Losartan
Brand names: Cozaar
Class: 💊 ACE Inhibitors & ARBs
The NP-board angle on losartan is the patient who needed an ACE inhibitor but couldn't tolerate the cough. Losartan blocks the angiotensin II type-1 receptor directly, providing the renoprotective and cardioprotective effects of an ACE inhibitor without the bradykinin-mediated cough or angioedema. Indications include hypertension, heart failure when ACE-intolerant, and diabetic nephropathy. Losartan also lowers serum uric acid — a quirk that makes it an attractive choice in hypertensive patients with gout. Like ACEs, it is contraindicated in pregnancy, bilateral renal artery stenosis, and hyperkalemia. Check potassium and creatinine 1–2 weeks after starting. Do not combine an ACE with an ARB — same target, additive harms, no added benefit.
✅ Indications
HTN, CHF (ACE intolerant), diabetic nephropathy, gout-friendly HTN.
⚙️ Mechanism of Action
Angiotensin II receptor blocker (ARB).
📏 Dosing
25–100 mg PO daily.
🚫 Contraindications
Pregnancy, bilateral RAS, history of angioedema (caution).
⚠️ Adverse Effects
Hyperkalemia, dizziness, AKI — no cough (key differentiator).
🔬 Monitoring
BP, K⁺, creatinine.
💎 Board Pearls
- ⚡ ↓ uric acid (unique among antihypertensives) → preferred in gouty HTN patients.
- 🫁 No bradykinin accumulation → no cough. Go-to ACE substitute.
Practice Questions
A 72-year-old woman returns from a rheumatology referral for a third gout flare in the past year. She has stage 2 hypertension, and her current regimen is hydrochlorothiazide (Microzide) 25 mg daily. Rheumatology has started allopurinol titration and asked you to reconsider her antihypertensive. Serum uric acid is 8.9 mg/dL, eGFR 62, K+ 4.1. Which of the following antihypertensive changes is MOST appropriate?
Related Drugs in This Class
- Lisinopril — Prinivil, Zestril
- Ramipril — Altace
- Valsartan — Diovan
Sources
Ready to practice?
1,500+ AANP-style questions with rationales — free trial.