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Arbli
losartan
Black Box Warnings .
Fetal Toxicity
fetal/neonatal morbidity/mortality may occur when drugs that act directly on the renin-angiotensin system are used in pregnancy; D/C drug ASAP once pregnancy detected
Adult Dosing .
Dosage forms: SUSPENSION: 10 mg per mL
HTN
- [50-100 mg/day PO divided qd-bid]
- Start: 50 mg PO qd; Max: 100 mg/day; Info: start 25 mg PO qd if on diuretic
nephropathy, diabetic
- [50-100 mg PO qd]
- Start: 50 mg PO qd; Max: 100 mg/day; Info: for patients with type 2 DM and HTN
stroke prevention
- [50-100 mg PO qd]
- Start: 50 mg PO qd; Max: 100 mg/day; Info: for patients with HTN and LVH; possibly ineffective in Black patients; may give with HCTZ
heart failure with reduced ejection fraction (off-label)
- [50-150 mg PO qd]
- Start: 25-50 mg PO qd; Max: 150 mg/day
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- mild-moderate impairment: start 25 mg qd; severe impairment: not defined
Peds Dosing .
- Dosage forms: SUSPENSION: 10 mg per mL
HTN
- [6 yo and older]
- Dose: 0.7-1.4 mg/kg/dose PO qd; Start: 0.7 mg/kg/dose PO qd up to 50 mg/day; Max: 1.4 mg/kg/day up to 100 mg/day
aortic dilation, Marfan syndrome-associated (off-label)
- [1 yo and older]
- Dose: 1-1.4 mg/kg/dose PO qd; Start: 0.4 mg/kg/dose PO qd; Max: 100 mg/day
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy
- caution: Black patients (possibly ineffective in stroke prevention use)
- caution: Black patients (incr. risk of angioedema)
- caution: renal disease
- caution: renal artery stenosis
- caution: renal impairment
- caution: hepatic impairment
- caution: volume depletion
- caution: hyponatremia
- caution: hyperkalemia risk
- caution: CHF, severe
Drug Interactions .
Overview
losartan
ARB
- angiotensin II Type 1 antagonist
- antihypertensive agent
- decreases renal perfusion/fxn
- hyperkalemia
- hypoglycemic effects
Contraindicated
- aliskiren
- isocarboxazid
- sparsentan
Avoid/Use Alternative
- aldesleukin
- amikacin
- amiloride
- angiotensin II
- aripiprazole lauroxil
- azilsartan medoxomil
- benazepril
- candesartan cilexetil
- captopril
- clofarabine
- enalapril
- enalaprilat
- fosinopril
- irbesartan
- lisinopril
- lofexidine
- losartan
- moexipril
- olmesartan medoxomil
- perindopril
- potassium chloride
- potassium phosphate
- quinapril
- ramipril
- tacrolimus
- telmisartan
- trandolapril
- trimethoprim
- valsartan
Monitor/Modify Tx
- abiraterone acetate
- acyclovir
- adefovir dipivoxil
- albuterol
- albuterol inhaled
- alfentanil
- alfuzosin
- allopurinol
- almotriptan
- alprostadil intracavernous
- amantadine
- amifostine
- amikacin inhaled
- amitriptyline
- amoxapine
- amphetamine
- amphotericin
- anthrax immune globulin
- apomorphine
- apraclonidine ophthalmic
- arformoterol inhaled
- aripiprazole bimonthly injection
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- articaine
- asciminib
- asenapine
- aspirin
- atogepant
- atomoxetine
- atropine ophthalmic
- auranofin
- avanafil
- axitinib
- balsalazide
- benzphetamine
- berberine
- betamethasone
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bortezomib
- botulism immune globulin
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
- cabergoline
- cabozantinib
- caffeine
- caffeine citrate
- canagliflozin
- cannabis
- capecitabine
- carboplatin
- carfilzomib
- cariprazine
- carteolol ophthalmic
- celecoxib
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cidofovir
- cilostazol
- cisplatin
- clindamycin
- clomipramine
- clonidine
- clozapine
- cocaine
- codeine
- coenzyme Q-10
- colistimethate
- copanlisib
- copper histidinate
- corticotropin
- cortisone
- creatine
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- danazol
- dapagliflozin
- darbepoetin alfa
- decitabine
- deferasirox
- deferoxamine
- deflazacort
- denileukin diftitox
- desflurane
- desipramine
- desmopressin
- desvenlafaxine
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- diazoxide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydrocodeine
- dihydroergotamine
- dinutuximab
- dipyridamole
- doxapram
- doxazosin
- doxepin
- dronabinol
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- droxidopa
- duloxetine
- eletriptan
- empagliflozin
- entacapone
- entrectinib
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epinephrine inhaled
- eplerenone
- epoetin alfa
- epoprostenol
- eptinezumab
- erenumab
- ergotamine
- ertugliflozin
- esketamine
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethanol injection
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- etripamil nasal
- fenfluramine
- fenoprofen
- fentanyl
- ferumoxytol
- finerenone
- fingolimod
- flaxseed
- flibanserin
- flucytosine
- fludrocortisone
- fluphenazine
- flurbiprofen
- formoterol inhaled
- foscarnet
- foslevodopa
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- furosemide
- galcanezumab
- ganciclovir
- garlic
- gentamicin
- gilteritinib
- glimepiride
- glipizide
- glyburide
- guanfacine
- haloperidol
- heparin
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydrocortisone
- hydromorphone
- hydroxocobalamin IV
- ibrutinib
- ibuprofen
