How to take Losartan correctly and what are its advantages

Who is the drug prescribed for?

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Death from strokes and heart disease ranks first in the structure of adult mortality worldwide. It is expected that in the near future these diseases will become the main cause of disability. European countries have managed to reverse this trend; the number of deaths due to cardiovascular diseases (CVD) is slowly but surely decreasing. Scientists have calculated that the main role in this success belongs not to high-tech treatment methods, but to simple measures to prevent CVD risk factors.

The most significant factors are:

• high blood pressure;
• excess cholesterol and triglycerides in blood vessels;
• diabetes;
• obesity.

If the pressure is higher than normal, the risk of death from CVD is about 1%, if high blood pressure is accompanied by 1 more factor - 1.6%, 2 more factors - 3.8%. The doctor’s task when identifying risk factors is to minimize their impact on the body: reduce blood pressure to target values, adjust the lipid profile and blood glucose, and normalize weight.

Losartan has a pronounced hypotensive effect, the dose of the drug is selected depending on the initial and target pressure.

The medicine is prescribed in the following cases:

If you choose the right dose and take Losartan without skipping, you can achieve the target blood pressure level in 50% of patients. For the rest, combination therapy is recommended: another antihypertensive drug is added to the treatment regimen. Modern drugs provide normalization of blood pressure in more than 90% of patients.

The statistics on taking antihypertensive drugs in Russia are depressing: among people with hypertension, about 70% of city residents and 45% of rural residents know about the disease. Only 23% are treated with discipline and maintain blood pressure at a normal level.

Reviews

Expert opinion

Basil

Reader

It became bad in the garage, I could barely get out from under the car, it’s good that my neighbor was nearby. He advised losartan, explained how to take it and immediately offered a pill. I have been taking the drug for more than a year and have no complaints: neither high blood pressure nor side effects. But I managed to go to the doctor; I wanted to get some advice.

Expert opinion

Peter

Site reader

I was told that the medications marked Richter and Teva on the packaging work best. However, I have been taking losartan for a long time and am pleased with the results. Pressure changes are no longer a concern and there are no side effects either. So I came to the conclusion that there is no need to overpay.

Expert opinion

Oksana Fedorovna

I often prescribe Losartan to my patients, as it is a fairly effective remedy for routine treatment. I have not encountered any side effects during my entire practice. The action is soft.

How does Losartan work?

The first discoveries, which ultimately led to the creation of Losartan, were made at the end of the 19th century. The enzyme renin, which is an important part of regulating blood pressure, was isolated from kidney cells. Several decades later, a substance was discovered in the renal artery that has a powerful effect on the blood vessels, leading to their narrowing. It was called angiotensin. The last link of the system was discovered in the mid-20th century. It was the hormone aldosterone, which is synthesized by the adrenal glands. This was enough to understand how the body maintains vascular tone and prevents hypertension.

To put it simply, the following mechanism works in our body: when pressure drops in the kidneys, renin is formed, which affects angiotensin. Angiotensin is degraded to angiotensin I, which is an inactive peptide, and then, with the participation of the ACE enzyme, is converted into angiotensin II. The resulting substance is a strong vasoconstrictor, causes a rapid rise in pressure and stimulates the production of aldosterone, which is responsible for water-salt metabolism.

Losartan was created in the 90s of the last century. It turned out to be the first drug in a fundamentally new group of blood pressure medications, which was called angiotensin II receptor blockers, abbreviated as ARBs. There are currently 6 drugs in this group. The names of all of them, except Losartan, end in -sartan, so they are also called sartans.

The action of Losartan is based on blocking the action of angiotensin II, while the substance does not in any way affect other types of regulation of the functioning of blood vessels and the heart.

What does this medicine help with:

1. The main effect is hypotensive. The medicine begins to reduce blood pressure after about an hour, reaching its maximum effect after 6 hours. The total operating time is 1 day. Losartan is always prescribed long-term, as it begins to provide a stable reduction in blood pressure only after 1-1.5 months.
2. Suppression of the pressure regulation system helps prevent the progression of heart failure. ACE inhibitors work a little more effectively in this case, but Losartan is better tolerated.
3. Protects kidney nephrons from destruction, slows down the development of renal failure, and delays the need for patients to undergo hemodialysis. Losartan can reduce the excretion of protein in the urine by 35%, the likelihood of complete kidney failure by 28%.
4. Protects the brain during hypertension: reduces the risk of stroke, improves memory. Scientists believe that this effect is associated not only with a decrease in blood pressure, but also with other, not yet studied, effects of the drug.
5. Leads to an improvement in the condition of connective tissues: strengthens the walls of blood vessels, promotes muscle recovery. It is believed that the additional effect of Losartan is to blame for this - stimulation of collagen production.
6. Helps eliminate excess uric acid, therefore it is especially recommended for reducing blood pressure in patients with gout.

