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Losartan Disease Interactions

There are 8 disease interactions with losartan.

Major

AR antagonist (applies to losartan) diabetes

Major Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

The coadministration of some angiotensin II receptor blocker agents with aliskiren is contraindicated in patients with diabetes.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  3. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  4. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  5. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  6. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  7. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 7 references
Major

AR antagonists (applies to losartan) angioedema

Major Potential Hazard, Moderate plausibility.

The use of these agents is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) therapy or in patients with hereditary angioedema. Patients with a history of angioedema unrelated to these agents may be at increased risk of angioedema while receiving angiotensin II receptor (AR) antagonists. Patients should be advised to immediately report any signs or symptoms suggestive of angioedema (swelling of face, extremities, eyes, lips, or tongue, or difficulty swallowing or breathing) and to stop taking the medication until otherwise directed by their physician. Emergency therapy and/or measures to prevent airway obstruction are required for angioedema involving the tongue, glottis, or larynx. Treatment with angiotensin II receptor (AR) antagonists should be discontinued permanently if angioedema develops in association with therapy.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  3. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  4. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  5. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  6. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  7. (2002) "Product Information. Benicar (olmesartan)." Sankyo Pharma
  8. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 8 references
Major

AR antagonists (applies to losartan) hypotension

Major Potential Hazard, High plausibility. Applicable conditions: Dehydration, Hyponatremia, hemodialysis

Angiotensin II receptor (AR) antagonists can cause symptomatic hypotension in patients with an activated renin-angiotensin system, such as volume- and/or sodium-depleted patients. Therapy with AR antagonists should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if recently instituted; those on dietary salt restriction; renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased.