- ibuprofen lysine
- ifosfamide
- iloperidone
- iloprost
- imipramine
- immune globulin
- indapamide
- indomethacin
- insulin
- iodixanol
- iohexol
- iomeprol
- iopamidol
- iopromide
- iothalamate meglumine
- ioversol
- iron sucrose
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- ketamine
- ketoprofen
- ketorolac
- landiolol
- lanreotide
- leflunomide
- lenvatinib
- levalbuterol inhaled
- levobunolol ophthalmic
- levodopa
- levomilnacipran
- levorphanol
- levothyroxine
- licorice
- lidocaine
- liothyronine
- lisdexamfetamine
- lithium
- lomustine
- lorlatinib
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- luspatercept
- lutetium Lu 177 vipivotide tetraxetan
- magnesium citrate
- magnesium salicylate
- magnesium sulfate
- maraviroc
- meclofenamate
- mefenamic acid
- meloxicam
- meperidine
- mepivacaine
- mesalamine
- mesalamine rectal
- methadone
- methamphetamine
- methohexital
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- midazolam
- midodrine
- milnacipran
- milrinone
- milsaperidone
- mirabegron
- mirtazapine
- mitomycin
- modafinil
- molindone
- morphine
- nabumetone
- nalbuphine
- naphazoline ophthalmic
- naproxen
- naratriptan
- nateglinide
- nattokinase
- naxitamab
- neomycin
- niacin (vitamin B3)
- nilotinib
- niraparib
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- nusinersen
- obinutuzumab
- olanzapine
- oliceridine
- olodaterol inhaled
- olsalazine
- opicapone
- opium
- osilodrostat
- oxaliplatin
- oxaprozin
- oxazepam
- oxycodone
- oxymetazoline nasal
- oxymetazoline ophthalmic
- oxymetazoline topical
- oxymorphone
- oxytocin
- ozanimod
- paliperidone
- palopegteriparatide
- pamidronate
- paromomycin
- pazopanib
- pemetrexed
- penicillamine
- pentamidine
- pentazocine
- pentobarbital
- pentostatin
- pentoxifylline
- perphenazine
- pexidartinib
- phendimetrazine
- phenelzine
- phenobarbital
- phentermine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- piroxicam
- plazomicin
- polyethylene glycol
- polyethylene glycol/electrolytes
- polymyxin B
- ponatinib
- ponesimod
- potassium acid phosphate
- potassium bicarbonate
- potassium citrate
- potassium iodide
- pralsetinib
- pramipexole
- prazosin
- prednisolone
- prednisone
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- protriptyline
- pseudoephedrine
- quetiapine
- ramucirumab
- rasagiline
- regorafenib
- remifentanil
- remimazolam
- repaglinide
- Rho(D) immune globulin
- rimegepant
- riociguat
- ripretinib
- risperidone
- rituximab
- rizatriptan
- ropeginterferon alfa-2b
- ropinirole
- ropivacaine
- rotigotine transdermal
- sacubitril
- safinamide
- salmeterol inhaled
- salsalate
- selegiline
- selegiline transdermal
- selpercatinib
- sevoflurane
- sildenafil
- silodosin
- siponimod
- sirolimus
- sitagliptin
- sodium ferric gluconate complex
- sorafenib
- sotagliflozin
- sotalol
- spironolactone
- streptomycin
- streptozocin
- succinylcholine
- sufentanil
- sulfate bowel prep
- sulindac
- sumatriptan
- sunitinib
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telavancin
- temsirolimus
- tenofovir alafenamide
- tenofovir disoproxil
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tetrahydrozoline ophthalmic
- thalidomide
- thioridazine
- thiothixene
- thyroid
- timolol ophthalmic
- tiopronin
- tivozanib
- tizanidine
- tobramycin
- tobramycin inhaled
- tolcapone
- tolmetin
- tolvaptan
- torsemide
- tramadol
- trametinib
- tranylcypromine
- trazodone
- treprostinil
- triamcinolone
- triamterene
- trifluoperazine
- trimipramine
- ubrogepant
- vaccinia immune globulin
- vadadustat
- valacyclovir
- valganciclovir
- vamorolone
- vancomycin
- vandetanib
- vardenafil
- vasopressin
- venlafaxine
- vilanterol inhaled
- viloxazine
- voclosporin
- vosoritide
- willow bark
- yohimbe
- zavegepant
- ziprasidone
- ziv-aflibercept
- zoledronic acid
- zolmitriptan
Caution Advised
- rifampin
Adverse Reactions .
Serious Reactions
- angioedema
- anaphylaxis
- hypotension, severe
- hyperkalemia
- renal failure
- renal impairment
- rhabdomyolysis
- hepatitis
- thrombocytopenia
Common Reactions
- URI
- diarrhea
- fatigue
- asthenia
- musculoskeletal pain
- chest pain
- cough
- hypotension
- hyperkalemia
- dyspepsia
- dizziness
Safety/Monitoring .
Monitoring Parameters
BUN/Cr at baseline, then periodically; electrolytes; BP
Look/Sound-Alike Drug Names
losartan confused with: lisinopril; loratadine; lovastatin; valsartan
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; if must use, monitor amniotic fluid and fetus closely; risk of fetal and neonatal harm, including intrauterine growth restriction, oligohydramnios, renal failure, and death, in 2nd and 3rd trimesters based on human data and drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: for losartan: liver; CYP450: 2C9 (primary), 3A4 substrate; Info: active metabolite
Excretion: for losartan: feces 60%, urine 35% (4% unchanged); Half-life: 2h (parent drug), 6-9h (active metabolite)
Subclass: Angiotensin Receptor Blockers (ARBs)
Mechanism of Action
for losartan: selectively antagonizes angiotensin II AT1 receptors
Formulary .
No Formulary Selected
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