue breastfeeding or the medication.
Monitoring and Follow-Up
Your doctor will monitor:
- Blood pressure levels (home monitoring encouraged)
- Kidney function (creatinine, BUN, eGFR)
- Potassium levels (especially when starting or adjusting dose)
- Electrolytes
- Response to treatment
- For diabetic nephropathy: proteinuria/albumin in urine
Important: Blood tests are typically done:
- Before starting treatment
- 1-2 weeks after starting or dose increase
- Periodically during treatment
Special Populations
Kidney Disease:
- May be used to protect kidneys
- Dose adjustment usually not needed for mild-moderate kidney disease
- Monitor kidney function closely
- Small initial decline in kidney function is expected and acceptable
Liver Disease:
- Lower starting dose recommended (25 mg daily)
- Use with caution in severe liver disease
Elderly Patients:
- No dose adjustment needed
- May be more sensitive to blood pressure-lowering effects
- Monitor for dizziness and falls
Dehydration/Volume Depletion:
- Correct volume depletion before starting
- Risk of excessive blood pressure drop
Managing Side Effects
Dizziness/Lightheadedness
- Common when starting or increasing dose
- Rise slowly from sitting or lying position
- Stay well hydrated
- Usually improves with time
- Avoid alcohol
High Potassium
- Avoid potassium supplements unless prescribed
- Limit high-potassium foods if levels elevated
- Regular blood monitoring
- Especially important if taking potassium-sparing diuretics or have kidney disease
Lifestyle Considerations
To maximize benefits of losartan:
- Follow DASH diet or similar heart-healthy eating plan
- Reduce sodium intake (less than 2,300 mg daily, ideally 1,500 mg)
- Exercise regularly (150 minutes moderate activity per week)
- Maintain healthy weight
- Limit alcohol consumption
- Quit smoking
- Manage stress
- Monitor blood pressure at home
- Take medication consistently
Combination Therapy
Losartan is often combined with:
- Hydrochlorothiazide (HCTZ): Available as combination pill (Hyzaar) - enhances blood pressure control
- Amlodipine: Calcium channel blocker for additional blood pressure lowering
- Other diuretics: For improved blood pressure control or fluid management
Comparison with ACE Inhibitors
Advantages of Losartan over ACE Inhibitors:
- Does not cause dry cough
- Lower risk of angioedema (though still possible)
- Similar cardiovascular and kidney protection
- May be better tolerated
Similarities:
- Both protect kidneys in diabetes
- Both reduce cardiovascular events
- Both contraindicated in pregnancy
- Both can cause hyperkalemia and kidney function changes
When to Contact Your Doctor
Seek immediate medical attention if you experience:
- Severe dizziness or fainting
- Chest pain or irregular heartbeat
- Swelling of face, lips, tongue, or throat (angioedema - rare)
- Difficulty breathing or swallowing
- Severe stomach pain
- Dark urine or yellowing of skin/eyes
- Signs of high potassium (muscle weakness, slow heartbeat)
Contact your doctor for routine issues:
- Persistent dizziness
- Ongoing back pain
- Frequent upper respiratory infections
- Questions about blood pressure readings
- Planning pregnancy
- Scheduled surgery
Effectiveness and Benefits
Clinical studies demonstrate that losartan:
- Lowers blood pressure effectively in most patients
- Reduces stroke risk by 25% in high-risk hypertensive patients with left ventricular hypertrophy
- Slows progression of diabetic kidney disease
- Reduces proteinuria (protein in urine)
- Decreases hospitalization for heart failure
- Provides 24-hour blood pressure control with once-daily dosing
- May lower uric acid levels (beneficial in gout)
Storage
Store losartan at room temperature (77°F/25°C) with excursions permitted to 59-86°F (15-30°C). Protect from light and moisture. Keep in original container. Keep out of reach of children and pets.
Cost Considerations
Losartan is available as a generic medication, making it more affordable than some newer ARBs. It is covered by most insurance plans and available on many $4 generic lists.
Disclaimer: This information is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always consult your physician or other qualified healthcare provider with any questions about a medical condition or medication.