Comment
Author: Admin | 2025-04-28
Safety, or efficacy of losartan monotherapy relative to younger adults, but increased sensitivity cannot be ruled out.Hepatic ImpairmentSystemic exposure to losartan and its active metabolite may be increased. Initial dosage adjustment recommended in mild to moderate hepatic impairment; losartan not studied in severe hepatic impairment.Renal ImpairmentPlasma concentrations and AUCs of losartan and its active metabolite increased and renal clearance reduced in patients with mild (Clcr 50–74 mL/minute) or moderate (Clcr 30–49 mL/minute) renal insufficiency. Not removed by hemodialysis. No dosage adjustments recommended in patients with renal impairment unless they are also volume depleted.Black PatientsBP reduction may be smaller in Black patients. No evidence that the benefits of losartan in reducing the risk of cardiovascular events in hypertensive patients with left ventricular hypertrophy apply to Black patients.Common Adverse EffectsAdverse effects (incidence ≥2%) include dizziness, upper respiratory infection, nasal congestion, back pain.Drug InteractionsIn vitro studies indicate CYP2C9 and 3A4 are involved in biotransformation of losartan to active and inactive metabolites.Drugs Affecting Hepatic Microsomal EnzymesPharmacodynamic consequences of concomitant use of losartan and CYP2C9 inhibitors have not been studied.Drugs Increasing Serum PotassiumHyperkalemia may occur with concomitant administration of losartan and other drugs that raise serum potassium levels. Monitor serum potassium levels if used concomitantly.Specific DrugsDrugInteractionCommentACE inhibitorsIncreased risk of renal impairment, hyperkalemia, and hypotensionGenerally avoid concomitant useMonitor BP, renal function, and electrolytes if used concomitantlyAliskirenIncreased risk of renal impairment, hyperkalemia, and hypotensionGenerally avoid concomitant useMonitor BP, renal function, and electrolytes if used concomitantlyConcomitant use contraindicated in patients with diabetes mellitusAvoid concomitant use in patients with GFR Angiotensin II receptor antagonistsIncreased risk of renal impairment, hyperkalemia, and hypotensionGenerally avoid concomitant useMonitor BP, renal function, and electrolytes if used concomitantlyCimetidinePharmacokinetic interaction unlikelyDigoxinPharmacokinetic interaction unlikelyErythromycinLosartan AUC increased by 30%; no impact on conversion of losartan to active metaboliteFluconazoleDecreased AUC of active metabolite of losartan by approximately 40% and
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