Losartan Tablets

Losartan belongs to a group of medicines called angiotensin II receptor antagonists. Angiotensin II is a substance produced in the body that binds to receptors present in blood vessels, causing them to narrow. This causes an increase in blood pressure. Losartan prevents the binding of angiotensin II to these receptors, causing the blood vessels to relax, which in turn lowers blood pressure. Losartan reduces worsening kidney function in patients with high blood pressure and type 2 diabetes.

Losartan is a synthetic oral angiotensin II receptor antagonist (type AT1). Angiotensin II, a potent vasoconstrictor, is the main active hormone in the renin-angiotensin system and an important determinant of the pathophysiology of hypertension. Angiotensin II binds to the AT1 receptor found in many tissues (eg smooth vascular muscle, adrenal gland, kidneys, and heart) and produces several important biological actions, including vasoconstriction and aldosterone release. Angiotensin II also stimulates the proliferation of smooth muscle cells.

Losartan selectively blocks the AT1 receptor. In vitro and in vivo, both losartan and its pharmacologically active metabolite, carboxylic acid E-3174, block all important physiological actions of angiotensin II, regardless of its origin or route of synthesis

losartan potassium uses include being utilised:

• to treat patients with high blood pressure (hypertension).
• to protect the kidney in hypertensive patients with type 2 diabetes and results of laboratory tests indicating kidney failure and proteinuria = 0.5 g per day (situation in which the urine contains an abnormal amount of protein).
• To treat patients with chronic heart failure, when your doctor considers that treatment with specific medicines, called angiotensin-converting enzyme inhibitors (ACE inhibitors, medicines used to lower high blood pressure) is not appropriate. If your heart failure has been stabilized with an ACE inhibitor, you should not switch to losartan.

In patients with high blood pressure and increased thickness of the left ventricle of the heart, losartan has been shown to decrease the risk of stroke.

Follow exactly the instructions for the administration of losartan tablets given by your doctor. Your doctor will decide on the appropriate dose of losartan tablets, depending on your condition and whether you are taking other medications. It is important to continue taking losartan tablets for as long as your doctor prescribes it to maintain constant control of your blood pressure.

Patients with high blood pressure

Treatment usually begins with losartan 50 mg (one losartan tablet 50 mg) once daily. The maximum effect of reducing blood pressure is reached 3-6 weeks after starting treatment. Thereafter, in some patients, the dose may be increased to 100 mg losartan (two losartan tablets 50 mg) once daily.

If you feel that the action of losartan tablets is too strong or weak, please inform your doctor or pharmacist.

Patients with high blood pressure and type 2 diabetes

Treatment usually begins with losartan 50 mg (one losartan tablet 50 mg) once daily. The dose can then be increased to losartan 100 mg (two losartan tablets 50 mg) once daily depending on your blood pressure response.

Losartan tablets can be taken together with other blood pressure-lowering medicines (for example diuretics, calcium channel blockers, alpha or beta-blockers, and centrally acting medicines), as well as insulin and other medicines frequently used to lower the glucose level in the blood (for example sulfonylureas, glitazones and glucosidase inhibitors).

Heart failure patients

Treatment usually begins with 12.5 mg losartan once daily (one losartan tablet 12.5 mg starting). Typically, the dose is increased gradually, weekly (i.e. 12.5 mg daily for the first week, 25 mg daily for the second week, and 50 mg daily for the third week), up to a dose of maintenance of losartan 50 mg (one losartan tablet 50 mg) once daily, depending on your condition.

In the treatment of heart failure, losartan is normally combined with a diuretic (medicine that increases the amount of water that passes through your kidneys) and/or digitalis (medicine that helps your heart to be stronger and more efficient) and/or a beta-blocker.

Dosage in special patient groups

The doctor may recommend a lower dose, especially when starting treatment in certain patients, such as those treated with high-dose diuretics, in patients with liver failure or in patients older than 75 years. The use of losartan is not recommended in patients with severe hepatic impairment.

Administration

The tablets should be taken with a glass of water. You should try to take your daily dose at around the same time each day. It is important that you continue to take losartan tablets until your doctor tells you otherwise.

Like all medicines, losartan potassium tablets can cause side effects, although not everybody gets them. If you experience the following, stop taking losartan tablets and tell your doctor immediately or go to the emergency department of your nearest hospital:

• A serious allergic reaction (skin rash, itching, swelling of the face, lips, mouth, or throat that can cause difficulty swallowing or breathing).

This is a serious but rare side effect, affecting more than 1 patient in 10,000, but less than 1 patient in 1,000. You may need urgent medical attention or hospitalization.

The following side effects have been reported with losartan:

Frequent:

• dizziness
• low blood pressure
• weakness
• Fatigue
• low blood sugar (hypoglycemia)
• too much potassium in the blood (hyperkalemia).

Uncommon:

• Drowsiness
• headache
• sleep disorders
• feeling very fast heartbeat (palpitations)
• severe chest pain (angina)
• low blood pressure (especially after excessive loss of water from the body within the blood vessels, for example in patients with severe heart failure or on treatment with high doses of diuretics)
• dose-related orthostatic effects, such as decreased blood pressure after rising after lying or sitting
• difficulty breathing (dyspnea)
• abdominal pain
• chronic constipation
• diarrhea
• sickness
• vomiting
• hives (hives)
• itching (pruritus)
• acne
• localized swelling (edema).

Rare:

• inflammation of the blood vessels (vasculitis, Schonlein Henoch purpura)
• numbness or tingling sensation (paresthesia)
• fainting (syncope)
• very fast and irregular heartbeat (atrial fibrillation), stroke (stroke)
• inflammation of the liver (hepatitis)
• elevation of blood levels of alanine aminotransferase (ALT), which usually resolves when treatment is stopped.

Frequency not known:

• reduced number of red blood cells (anemia)
• reduced number of platelets
• migraine
• cough
• liver function abnormalities
• muscle and joint pain
• changes in kidney function (may be reversible by stopping treatment), including kidney failure
• flu-like symptoms
• increase in blood urea, creatinine and plasma potassium in patients with heart failure
• back pain and urinary tract infection.

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