There has been 1 large trial to show the outcome benefit of losartan in type 2 diabetes patients. In this trial, 1, individuals with a mean creatinine of 1. During a follow-up of 3. This protection was larger than what would be expected with blood pressure reduction alone and that these benefits exceeded those attributable to measured reductions in blood pressure. Unfortunately, there is insufficient evidence to show that combination treatment slows the progression of renal disease.
Initially, the combination treatment of angiotensin-II receptor blocker and ACE inhibitor in nondiabetic renal disease COOPERATE study was thought to show this benefit; however, due to significant questions regarding this study, it was later retracted. The first effective, oral, direct renin inhibitor, aliskiren, has been evaluated in combination with the first ARB.
The outcome benefit on slowing the progression of renal disease has not yet been shown. Blockade of the RAS system has been shown to improve survival and hospitalizations in heart failure patients being treated with ACE inhibitors.
These benefits of treating with losartan have also been evaluated. The primary end point was a worsening renal function. There were no significant changes in renal function. It is important to note that the event rate was lower than anticipated, and therefore, the study may not have been powered to show a significant difference.
Patients were treated with either losartan 50 mg a day or captopril 50 mg 3 times a day. There were no statistical differences between the 2 treatment arms regarding the primary end points, including sudden death and the composite of mortality and hospitalizations. Losartan was better tolerated than captopril with fewer patients discontinuing prematurely owing to adverse events not counting death. These 2 studies were conducted with losartan 50 mg a day. Higher doses of losartan are associated with further decrease in blood pressure, and with increases up to l50 mg of losartan, there is increasing renin levels and circulating AII.
The primary end point was death or admission for heart failure. With an intention to treat analysis, there was no difference in deaths, but there was a significant decrease in hospitalizations for heart failure with fewer hospitalizations with the higher dose.
Renal impairment, hypotension, and hyperkalemia were also higher in the higher dose group, but there was not an increase in discontinuation rate in this group. The Losartan Intervention for Endpoint Reduction LIFE trial was a double-blind study of 9, hypertensive patients between the ages of 55 and 80, who were at high risk. Participants were randomly assigned to either losartan or atenolol. Both medications were started at 50 mg and titrated to mg as needed.
The primary end points were occurrence of cardiovascular death, myocardial infarction, or stroke, and the composite end point was any of these events. Losartan was associated with a significantly decreased incidence of the primary composite end point. This was primarily due to a decrease in fatal and nonfatal stroke. Blood pressure control was similar in the 2 groups.
This stroke benefit was not seen in African Americans. Substudies of this outcome trial have provided a number of additional benefits of losartan therapy in this population. Findings show a benefit of losartan over atenolol in surrogate markers, as well as in clinical outcomes.
For example, losartan-treated individuals had significant LVH regression 48 , 49 and decrease in left atrial size 50 , 51 and decreased BNP.
Clinically significant findings were decreased incidence of atrial fibrillation 58 and new onset diabetes. Several studies have looked at the economic impact of treating patients with type 2 diabetes with losartan using the RENAAL trial for analysis. A cost benefit was seen after 2—2. Over the past 15 years, there has been a wide variety of studies conducted with losartan.
It has shown benefit in controlling hypertension, decreasing proteinuria, slowing the progression of type 2 diabetic nephropathy, and decreasing the risk of stroke in certain populations. In addition, favorable surrogate markers such as decreased platelet aggregation, decreased uric acid, decreased proteinuria, and regression of LVH have also been documented.
For a first in class medication, which is touted as being a weaker angiotensin receptor blocker, it has shown remarkable outcomes. Although, pharmacokinetic differences, particularly the shorter half-life, should be kept in mind, this drug should remain an active part of our armamentarium. National Center for Biotechnology Information , U. Int J Nephrol Renovasc Dis.
Published online Jun Elizabeth Ripley and Ari Hirsch. Author information Article notes Copyright and License information Disclaimer. Received Jun This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Keywords: losartan, chronic kidney disease.