References

  1. Goldberg MR, Bradstreet TE, McWilliams EJ, Tanaka WK, Lipert S, Bjornsson TD, Waldman SA, Osborne B, Pivadori L, Lewis G, et al. (1995) "Biochemical effects of losartan, a nonpeptide angiotensin II receptor antagonist, on the renin-angiotensin-aldosterone system in hypertensive patients." Hypertension, 25, p. 37-46
  2. Doig JK, MacFadyen RJ, Sweet CS, Lees KR, Reid JL (1993) "Dose-ranging study of the angiotensin type I receptor antagonist losartan (DuP753/MK954), in salt-deplete normal man." J Cardiovasc Pharmacol, 21, p. 732-8
  3. Goldberg AI, Dunlay MC, Sweet CS (1995) "Safety and tolerability of losartan potassium, and angiotensin II receptor antagonist, compared with hydrochlorothiazide, atenolol, felodipine ER, and angiotensin-converting enzyme inhibitors for the treatment of systemic hypertension." Am J Cardiol, 75, p. 793-5
  4. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  5. Weber MA, Bryyny RL, Pratt JH, et al. (1995) "Blood pressure effects of the angiotensin II receptor blocker, losartan." Arch Intern Med, 155, p. 405-11
  6. Mcintyre M, Macfadyen RJ, Meredith PA, Menard J, Brunner HR, Insuasty J, Reid JL (1995) "Comparison of the oral angiotensin II receptor antagonist UP 269-6 or enalapril 20 mg on blood pressure and neurohormonal effects in salt-deplete man." J Cardiovasc Pharmacol, 25, p. 994-1000
  7. Goldberg AI, Dunlay MC, Sweet CS (1995) "Safety and tolerability of losartan compared with atenolol, felodipine and angiotensin converting enzyme inhibitors." J Hypertens, 13 Suppl, s77-80
  8. Tikkanen I, Omvik P, Jensen HA (1995) "Comparison of the angiotensin II antagonist losartan with the angiotensin converting enzyme inhibitor enalapril in patients with essential hypertension." J Hypertens, 13, p. 1343-51
  9. Schaefer KL, Porter JA (1996) "Angiotensin II receptor antagonists: the prototype losartan." Ann Pharmacother, 30, p. 625-36
  10. Weir MR, Elkins M, Liss C, Vrecenak AJ, Barr E, Edelman JM (1996) "Efficacy, tolerability, and quality of life of losartan, alone or with hydrochlorothiazide, versus nifedipine GITS in patients with essential hypertension." Clin Ther, 18, p. 411-28
  11. Waeber B, Brunner HR (1996) "Angiotensin II antagonists: a new class of antihypertensive agent." Br J Clin Pract, 50, p. 265-8
  12. Gibbs CR, Ferner RE, Beevers DG (1996) "Angiotensin receptor antagonists - a new class of antihypertensive drug." J Clin Pharm Ther, 21, p. 127-30
  13. Ellis ML, Patterson H (1996) "A new class of antihypertensive therapy: angiotensin II receptor antagonists." Pharmacotherapy, 16, p. 849-60
  14. Holwerda NJ, Fogari R, Angeli P, et al. (1996) "Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: efficacy and safety compared with placebo and enalapril." J Hypertens, 14, p. 1147-115
  15. Oparil S, Barr E, Elkins M, Liss C, Vrecenak A, Edelman J (1996) "Efficacy, tolerability, and effects on quality of life of losartan, alone or with hydrochlorothiazide, versus amlodipine, alone or with hydrochlorothiazide, in patients with essential hypertension." Clin Ther, 18, p. 608-25
  16. Waeber B, Burnier M, Nussberger J, Brunner HR (1996) "Experience with angiotensin II antagonists in hypertensive patients." Clin Exp Pharmacol Physiol, 23 ( Suppl, s142-6
  17. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  18. van den Meiracker AH, Admiraal PJ, Janssen JA, Kroodsma JM, de Ronde WA, Boomsma F, Sissmann J, Blankestijn PJ, Mulder PG, Man In 't Veld AJ (1995) "Hemodynamic and biochemical effects of the AT1 receptor antagonist irbesartan in hypertension." Hypertension, 25, p. 22-9
  19. McIntyre M, MacFadyen RJ, Meredith PA, Brouard R, Reid JL (1996) "Dose-ranging study of the angiotensin II receptor antagonist irbesartan (SR 47436/BMS-186295) on blood pressure and neurohormona effects in salt-deplete men." J Cardiovasc Pharmacol, 28, p. 101-6
  20. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  21. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  22. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  23. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  24. Karlberg BE, Lins LE, Hermansson K (1999) "Efficacy and safety of telmisartan, a selective AT(1) receptor antagonist, compared with enalapril in elderly patients with primary hypertension." J Hypertens, 17, p. 293-302
  25. McClellan KJ, Markham A (1998) "Telmisartan." Drugs, 56, p. 1039-44
  26. (2002) "Product Information. Benicar (olmesartan)." Sankyo Pharma
  27. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 27 references
Moderate

AR antagonists (applies to losartan) CHF

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure

Angiotensin II receptor (AR) antagonists can cause renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic hypotension can occur in susceptible individuals, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with AR antagonists has been associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia, and death. Therapy with AR antagonists should be initiated cautiously in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. In patients who experience a decline in renal function, discontinuation of AR antagonist therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with AR antagonists, since therapy can usually be reinstated without difficulty after blood pressure stabilizes.

