Names and pronunciation
(lo-zar′tan) Cozaar
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Individual generic drug information
Extracted information for losartan only.
(lo-zar′tan) Cozaar
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Func. class.: Antihypertensive
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Chem. class.: Angiotensin II receptor (type AT1) antagonist
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Do not confuse: losartan/valsartan Cozaar/Zocor
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ACTION: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
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USES: Hypertension, alone or in combi- nation; nephropathy in type 2 diabetes; pro- teinuria; stroke prophylaxis for hypertensive patients with left ventricular hypertrophy
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Unlabeled uses: Heart failure
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Extracted information for losartan only.
CONTRAINDICATIONS: Hyper- sensitivity
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Black Box Warning: Pregnancy Precautions: breastfeeding, children, geriatric patients, hypersensitivity to ACE inhibitors, hepatic disease, angioedema, renal artery stenosis, African descent, hyperkalemia, hypotension Black Box Warning: Pregnancy/breast- feeding: assess for pregnancy before starting treatment; do not use in preg- nancy; do not breastfeed Black Box Warning: Pregnancy/breast- feeding: to use contraception while tak- ing this product; not to breastfeed • To avoid salt substitutes, alcohol, OTC products unless approved by prescriber
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SIDE EFFECTS CNS: Dizziness, insomnia, anxiety, con- fusion, abnormal dreams, migraine, tremor, vertigo, headache, malaise, depression, fatigue CV: Angina pectoris, 2nd-degree AV block, cerebrovascular accident, hypo- tension, MI, dysrhythmias EENT: Blurred vision, burning eyes, conjunctivitis GI: Diarrhea, dyspepsia, anorexia, con- stipation, dry mouth, flatulence, gastritis, vomiting GU: Impotence, nocturia, urinary fre- quency, UTI, renal failure HEMA: Anemia, thrombocytopenia INTEG: Alopecia, dermatitis, dry skin, flushing, photosensitivity, rash, pruritus, sweating, angioedema META: Gout, hyperkalemia, hypo glycemia MS: Cramps, myalgia, pain, stiffness RESP: Cough, upper respiratory infection, congestion, dyspnea, bronchitis MISC: Diabetic vascular disease
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INTERACTIONS Increase: lithium toxicity—lithium; monitor lithium level Increase: antihypertensive effect—garlic Increase: hyperkalemia—potassium- sparing diuretics, potassium supple- ments, ACE inhibitors Decrease: antihypertensive effect— NSAIDs Drug/Herb Decrease: antihypertensive effects—ma huang, black licorice Drug/Lab Test Increase: AST, ALT
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Extracted information for losartan only.
DOSAGE AND ROUTES Hypertension • Adult: PO 50 mg/day alone or 25 mg/ day in combination with diuretic; mainte- nance 25-100 mg/day • Child ≥6 yr: PO 0.7 mg/kg/day, max 50 mg/day Hypertension with left ventricular hypertrophy to reduce stroke • Adult: PO 50 mg/day; add hydrochlo- rothiazide 12.5 mg/day and/or in- crease losartan to 100 mg/day, then increase hydrochlorothiazide to 25 mg/day Nephropathy in type 2 diabetic patients/proteinuria • Adult: PO 50 mg/day, may increase to 100 mg/day Heart failure (unlabeled) • Adult: PO 25-50 mg/day initially, then titrate to max 50-150 mg/day mainte- nance Hepatic dose/volume depletion • Adult: PO 25 mg/day as starting dose • Child: PO Don’t use in eGFR <30 mL/ min/1.73 m2
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Available forms: Tabs 25, 50, 100 mg
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Administer: • Without regard to meals • If product is compounded into suspen- sion, store in refrigerator and shake well before use • May use alone or in combination
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Extracted information for losartan only.
Assess: • B/P with position changes, pulse be- fore and periodically during treatment; note rate, rhythm, quality; black patients should use combination therapy for better control of B/P • Baselines of renal, hepatic, electrolyte studies before therapy begins and peri- odically thereafter • Skin turgor, dryness of mucous mem- branes for hydration status • Angioedema: facial swelling, dyspnea, wheezing; may occur rapidly; tongue swelling (rare) • HF: jugular venous distention; edema in feet/legs, weight daily • Blood dyscrasias: thrombocytopenia, anemia (rare) L
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Evaluate: • Therapeutic response: decreased B/P, slowing diabetic neuropathy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid sunlight or to wear sunscreen if in sunlight; that photosensitivity may occur • To comply with dosage schedule, even if feeling better; not to discontinue abruptly; not to share with others • To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain • That excessive perspiration, dehydra- tion, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur • That product may cause dizziness, fainting, light-headedness; to avoid haz- ardous activities until reaction is known • To rise slowly to sitting or standing position to minimize orthostatic hypoten- sion
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Extracted information for losartan only.
PHARMACOKINETICS Peak 1 hr, extensively metabolized, half-life 2 hr, metabolite 6-9 hr, excreted in urine/feces, protein bind- ing 98.7%
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Filter the extracted dose blocks for this individual drug.
Hypertension
• Child ≥6 yr: PO 0.7 mg/kg/day, max 50 mg/day Hypertension with left ventricular hypertrophy to reduce stroke
Candidate age grouping · source page 816
Hypertension
• Child: PO Don’t use in eGFR <30 mL/ min/1.73 m2
Candidate age grouping · source page 816