Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Losartan

Losartan

Angiotensin receptor blocker (ARB)

AdultARBHTNCKD

Indication

HTN β€’ CKD albuminuria β€’ ACEi-cough alternative

At a glance

INDICATIONS (CORE USE)

HTN, CKD with albuminuria/proteinuria, ACEi alternative when cough limits use.

ADULT DOSE (STANDARD)

PO START 25–50 mg daily; titrate to BP/lab response.

MAX DOSE

Typical max 100 mg/day.

Route

PO once-daily profile common

PEDIATRIC DOSE

Specialist pediatric HTN protocols only.

Do not miss

Must-not-miss safety points

Major warning

- Pregnancy contraindicated β†’ DO NOT use - Check creatinine + potassium after start and dose changes

Indications

USE IF: HTN, CKD albuminuria/proteinuria, ACEi cough intolerance. AVOID IF: pregnancy, bilateral renal artery stenosis, baseline hyperkalemia, or active hypoperfusion.

Primary

  • Hypertension
  • CKD with albuminuria/proteinuria

Secondary

  • ACEi intolerance (e.g., cough)

Other

  • Uricosuric nuance may be useful in selected hyperuricemia/gout contexts

Dosing

STANDARD (ADULT PO)

START low, then titrate with BP + creatinine + potassium.

ADULT DOSE

HTN: START 25–50 mg daily; titrate to response.

PEDIATRIC DOSE

Specialist only.

MAX DOSE

Typical max 100 mg/day.

Practical Note

Correct volume depletion before initiation to reduce first-dose hypotension risk.

Warnings

Clinical warnings

  • Lower cough/angioedema risk vs ACE inhibitors, but not zero
  • First-dose hypotension risk (especially HF / volume depletion)
  • Renal perfusion-dependent β†’ creatinine rise possible

Contraindications

  • Pregnancy
  • Bilateral renal artery stenosis (known/suspected)
  • Baseline K+ β‰₯5.5 mmol/L

Drug interactions

  • ACE inhibitor / aliskiren combination: avoid routine dual RAAS blockade (AKI, hyperkalemia, hypotension risk)
  • Potassium-sparing agents / supplements: hyperkalemia risk
  • NSAIDs β†’ ↑ AKI risk + ↓ ARB effect β€” avoid or monitor closely
  • Diuretic-associated volume depletion increases hypotension risk.

Special populations

Pediatrics

Specialist pediatric HTN protocols only.

Pregnancy

Pregnancy: DO NOT use.

Lactation

specialist risk/benefit assessment.

Renal impairment

Monitor creatinine/potassium closely after initiation and dose changes.

Hepatic impairment

Use lower starts in hepatic impairment contexts.

Elderly

Start low, monitor orthostasis and renal response early.

Administration

PO at consistent timing; reinforce lab follow-up after titration.

Monitoring

  • Recheck: - Check creatinine + potassium within 1–2 weeks after initiation - Recheck creatinine + potassium within 1–2 weeks after dose increase - Check earlier if CKD, elderly, volume depletion, or interacting drugs
  • Hold if:
    - HOLD if:
    - SBP <90–100
    - K+ β‰₯5.5 mmol/L
    - creatinine rise >30% from baseline
    - symptomatic hypotension
  • If targets not met after reassessment of dose, organ function, and interactions β†’ escalate per protocol (DO NOT continue blindly)

Overdose / toxicity

Clinical Picture

A) Mild β†’ dizziness, hypotension, fatigue B) Moderate β†’ persistent hypotension, AKI trend, hyperkalemia C) Severe β†’ refractory shock, severe hyperkalemia, respiratory compromise

Immediate Actions

β€’ Airway + continuous monitoring (ABC, BP, telemetry) β€’ Hypotension β†’ IV fluids first-line β€’ Refractory hypotension β†’ early vasopressors β€’ Stop ARB immediately

Antidote

- No specific antidote - Supportive care + hemodynamic stabilization - Hyperkalemia treatment β†’ calcium + insulin/dextrose + potassium-shifting protocol

Decontamination

β€’ Recent oral ingestion β†’ activated charcoal if protected airway and early presentation (toxicology-guided)

Escalation

- Refractory hypotension β†’ ICU / vasopressors - Severe hyperkalemia / AKI β†’ nephrology + renal replacement planning if indicated

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield Summary

Losartan identity: broad HTN/CKD utility with uricosuric nuance in selected patients.

Clinical pearls

Angioedema risk lower than ACEi but not zero β†’ use caution if prior ACEi angioedema. Uricosuric effect β†’ useful in hypertensive patients with gout.

ARB safety

    Pharmacokinetics

    Once-daily use common; active metabolite contributes antihypertensive effect.

    Mechanism of action

    AT1 receptor blockade reduces angiotensin II signaling and aldosterone effect.

    Common brand names

    Saudi Arabia

    Cozaar, Angizaar, Losacor

    Global

    Hyzaar, (placeholder β€” verify local formulation)

    Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

    Country practice notes

    Global data (no country-specific data available)

    • Follow local antimicrobial stewardship policy, hospital formulary, and national resistance guidance.
    • Confirm dosing, stock, and restrictions with institutional pharmacy and current product labeling.

    References

    Saudi Arabia

    • SFDA (Saudi Food & Drug Authority)
    • Saudi National Formulary / MOH (where available)

    International

    • WHO Model List of Essential Medicines (verify current edition)
    • US FDA or EU EMA product information (when national SmPC is unavailable)
    • ACC / AHA HF, HTN, CKD guidance
    • KDIGO CKD / albuminuria guidance
    • FDA / SFDA product labeling

    Do not miss

    • Pregnancy contraindicated β†’ DO NOT use
    • Hyperkalemia risk β†’ monitor potassium early
    • Creatinine rise / AKI risk (bilateral renal artery stenosis / volume depletion)
    • First-dose hypotension β†’ correct volume before starting