References

  1. Weber MA, Byyny RL, Pratt JH, Faison EP, Snavely DB, Goldberg AI, Nelson EB (1995) "Blood pressure effects of the angiotensin II receptor blocker, losartan." Arch Intern Med, 155, p. 405-11
  2. Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L, et al. (1995) "Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group." Circulation, 91, p. 691-7
  3. Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M (1993) "Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure." Circulation, 88, p. 1602-9
  4. Goldberg MR, Bradstreet TE, McWilliams EJ, Tanaka WK, Lipert S, Bjornsson TD, Waldman SA, Osborne B, Pivadori L, Lewis G, et al. (1995) "Biochemical effects of losartan, a nonpeptide angiotensin II receptor antagonist, on the renin-angiotensin-aldosterone system in hypertensive patients." Hypertension, 25, p. 37-46
  5. Goldberg MR, Tanaka W, Barchowsky A, Bradstreet TE, McCrea J, Lo MW, McWilliams EJ Jr, Bjornsson TD (1993) "Effects of losartan on blood pressure, plasma renin activity, and angiotensin II in volunteers." Hypertension, 21, p. 704-13
  6. Doig JK, MacFadyen RJ, Sweet CS, Lees KR, Reid JL (1993) "Dose-ranging study of the angiotensin type I receptor antagonist losartan (DuP753/MK954), in salt-deplete normal man." J Cardiovasc Pharmacol, 21, p. 732-8
  7. Dickstein K, Gottlieb S, Fleck E, Kostis J, Levine B, DeKock M, LeJemtel T (1994) "Hemodynamic and neurohumoral effects of the angiotensin II antagonist losartan in patients with heart failure." J Hypertens Suppl, 12, s31-5
  8. Abdelrahman AM, Burrell LM, Johnston CI (1993) "Blockade of the renin-angiotensin system at different sites: effect on renin, angiotensin and aldosterone." J Hypertens, 11 Suppl 3, s23-6
  9. Rush JE, Rajfer SI (1993) "Theoretical basis for the use of angiotensin II antagonists in the treatment of heart failure." J Hypertens, 11 Suppl 3, s69-71
  10. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  11. Crozier I, Ikram H (1995) "The acute and chronic effects of losartan in heart failure." J Hypertens, 13 Suppl, s59-61
  12. Saine DR, Ahrens ER (1996) "Renal impairment associated with losartan." Ann Intern Med, 124, p. 775
  13. Schaefer KL, Porter JA (1996) "Angiotensin II receptor antagonists: the prototype losartan." Ann Pharmacother, 30, p. 625-36
  14. Waeber B, Brunner HR (1996) "Angiotensin II antagonists: a new class of antihypertensive agent." Br J Clin Pract, 50, p. 265-8
  15. Gibbs CR, Ferner RE, Beevers DG (1996) "Angiotensin receptor antagonists - a new class of antihypertensive drug." J Clin Pharm Ther, 21, p. 127-30
  16. Ellis ML, Patterson H (1996) "A new class of antihypertensive therapy: angiotensin II receptor antagonists." Pharmacotherapy, 16, p. 849-60
  17. Holwerda NJ, Fogari R, Angeli P, et al. (1996) "Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: efficacy and safety compared with placebo and enalapril." J Hypertens, 14, p. 1147-115
  18. Waeber B, Burnier M, Nussberger J, Brunner HR (1996) "Experience with angiotensin II antagonists in hypertensive patients." Clin Exp Pharmacol Physiol, 23 ( Suppl, s142-6
  19. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  20. Pitt B, Segal R, Martinez FA, et al. (1997) "Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE)." Lancet, 349, p. 747-52
  21. van den Meiracker AH, Admiraal PJ, Janssen JA, Kroodsma JM, de Ronde WA, Boomsma F, Sissmann J, Blankestijn PJ, Mulder PG, Man In 't Veld AJ (1995) "Hemodynamic and biochemical effects of the AT1 receptor antagonist irbesartan in hypertension." Hypertension, 25, p. 22-9
  22. McIntyre M, MacFadyen RJ, Meredith PA, Brouard R, Reid JL (1996) "Dose-ranging study of the angiotensin II receptor antagonist irbesartan (SR 47436/BMS-186295) on blood pressure and neurohormona effects in salt-deplete men." J Cardiovasc Pharmacol, 28, p. 101-6
  23. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  24. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  25. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  26. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  27. (2002) "Product Information. Benicar (olmesartan)." Sankyo Pharma
  28. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 28 references
Moderate

AR antagonists (applies to losartan) hyperkalemia

Moderate Potential Hazard, Moderate plausibility.

Drugs that inhibit the renin-angiotensin, such as angiotensin II receptor antagonist system can cause hyperkalemia. Concomitant use of these agents with drugs that increase potassium levels may increase the risk of hyperkalemia. Use caution when using these agents together and monitor serum potassium periodically.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  3. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  4. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  5. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  6. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  7. (2002) "Product Information. Benicar (olmesartan)." Sankyo Pharma
  8. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 8 references
Moderate

AR antagonists (applies to losartan) renal artery stenosis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Artery Atherosclerosis

In patients with bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, angiotensin II receptor (AR) antagonists may reduce renal perfusion to a critically low level. Increases in serum creatinine or blood urea nitrogen have been reported with ACE inhibitors, a class of drugs that also block the renin-angiotensin-aldosterone system. Although there are no long-term data on the use of AR antagonists in patients with renal artery stenosis, a similar effect should be anticipated. Renal function should be monitored closely for the first few weeks of therapy.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  3. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  4. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  5. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  6. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  7. (2002) "Product Information. Benicar (olmesartan)." Sankyo Pharma
  8. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 8 references
Moderate

AR antagonists (applies to losartan) renal impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure with these agents. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function with these agents.