Dosage of Losartan tablets

The active substance included in Losartan is losartan potassium. The original drug is American Cozaar from Merck. Medicines with the name Losartan are generics. They contain the same active ingredient and have the same dosages as the original Cozaar.

The following analogues are registered in Russia:

Dosages of Losartan tablets:

• 12.5 mg may be used if Losartan is prescribed with other antihypertensive drugs.
• 25 mg is the standard dose when taking diuretics.
• 50 mg - according to the instructions, this dose allows you to normalize blood pressure in most patients; it is prescribed most often.
• 100 mg is taken if pressure reduction from high levels is required.

There are also combination tablets that contain 2 substances with a hypotensive effect: losartan potassium and the diuretic hydrochlorothiazide. They are produced under the name Losartan N by Canonpharma, Atoll and Gedeon Richter. The price of Losartan N is 160-430 rubles.

pharmachologic effect

Manufacturer: Ozone, Vertex, Pranapharm, Canon, etc., Russia, Richter (Hungary), Teva (Russia), Alkaloid (Macedonia)

Release form: tablets

Active ingredient: losartan

Synonyms: Lozap, Lorista, Presartan, Gizaar, Vasotens, Cozaar, Bloktran, etc.

The drug belongs to the group of angiotensin II receptor antagonists. It lowers and maintains normal blood pressure, reduces the risk of complications, disability and death.

Important! Losartan is a cumulative drug. The maximum effect is observed with continuous use for 3-6 weeks. During therapy, monitoring blood pressure and collaborating with a doctor to accurately select the dosage of an antihypertensive drug are extremely important.

How to take it correctly

Rules for taking Losartan from the instructions for use:

1. The drug is taken once a day, but for convenience the tablet can be divided into 2 doses.
2. The instructions state that it does not matter when to take this drug, morning or evening. Losartan works for at least 24 hours. The main thing is not to change the appointment time once set. Reviews from patients indicate that a morning appointment is still preferable. In this case, the peak effectiveness of Losartan occurs during the most active daytime.
3. Eating food does not have a significant effect on the absorption and functioning of Losartan, so it can be taken before or after meals.
4. The initial daily dosage for most patients is 50 mg. It can be increased no earlier than after a week of taking the medicine.
5. For heart failure, start with 12.5 mg, gradually increasing the dose to 50 mg.
6. For liver failure, severe renal failure, in patients over 75 years of age, the initial dose is 25 mg.
7. The maximum daily dose is 100 mg; in the presence of heart failure, it can be increased by the doctor to 150 mg.

If 1 tablet of Losartan 100 mg is not enough to normalize blood pressure, it can be combined with antihypertensive drugs from other groups.

At what blood pressure do doctors recommend starting treatment with Losartan? As a rule, from the level of 140/90. This level is already considered elevated and negatively affects the condition of blood vessels and the functioning of the heart, kidneys, and brain. If your blood pressure is constantly high or if it repeatedly jumps, you are prescribed continuous use of Losartan. Hypertension is a chronic disease, so people take the medicine even if it seems that the blood pressure has returned to normal. In addition to pills, effective ways to combat hypertension are losing weight, being active, quitting smoking, limiting alcohol, increasing the consumption of vegetables and reducing the amount of salt, and avoiding stressful situations.

Possible side effects

Side effects of Losartan are mild, usually go away on their own, and do not require discontinuation of treatment. The drug has successfully completed several placebo-controlled studies, during which it was found that the overall incidence of adverse symptoms occurring when taking Losartan was even slightly lower than in the placebo group (2.3 versus 3.7%).

According to reviews of hypertensive patients, they experience undesirable effects extremely rarely; it is possible to track the relationship between taking pills and deterioration in well-being in isolated cases. As a rule, side effects are transient. Patients noted fog in the head, dizziness, and dry mouth at the beginning of treatment. By the end of 1 month these phenomena disappear.

