Losartan

CLINICAL USE

Angiotensin-II receptor antagonist:Hypertension Type 2 diabetic nephropathy

DOSE IN NORMAL RENAL FUNCTION

25–100 mg daily

PHARMACOKINETICS

Molecular weight :461

%Protein binding :>98

%Excreted unchanged in urine : 4

Volume of distribution (L/kg) :0.4

half-life – normal/ESRD (hrs) :1.5–2.5 (active metabolite 3–9)/4–6

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Initial dose 25 mg and titrate according to response

<10 : Initial dose 25 mg and titrate according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs

Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity

Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics

Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect

Lithium: reduced excretion (possibility of enhanced lithium toxicity)

Potassium salts: increased risk of hyperkalaemia

Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Adverse reactions, especially hyperkalaemia are more common in patients with renal impairmentRenal failure has been reported in association with angiotensin-II antagonists in patients with renal artery stenosis, post renal transplant, and in those with congestive heart failureClose monitoring of renal function during therapy is necessary in those with renal insufficiencyLosartan potassium.

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