References

  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  3. (2001) "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb
  4. (2001) "Product Information. Teveten (eprosartan)." SmithKline Beecham
  5. (2001) "Product Information. Atacand (candesartan)." Astra-Zeneca Pharmaceuticals
  6. (2001) "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim
  7. (2002) "Product Information. Benicar (olmesartan)." Sankyo Pharma
  8. (2011) "Product Information. Edarbi (azilsartan)." Takeda Pharmaceuticals America
View all 8 references
Moderate

Losartan (applies to losartan) renal/liver disease

Moderate Potential Hazard, High plausibility. Applicable conditions: Biliary Obstruction, Renal Dysfunction

Losartan is converted in the liver to an active carboxylic acid metabolite and several inactive metabolites, and both parent drug and metabolites are eliminated by the kidney (35%) as well as by biliary excretion (60%). Dosage adjustments are not necessary in patients with renal impairment unless they are also volume-depleted, in which case therapy should be initiated under medical supervision. In patients with cirrhosis, however, significantly increased plasma concentrations of parent drug and active metabolite have been reported. Therapy with losartan should be initiated cautiously at a reduced dosage (50%) in patients with impaired liver function.

References

  1. Christ DD, Wong PC, Wong YN, Hart SD, Quon CY, Lam GN (1994) "The pharmacokinetics and pharmacodynamics of the angiotensin II receptor antagonist losartan potassium (DuP 753/MK 954) in the dog." J Pharmacol Exp Ther, 268, p. 1199-205
  2. Ishizaki H, Ohtawa M (1994) "Inhibitory effect of the nonpeptide angiotensin II receptor antagonist losartan and its active metabolite, E-3174, on cAMP phosphodiesterase: additional action of the antagonists." Biochem Pharmacol, 48, p. 201-4
  3. Ohtawa M, Takayama F, Saitoh K, Yoshinaga T, Nakashima M (1993) "Pharmacokinetics and biochemical efficacy after single and multiple oral administration of losartan, an orally active nonpeptide angiotensin II receptor antagonist, in humans." Br J Clin Pharmacol, 35, p. 290-7
  4. Furtek CI, Lo MW (1992) "Simultaneous determination of a novel angiotensin II receptor blocking agent, losartan, and its metabolite in human plasma and urine by high-performance liquid chromatography." J Chromatogr, 573, p. 295-301
  5. Sachinidis A, Ko Y, Weisser P, Meyer zu Brickwedde MK, Dusing R, Christian R, Wieczorek AJ, Vetter H (1993) "EXP3174, a metabolite of losartan (MK 954, DuP 753) is more potent than losartan in blocking the angiotensin II-induced responses in vascular smooth muscle cells." J Hypertens, 11, p. 155-62
  6. Gansevoort RT, de Zeeuw D, Shahinfar S, Redfield A, de Jong PE (1994) "Effects of the angiotensin II antagonist losartan in hypertensive patients with renal disease." J Hypertens Suppl, 12, s37-42
  7. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  8. Sica DA, Lo MW, Shaw WC, Keane WF, Gehr TWB, Halstenson CE, Lipschutz K, Furtek CI, Ritter MA, Shahinfar S (1995) "The pharmacokinetics of losartan in renal insufficiency." J Hypertens, 13 Suppl, s49-52
  9. Lo MW, Goldberg MR, Mccrea JB, Lu H, Furtek CI, Bjornsson TD (1995) "Pharmacokinetics of losartan, an angiotensin II receptor antagonist, and its active metabolite EXP3174 in humans." Clin Pharmacol Ther, 58, p. 641-9
View all 9 references

Losartan drug interactions

There are 320 drug interactions with losartan.

Losartan alcohol/food interactions

There are 2 alcohol/food interactions with losartan.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.