Losartan

COZAAR

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Pronunciation: loe-SAR-tan (KOE-zar)

Losartan ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Losartan ballicule

Losartan COZAAR mascot mnemonic cartoon — Visual mnemonic: Losartan mascot
**“Cozier Lord sartan”**
Arby’s for ARB
Satan for sartan
Bananas in bunches → ↑ serum potassium

What it isAT1 receptor antagonist for hypertension and diabetic nephropathy.

Why this oneIts uricosuric effect distinguishes it from other ARBs and can help when gout coexists.

What limits itCheck potassium and creatinine; avoid in pregnancy. CYP2C9 inhibition or poor metabolism can blunt formation of its more potent metabolite.

Losartan molecular structure (skeletal formula) — Molecular structure: Losartan

FDA-approved for

hypertension (1995)
diabetic nephropathy (2002)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity — discontinue as soon as pregnancy is detected; drugs acting on the renin-angiotensin system can injure and kill the developing fetus.

FDA dosing	Population	Start	Target	Max
Hypertension	Adults	50 mg QD (25 mg if volume-depleted)		100 mg/day
Hypertension	Peds ≥6 yr	0.7 mg/kg QD (up to 50 mg)		1.4 mg/kg or 100 mg/day
Hypertension with left ventricular hypertrophy	Adults	50 mg QD	add HCTZ 12.5 mg and/or increase to 100 mg, then HCTZ 25 mg
Nephropathy in type 2 diabetes	Adults	50 mg QD	100 mg QD if further BP response needed

Renal No adjustment needed (unless volume-depleted); not recommended if GFR <30 mL/min/1.73 m² (peds)

Hepatic Mild–moderate: 25 mg QD; not studied in severe impairment

Instructions

Correct volume or salt depletion before starting
Oral suspension (2.5 mg/mL) may be compounded from tablets for pediatric use

Available strengths

tab 25, 50, 100 mg
susp 10 mg/mL

Contraindications

Coadministration with aliskiren in patients with diabetes

Cautions

Fetal toxicity
Hypotension in volume- or salt-depleted patients
Renal function deterioration (esp. renal artery stenosis, CKD, severe HF)
Hyperkalemia

Adverse reactions

Dizziness
Upper respiratory infection
Nasal congestion
Back pain
Angioedema (postmarketing)

Pregnancy Can cause fetal harm (oligohydramnios, fetal/neonatal renal failure, death); discontinue when pregnancy detected

Lactation Unknown whether excreted in human milk; decide whether to discontinue nursing or the drug

Cost

Losartan (COZAAR)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
25 mg	tab	30 qd	$0.65	offered
50 mg	tab	30 qd	$0.98	offered
100 mg	tab	30 qd	$1.34	offered

Available combined with: hydrochlorothiazide / losartan

Generic entry2010

⚠ BOXED WARNING

Fetal toxicity; discontinue as soon as pregnancy is detected

Principal riskHyperkalemia and acute kidney injury

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, fetal toxicity and increased lithium exposure.

Active metabolites

EXP3179

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Memory aids: interaction avatars

CYP2C9 substrate

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