LOSARTAN

GENERIC NAME: Losartan Potassium

BRAND NAME: Cozaar

DRUG CLASS: Angiotensin II receptor blockers, antihypertensive

MECHANISM OF ACTION:
Inhibits vasoconstrictive and aldosterone-secreting action of angiotensin II
by blocking angiotensin II receptor onthe surface ofvascular smooth
muscle and other tissue cells.

DOSE/ROUTE: ORAL ROUTE

-adult dose for hypertension:he usual starting dose of cozaar is 50 mg
once daily. a starting dose of 25 mg is recommended for patients with
possible intravascular depletion 
-usual adult dose for diabetic nephropathy:
initial dose: 50 mg orally once a day
maximum dose: 100 mg orally once a day
-pediatric dose for hypertension: 6 years or older:
initial dose: 0.7 mg/kg orally once a day (up to 50 mg total)

INDICATIONS: Hypertension, Hypertensive patient with left ventricular

hypertrophy, neuropathy in type 2 diabetic patient

CONTRAINDICATIONS:
-In patients who are hypersensitive to any component of this product.
-For coadministration with aliskiren in patients with diabetes.
-Patients hypersensitive to drug, breast-feeding is not
recommended,causes fetal and neonatal morbidity and death

SIDE EFFECTS:
-Commonly reported side effects of losartan include: asthenia, chest pain,
diarrhea, fatigue, and hypoglycemia. 

ADVERSE EFFECTS:

Blood and lymphatic system disorders: Anemia.

Psychiatric disorders: Depression.
 Nervous system disorders: Somnolence, headache, sleep disorders,
paresthesia, migraine.

Ear and labyrinth disorders: Vertigo, tinnitus.

Cardiac disorders: Palpitations, syncope, atrial fibrillation, CVA.

Respiratory, thoracic and mediastinal disorders: Dyspnea.

Gastrointestinal disorders: Abdominal pain, constipation, nausea,

vomiting.

Skin and subcutaneous tissue disorders: Urticaria, pruritus, rash,

photosensitivity.

Musculoskeletal and connective tissue disorders: Myalgia, arthralgia.

Reproductive system and breast disorders: Impotence.

General disorders and administration site conditions: Edema.

DRUG INTERACTIONS:
1. Agents Increasing Serum Potassium
-Coadministration of losartan with other drugs that raise serum potassium
levels may result in hyperkalemia

2. Lithium
-Increases in serum lithium concentrations and lithium toxicity have been
reported during concomitant administration of lithium with angiotensin II
receptor antagonists.
 
3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Including Selective
Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
-In patients who are elderly, volume-depleted (including those on diuretic
therapy), or with compromised renal function, coadministration of NSAIDs,
including selective COX-2 inhibitors, with angiotensin II receptor antagonists
(including losartan) may result in deterioration of renal function, including
possible acute renal failure.

4. Dual Blockade Of The Renin-Angiotensin System (RAS)

-Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors,
or aliskiren is associated with increased risks of hypotension, syncope,
hyperkalemia, and changes in renal function (including acute renal failure)
compared to monotherapy

5. Phenobarbital 
-decreases serum levels of losartan and its metabolite.

NURSING RESPONSIBILITIES:
-Monitor patient response to therapy through blood pressure monitoring
-Monitor for presence of manifestations that signal decreased in fluid volume
(e.g. diarrhea, vomiting, dehydration) to prevent exacerbation of hypotensive
effect of drug.
-Administer drug on empty stomach one hour before or two hours after meal
to ensure optimum drug absorption.
-Monitor renal and hepatic function tests to alert doctor for possible
development of renal and/or hepatic failure as well as to signal need for
reduced drug dose.
-Educate patient on importance of healthy lifestyle choices which include
regular exercise, weight loss, smoking cessation, and low-sodium diet to
maximize the effect of antihypertensive therapy.
-Educate patient and family members about drug’s effect to the body and
manifestations that would need reporting to enhance patient knowledge on
drug therapy and promote adherence.
-To rise slowly to sitting or standing position to minimize orthostatic
hypotension.
-To avoid salt substances, alcohol, grapefruit juice, OTC products unless
approved by prescribed
-If treating diabetic neuropathy, establish baseline electroneuromyographic
values at the beginning of drug treatment whenever possible. Periodically
reexamine these values to monitor peripheral nerve function and document
whether drug therapy delays the progression of neuropathic disease.
-Assess peripheral edema using girth measurements, volume displacement,
and measurement of pitting edema (See Appendix N). Report increased
swelling in feet and ankles or a sudden increase in body weight due to fluid
retention.

REFERENCES:

Ciccone,C.(2013).Losartan.Davis's Drug Guide for Rehabilitation

Professionals.222 Rosewood Drive, Danvers. F.A Davis Company.

Rxlist.(2018.)Cozaar.Retreived from https://www.rxlist.com/cozaar-

drug.htm#description

Sinha,S.(2018). Losartan.Drug.com. Retreived from

https://www.drugs.com/losartan.html