Cozaar: Effective Blood Pressure Control and Kidney Protection
Cozaar
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Cozaar (losartan potassium) is an angiotensin II receptor blocker (ARB) prescribed for the management of hypertension. It works by blocking the action of certain natural substances that tighten blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. This medication is also indicated to protect kidney function in patients with type 2 diabetes and hypertension, reducing the risk of end-stage renal disease. Its targeted mechanism offers a well-tolerated therapeutic option for long-term cardiovascular and renal risk management.
Features
- Active Ingredient: Losartan Potassium
- Drug Class: Angiotensin II Receptor Blocker (ARB)
- Available Formulations: Oral tablets in 25 mg, 50 mg, and 100 mg strengths
- Bioavailability: Approximately 33%
- Peak Plasma Time: 1 hour (losartan), 3-4 hours (active metabolite E-3174)
- Half-Life: 2 hours (losartan), 6-9 hours (active metabolite)
- Protein Binding: >98% (losartan), >99% (E-3174)
- Metabolism: Hepatic, primarily via CYP2C9 and CYP3A4
- Excretion: Urinary (35%) and fecal (60%)
Benefits
- Effectively lowers blood pressure, reducing strain on the heart and vascular system
- Demonstrates nephroprotective effects in patients with type 2 diabetes and proteinuria
- Lowers the risk of stroke in patients with hypertension and left ventricular hypertrophy
- Generally well-tolerated with a lower incidence of cough compared to ACE inhibitors
- Provides 24-hour hemodynamic control with once-daily dosing in most patients
- May offer uric acid-lowering effects, beneficial in certain patient populations
Common use
Cozaar is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also used for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and a history of hypertension. Additionally, it is prescribed for stroke risk reduction in patients with hypertension and left ventricular hypertrophy, as demonstrated in the LIFE trial. Off-label uses may include heart failure management (when ACE inhibitors are not tolerated) and Marfan syndrome-related aortic root dilation.
Dosage and direction
Hypertension: The usual starting dose is 50 mg once daily. The dosage can be increased to 100 mg once daily based on blood pressure response. For patients with intravascular volume depletion (e.g., those treated with diuretics), a starting dose of 25 mg is recommended.
Diabetic Nephropathy: The usual starting dose is 50 mg once daily. The dose may be increased to 100 mg once daily based on blood pressure response.
Hypertension with Left Ventricular Hypertrophy: The usual starting dose is 50 mg once daily. Add hydrochlorothiazide 12.5 mg daily and/or increase Cozaar to 100 mg daily based on blood pressure response.
Cozaar may be administered with or without food. Tablets should be swallowed whole with a glass of water. Dosage adjustments are necessary in patients with hepatic impairment or renal impairment (CrCl <30 mL/min). Not recommended for use in pediatric patients under 6 years of age.
Precautions
Monitor renal function and electrolytes periodically, particularly in patients with renal artery stenosis, heart failure, or volume depletion. Use with caution in patients with impaired hepatic function due to possible reduced conversion to active metabolite. May cause hyperkalemia, especially in patients with renal impairment, diabetes, or those using potassium-sparing diuretics. Monitor blood pressure within 2-4 weeks of initiation and periodically thereafter. Discontinue if pregnancy is detected due to risk of fetal injury. May cause dizziness or drowsiness; caution patients about operating machinery or driving until drug effects are known. Avoid use in patients with significant aortic or mitral stenosis.
Contraindications
Hypersensitivity to losartan or any component of the formulation. Concomitant use with aliskiren in patients with diabetes. Second and third trimester of pregnancy. Severe hepatic impairment. Bilateral renal artery stenosis or stenosis to a solitary kidney. Concomitant use with ACE inhibitors in patients with diabetic nephropathy.
Possible side effect
Common (≥1%): Dizziness (3.5%), upper respiratory infection (2.1%), cough (1.1%), fatigue (1.1%), diarrhea (1.9%), back pain (1.6%), hypoglycemia (1.5%), hypotension (1.4%)
Less common (<1%): Orthostatic hypotension, insomnia, palpitations, angina pectoris, abdominal pain, nausea, dyspepsia, muscle cramps, myalgia, rash, urticaria, pruritus, hyperkalemia, increased BUN/creatinine
Rare: Angioedema (0.1%), hepatitis, liver function abnormalities, neutropenia, thrombocytopenia, syncope, arrhythmias
Drug interaction
Potassium-sparing diuretics (spironolactone, amiloride): Increased risk of hyperkalemia Potassium supplements/salt substitutes: Increased risk of hyperkalemia NSAIDs (ibuprofen, naproxen): May reduce antihypertensive effect and increase risk of renal impairment Lithium: Increased lithium levels and toxicity risk ACE inhibitors: Increased risk of hyperkalemia, hypotension, and renal impairment Diuretics: Potentiated hypotensive effect Rifampin: Decreased losartan and active metabolite concentrations Fluconazole: Reduced conversion to active metabolite Warfarin: Minor interaction reported in some patients
Missed dose
If a dose is missed, it should be taken as soon as remembered on the same day. If it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. Maintain consistent dosing intervals for optimal blood pressure control.
Overdose
Symptoms may include hypotension, tachycardia, or bradycardia. Supportive treatment should be initiated with volume expansion with normal saline. Hemodialysis is not effective for removing losartan or its active metabolite due to high protein binding. Monitor vital signs and electrolyte status closely. Vasopressors may be required in severe cases. Contact poison control center for latest guidance.
Storage
Store at room temperature (20-25°C or 68-77°F). Excursions permitted to 15-30°C (59-86°F). Keep container tightly closed. Protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Do not flush medications down toilet or pour into drain unless instructed to do so.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual patient responses may vary. Proper diagnosis and treatment should be based on comprehensive medical evaluation by a licensed physician. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.
Reviews
“Cozaar has been effectively controlling my hypertension for over five years with minimal side effects. The once-daily dosing is convenient and my blood pressure has remained stable within target range.” - John D., 62
“As a nephrologist, I’ve observed excellent renal protective effects with losartan in my diabetic patients. The reduction in proteinuria is significant and well-documented in clinical studies.” - Dr. Emily R., Nephrologist
“After experiencing cough with lisinopril, my physician switched me to Cozaar. My blood pressure control has been maintained without the bothersome side effect. Laboratory monitoring has shown no electrolyte abnormalities.” - Maria S., 58
“The transition to losartan from another ARB was seamless. The 100 mg dose provides consistent 24-hour coverage and my patients report better tolerability compared to some other antihypertensive agents.” - Dr. Robert K., Cardiologist