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Losartan
Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure
💊 About: Always check the BNF link here
- 🔹 Angiotensin II receptor blocker (ARB) – primarily AT1 antagonist.
⚙️ Action
- There are two angiotensin II receptors: AT1 and AT2.
- 🩸 AT1 receptor → vasoconstriction + aldosterone release.
- 🚫 Losartan blocks AT1 receptor → vasodilation + reduced aldosterone.
- 📉 Results in lower blood pressure and reduced afterload.
- ℹ️ Losartan is a prodrug, converted to active metabolite by the liver.
🎯 Indications / Dose
- ❤️ Hypertension.
- 💔 Heart failure with reduced ejection fraction.
- 🧪 Prevention and treatment of diabetic nephropathy (especially with proteinuria).
- ➡️ Typical initiation: Losartan 25–50 mg PO OD.
- ➡️ Maintenance range: titrate up slowly to max 100 mg PO OD (adjusted for renal function and BP).
⛔ Contraindications
- 🚫 Pregnancy – teratogenic, risk of birth defects.
- ⚠️ Severe aortic stenosis or hypertrophic cardiomyopathy (risk of collapse).
- ⚠️ Bilateral renal artery stenosis or severe renal impairment (risk of renal failure).
🔄 Interactions
- May be used instead of or with ACE inhibitors (avoid dual blockade unless specialist indication).
- ⬆️ Risk of hyperkalaemia with potassium-sparing diuretics, supplements, or ARBs/ACEI combinations.
⚠️ Side Effects
- 🧪 Hyperkalaemia (monitor K⁺, particularly in CKD).
- 💨 Unlike ACE inhibitors, not typically associated with cough.
- Rare: dizziness, hypotension, renal impairment.
📋 Monitoring
- 🔍 Check renal function and electrolytes 4 days and 2 weeks after initiation.
- 📈 Recheck 1 week after any dose increase.
- ⚠️ Stop or reduce if creatinine ↑ >30% or K⁺ >6.0 mmol/L.
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