Data from the instructions about side effects that occur in more than 1% (according to the WHO classification are considered frequent) of patients taking Losartan:

In 10% of patients with diabetes and impaired renal function, an increase in blood potassium to 5.5 or higher was observed, with the norm being 3.4-5.3. When taking placebo, such an increase was detected in 3.4% of patients. Otherwise, Losartan is well tolerated in this group of patients.

According to the instructions, in heart failure, hyperkalemia was observed in less than 1%, the frequency of undesirable effects increased with increasing dose from 50 to 150 mg.

Interaction

There are a number of drugs that cannot be taken simultaneously with Losartan. Otherwise, this may lead to drug interactions accompanied by a number of undesirable symptoms. Losartan should not be taken with the following medications:

1. drugs and dietary supplements in capsules with a high potassium content;
2. potassium-sparing diuretics;
3. heparin because it may increase plasma potassium concentrations;
4. non-steroidal anti-inflammatory drugs;
5. angiotensin-converting enzyme inhibitors, since renal failure, hyperkalemia and hypotension may develop or worsen;
6. rifampicin, since this drug can cause a decrease in the active fraction of Losartan in the blood and reduce the effectiveness of the drug;
7. antidepressants, as the risk of hypotension increases.

Potassium supplements should not be taken together with Losartan

Contraindications for use

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The instructions for use of Losartan contain an exhaustive list of contraindications for its use:

1. The drug may cause allergic reactions. They occur in less than 1% of hypertensive patients. Anaphylactic reactions are possible, so patients who have previously suffered angioedema need to be especially careful when starting treatment. The risk is highest in people allergic to ACE inhibitors.
2. It is prohibited in case of severe liver failure, since impaired liver function leads to a significant increase in the concentration of losartan potassium in the blood, that is, an overdose. The patient may experience severe hypotension and tachycardia.
3. Losartan and all sartans should not be taken during pregnancy. According to the FDA classification, this medicine belongs to category D. This means that during research, its negative effect on the fetus was established and proven. Possible disruption of the child’s kidney function, slow growth of the skull bones, and oligohydramnios. In the 1st trimester, the use of the drug is less dangerous. The instructions for use contain the following instruction: if pregnancy begins while taking Losartan, the medicine should be immediately discontinued. A woman needs to undergo an additional examination in the 2nd trimester - an ultrasound of the fetus to identify possible abnormalities in the development of the kidneys and skull.
4. Losartan is prohibited during breastfeeding, since it is unknown whether it passes into milk.
5. Losartan tablets cannot be used in children due to the lack of data on its safety for the developing body.
6. Losartan contains lactose (or cellactose), so the medicine should not be taken if its absorption is impaired.
7. Due to drug interactions, Losartan should not be taken together with aliskiren (pressure medications Rixila, Rasilez, Rasilam) in patients with a high risk of renal failure: with diabetes mellitus and kidney disease.

The following conditions are not strict contraindications for treatment with Losartan, but require special attention to your health: kidney disease, hyperkalemia, heart failure, any disorders of the blood supply to the brain, excess production of aldosterone.

Since Losartan does not interact with ethanol, the instructions do not describe the compatibility of alcohol with the drug. However, doctors strictly prohibit drinking alcohol during treatment with any blood pressure pills. Ethanol worsens the condition of blood vessels, promotes the development of hypertension and thereby completely neutralizes the therapeutic effect of Losartan.

Overdose

Cases of Losartan overdose have occurred very rarely, so there is very little information about them. If the recommended dose of the drug is exceeded, heart rhythm disturbances, tachycardia, bradycardia and a decrease in blood pressure may occur. Treatment of an overdose of Losartan is exclusively symptomatic and depends on the dose taken, the time that has passed after taking the drug, the general condition of the patient and the symptoms that manifest the pathological condition. Therapeutic measures should be aimed at stabilizing, controlling and maintaining vital functions and normalizing cardiac activity.

An overdose of Losartan may cause cardiac dysfunction

Analogues and substitutes

At the moment, more than a dozen analogues of Cozaar are registered in Russia alone, and there are many more of them in the world. In most pharmacies you can buy 2 versions of Cozaar:

• a pack of 14 tablets of 50 mg costs about 110 rubles,
• packaging for 28 tablets of 100 mg each - 185 rubles.

