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Losartan – Uses, Dosage & Side Effects

Losartan is a blood pressure-lowering medication belonging to the class of AT1 receptor blockers. It is used to treat high blood pressure, heart failure, and to protect the kidneys in patients with diabetes.

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Things worth knowing about "Losartan"

Losartan is a blood pressure-lowering medication belonging to the class of AT1 receptor blockers. It is used to treat high blood pressure, heart failure, and to protect the kidneys in patients with diabetes.

What is Losartan?

Losartan is a prescription medication belonging to the class of angiotensin II receptor blockers (ARBs), also known as sartans. It is primarily used to treat high blood pressure (arterial hypertension). It is also indicated for heart failure and for protecting kidney function in patients with type 2 diabetes and high blood pressure. Losartan is widely available in various dosage strengths, most commonly as the potassium salt (losartan potassium).

Mechanism of Action

Angiotensin II is a hormone produced naturally in the body that causes blood vessels to narrow, thereby raising blood pressure. Losartan selectively blocks AT1 receptors, which are the binding sites for angiotensin II. By blocking these receptors, losartan prevents blood vessel constriction, reduces vascular resistance, and helps normalize blood pressure. Additionally, it inhibits the release of aldosterone, which reduces sodium and water retention in the kidneys, contributing further to its blood pressure-lowering effect.

Indications

Arterial Hypertension: Reduction of elevated blood pressure in adults and children aged 6 years and older.
Diabetic Nephropathy: Kidney protection in patients with type 2 diabetes, hypertension, and elevated serum creatinine.
Heart Failure: Treatment of patients who cannot tolerate ACE inhibitors.
Stroke Prevention: Reduction of stroke risk in hypertensive patients with left ventricular hypertrophy.

Dosage

The standard starting dose for hypertension is 50 mg once daily. The dose may be increased to a maximum of 100 mg per day if needed. In elderly patients, those with liver impairment, or those taking diuretics, a lower starting dose of 25 mg is often recommended. Losartan is taken orally as a tablet and can be administered with or without food. The appropriate dosage should always be determined by a healthcare professional.

Side Effects

Losartan is generally well tolerated. Possible side effects include:

Common: Dizziness, fatigue, hyperkalemia (elevated blood potassium), hypotension (low blood pressure)
Occasional: Headache, sleep disturbances, cough (significantly less frequent than with ACE inhibitors), nausea, abdominal pain
Rare: Angioedema (swelling beneath the skin, particularly of the face), kidney function impairment, elevated liver enzymes

Compared to ACE inhibitors, losartan causes a much lower incidence of dry cough, as it does not affect the breakdown of bradykinin.

Contraindications and Interactions

Losartan must not be used in the following cases:

Hypersensitivity to the active substance
Pregnancy (especially from the second trimester onwards), as it may harm the unborn child
Severe hepatic impairment
Concomitant use of aliskiren in patients with diabetes or renal impairment

Important drug interactions exist with potassium-sparing diuretics, NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, lithium, and other antihypertensive agents. Regular monitoring of blood pressure, kidney function, and potassium levels is recommended during therapy.

References

European Medicines Agency (EMA) – Losartan Summary of Product Characteristics, available at: www.ema.europa.eu
Williams B. et al. – 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021-3104.
Goodman & Gilman's The Pharmacological Basis of Therapeutics, 13th Edition, McGraw-Hill (2018)

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