Pharmacokinetics and FDA approval Losartan is a nonpeptide molecule, which is a competitive antagonist with selective binding to AT1 receptors. Effects of losartan on the kidney AT1 plays a significant role in the hemodynamic, electrolyte, and fluid balance regulation of the kidneys. Table 1 Renal effects of blocking AT1 receptors. In children weighing more than 50 kg, the starting dose is 50 mg taken once daily.
This dose may be increased to mg once daily. Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications.
If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor. It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule.
Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. Do not dispose of medications in wastewater e. Ask your pharmacist how to dispose of medications that are no longer needed or have expired. Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Many of these side effects can be managed, and some may go away on their own over time. Contact your doctor if you experience these side effects and they are severe or bothersome.
Your pharmacist may be able to advise you on managing side effects. Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention. Stop taking the medication and seek immediate medical attention if any of the following occur:. Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. Check with your doctor right away if you become sick while taking this medicine, especially if you have severe or continuing nausea, vomiting, or diarrhea that does not stop. These conditions may cause you to lose too much water and may lead to low blood pressure.
You can also lose water by sweating, so drink plenty of water during exercise or in hot weather. Ask your doctor before you use medicines, supplements, or salt substitutes that contain potassium.
Avoid alcoholic beverages until you have discussed their use with your doctor. Alcohol may make the low blood pressure effect worse or increase the possibility of dizziness or fainting. Do not take other medicines unless they have been discussed with your doctor.
This especially includes prescription or nonprescription over-the-counter [OTC] medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.
Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:.
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below.
Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only.
Drugs and Supplements Losartan Oral Route. Bananas are rich in potassium. Also, drinking coffee can increase your blood pressure. And losartan is used to lower blood pressure. So if you drink coffee while taking losartan, the drug may not work as well for you. If you have questions about taking losartan with certain foods or drinks, talk with your doctor or pharmacist. Losartan belongs to a group of drugs called angiotensin II receptor blockers.
It works by blocking a hormone in your body called angiotensin. The way a drug works is called its mechanism of action. By blocking angiotensin, losartan relaxes your blood vessels and increases blood flow to your kidneys. This lowers your blood pressure and helps your kidneys work correctly. The half-life of losartan is about 2 hours. In other words, it takes about 2 hours for half of a losartan dose to leave your body.
Losartan, telmisartan Micardis , and irbesartan Avapro belong to a group of drugs called angiotensin receptor blockers ARBs. Lisinopril Zestril belongs to a different group of drugs called angiotensin converting enzyme ACE inhibitors. The drugs block this hormone in different ways. To learn more about how losartan compares with telmisartan, irbesartan, and lisinopril, talk with your doctor or pharmacist. They can recommend which drug is right for you. Yes, losartan can cause a cough.
Losartan belongs to a group of drugs called angiotensin receptor blockers ARBs. A different group of drugs called angiotensin converting enzyme ACE inhibitors commonly cause cough. In fact, an ARB, such as losartan, is sometimes prescribed as an alternative for people who have a cough with an ACE inhibitor. Tell them about:.
Be sure to tell your doctor if you have kidney or liver problems. Taking medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions.
Before taking losartan oral tablets, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with losartan oral tablets. This list does not contain all types of drugs that may interact with losartan oral tablets.
Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of losartan. Losartan oral tablets may not be right for you if you have certain medical conditions or other factors that affect your health.
Talk with your doctor about your health history before you take losartan oral tablets. Factors to consider include those in the list below.
But alcohol causes some of the same side effects as losartan does. This is a serious warning from the FDA. In fact, the drug has a boxed warning about harm if used during pregnancy. A boxed warning is a serious warning from the FDA. Losartan can cause pregnancy loss. The drug can also cause harm to an unborn fetus. Examples of problems that have happened in infants born to people who took losartan during pregnancy include:.
0コメント