Generics from major pharmaceutical companies cost no less, and sometimes even a little more, than the original. But you can buy them at the nearest pharmacy, and you can choose the desired dosage.

You can replace Losartan with the following drugs:

Analogs may differ slightly from the original in absorption rate and strength, so doctors recommend choosing those generics that have passed their own clinical trials. For example, Lozap and Lorista have been proven to have a 24-hour hypotensive effect, a uniform effect throughout the entire duration of action, and a low level of side effects. Reviews from patients confirm the opinion of doctors. The highest rated tablets are Losartan from Vertex and Ozone (Atoll), Lorista and Lozap.

Release form

Losartan is produced in oval-shaped tablets with a biconvex surface. They are covered with a shell, usually white, however, deviations towards a yellowish tint are acceptable. For ease of use, Losartan is produced in several different dosages, for example:

• 25 milligrams of losartan;
• 50 milligrams of losartan;
• 100 milligrams of losartan.

Each blister pack contains 10 tablets. A pack of the drug contains one, two or three such packages, with instructions attached to them. The drug must be stored in a dry, dark place, at an air temperature of no more than 25°C. The shelf life is 24 months from the date of manufacture indicated on the package. The medicine “Losartan” can be purchased in pharmacies upon presentation of a prescription from a doctor.

Currencies of the drug Losartan

Comparison with similar drugs

Studies involving different groups of antihypertensive drugs have not revealed any significant benefits for any of the drugs. This means that all modern medications are equally effective in reducing blood pressure and the risk of CVD. Naturally, provided that the dose is selected correctly and the tablets are taken constantly, without skipping. The main differences between blood pressure medications are their tolerability and the strength of side effects; it is based on these criteria that the right medication is selected.

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Losaratan and its analogues are characterized by very good tolerability:

1. They are less likely than others to lead to an excessive decrease in pressure, and are less likely to cause collapsed states in patients.
2. Unlike beta-blockers (propranolol, atenolol, etc.), Losartan analogues do not affect heart rhythm, erection, or cause bronchospasm with cough.
3. If we compare sartans with their main competitors, ACE inhibitors (captopril, enalapril, ramipril, etc.), it turns out that Losartan causes cough less often (the instructions for use indicate a frequency of 9.9% for ACE inhibitors, 3.1% for Losartan ), hyperkalemia, Quincke's edema.
4. The effect of Losartan does not depend on age, race, gender and hemodynamic parameters.
5. In reviews of patients who have taken the drug, there is often a statement that Losartan is weaker than other blood pressure pills. Research refutes this fact. The fact is that the effect of this drug increases gradually; it gains full strength within 2-5 weeks. After this time, the effectiveness of Losartan is the same as that of other antihypertensive drugs.
6. A review of data from numerous studies involving Losartan showed that its potency is no different from ACE inhibitors. They are also close in reducing the frequency of strokes and heart attacks, quality of life, and the effect on the body of patients with nephropathy and diabetes.
7. The long time required to achieve maximum effect is compensated by the persistence of Losartan's action. With long-term use, the effectiveness of ACE inhibitors and beta-blockers may decrease, but with Losartan tablets this is much less common.
8. In heart failure, the advantage of Losartan and its analogues has not yet been proven; clinical trial data do not yet allow a final conclusion. So far, the combination of aldosterone antagonists (spironolactone) with beta-blockers is considered the most effective. The combination of sartans with ACE inhibitors is in second place.

Answers on questions

1. Losartan - diuretic or not?
   

   The drug is an antihypertensive drug, i.e. it reduces blood pressure, normalizes blood pressure, and may have some effect on kidney function. The combination of Losartan and Hydrochlorothiazide has a diuretic effect.

2. Is Losartan banned or not?
   

   No, the medicine is approved for use and is safe if you follow your doctor’s recommendations and select the correct dosage.

3. Does Losartan Cause Cancer or Not?
   

   According to a report from the European Medicines Agency in 2018, when testing one of the manufacturers of Losartan, a carcinogen was discovered that can cause cancer in 1 in 8 thousand patients taking the drug for 4 years and older. This percentage of negative effects on the body is extremely small to confirm the carcinogenic properties of the drug. And the substance contained is also present in tobacco smoke and the atmosphere.