Losartan detailed information
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| Losartan detailed information
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| Systematic (IUPAC) name | |
| (1-((2'-(2H-tetrazol-5-yl)biphenyl-4-yl)methyl)- 2-butyl-4-chloro-1H-imidazol-5-yl)methanol | |
| Identifiers | |
| CAS number | |
| ATC code | C09 |
| PubChem | |
| DrugBank | |
| Chemical data | |
| Formula | C22H23ClN6O |
| Mol. mass | 422.91 |
| Pharmacokinetic data | |
| Bioavailability | 25–35% |
| Metabolism | Hepatic (CYP2C9, CYP3A4) |
| Half life | 1.5–2 hours |
| Excretion | Renal 13–25%, biliary 50–60% |
| Therapeutic considerations | |
| Pregnancy cat. |
D (USA, Australia) |
| Legal status |
℞ Prescription only |
| Routes | Oral |
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Overview
Losartan (rINN) (pronounced /loʊˈsɑrtən/) is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure (hypertension). Losartan was the first angiotensin II receptor antagonist to be marketed. It is currently marketed by Merck & Co. under the trade name Cozaar.
Clinical use
As with all angiotensin II receptor antagonists, losartan is indicated for the treatment of hypertension. Losartan may also delay progression of diabetic nephropathy and is also indicated for the reduction of renal disease progression in patients with type 2 diabetes, hypertension and microalbuminuria (>30 mg/24 hours) or proteinuria (>900 mg/24 hours).[1]
Although angiotensin II receptor antagonists are not usually considered first-line, because of the proven effectivity and lower costs of thiazide diuretics and beta blockers, losartan may be used first-line in patients with increased cardiovascular risk. The LIFE study demonstrated that losartan was significantly superior to atenolol in the primary prevention of adverse cardiovascular events (myocardial infarction or stroke), with a significant reduction in cardiovascular morbidity and mortality for a comparable reduction in blood pressure.[1]
Combination with diuretic
Losartan is available in a combination formulation with a low dose thiazide diuretic, invariably hydrochlorothiazide, to counteract the increase in renin and to achieve an additive antihypertensive effect. The losartan/hydrochlorothiazide combination preparation is marketed by Merck under the trade name Hyzaar.
Pharmacokinetics
Absorption
Losartan is well absorbed following oral administration.
Metabolism
Losartan undergoes significant first-pass metabolism to produce 5-carboxylic acid metabolite, designated as EXP3174. This metabolite is long-acting (6 to 8 hr), noncompetitive antagonist at the AT1 receptor and contribute to the pharmacological effects of Losartan. It is 10-40 times more potent in blocking AT1 receptors than Losartan.
Bioavailability
Losartan's bioavailability is about 32%.
Half life
Losartan's half life is very short: i.e only 2 hrs.
Excretion
Following oral administration, 6 % of Losartan is excreted unchanged in the urine.
Doses
- Initial dose; 50mg/day
- Usual dose: 25-100 mg/day
Research
Losartan has been found to downregulate the expression of transforming growth factor beta (TGF-β) types I and II receptors in the kidney of diabetic rats, which may partially account for its nephroprotective effects.[1] Effects on TGF-β expression may also account for its potential efficacy in Marfan syndrome and Duchenne muscular dystrophy (DMD) – losartan has been shown to prevent aortic aneurysm and certain pulmonary complications in a mouse model of the disease.[1]
Mechanism of action & pharmacological actions
Losartan is a selective, competitive Angiotensin II receptor type 1 (AT1) receptor antagonist, reducing the end organ responses to angiotensin II. Losartan administration results in a decrease in total peripheral resistance (afterload) and cardiac venous return (preload) All of the physiological effects of angiotensin II, including stimulation of release of aldosterone, are antagonized in the presence of losartan. Reduction in blood pressure occurs independently of the status of the renin-angiotensin system. As a result of losartan dosing, plasma renin activity increases due to removal of the angiotensin II feedback.
References
See also
Agents acting on the renin-angiotensin system (C09) | |
|---|---|
| ACE inhibitors | Benazepril • Captopril • Delapril • Enalapril • Fosinopril • Imidapril • Lisinopril • Moexipril • Perindopril • Quinapril • Ramipril • Spirapril • Temocapril • Trandolapril • Zofenopril |
| Angiotensin II receptor antagonists (AIIRA) | Candesartan • Eprosartan • Irbesartan • Losartan • Olmesartan • Tasosartan • Telmisartan • Valsartan |
| Renin inhibitors | Aliskiren • Remikiren |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
