Cozaar^® (Tablets) Instructions for Use

ATC Code

C09CA01 (Losartan)

Active Substance

Losartan (Rec.INN registered by WHO)

Clinical-Pharmacological Group

Angiotensin II receptor antagonist

Pharmacotherapeutic Group

Angiotensin II receptor antagonist

Pharmacological Action

Antihypertensive agent. It is a non-peptide blocker of angiotensin II receptors. It has high selectivity and affinity for AT₁ type receptors (through which the main effects of angiotensin II are mediated). By blocking these receptors, Losartan prevents and eliminates the vasoconstrictive action of angiotensin II, its stimulating effect on aldosterone secretion by the adrenal glands, and some other effects of angiotensin II. It is characterized by a long duration of action (24 hours or more), which is due to the formation of its active metabolite.

Pharmacokinetics

After oral administration, Losartan is rapidly absorbed from the gastrointestinal tract. Its bioavailability is about 33%. It is metabolized during the first pass through the liver with the formation of a carboxyl metabolite, which has more pronounced pharmacological activity than Losartan, and a number of inactive metabolites. The C_max in plasma for losartan and the active metabolite is reached after 1 hour and 3-4 hours, respectively. Plasma protein binding for losartan and the active metabolite is high – more than 98%.

The T_1/2 of losartan and the active metabolite in the terminal phase is about 1.5-2.5 hours and 3-9 hours, respectively. Losartan is excreted in the urine and feces (via bile) unchanged and in the form of metabolites. About 35% is excreted in the urine and about 60% in the feces.

Indications

Arterial hypertension.

Reduction of the risk of associated cardiovascular morbidity and mortality in patients with arterial hypertension and left ventricular hypertrophy, manifested by a reduction in the combined frequency of cardiovascular mortality, stroke, and myocardial infarction.

Renal protection in patients with type 2 diabetes mellitus with proteinuria – slowing the progression of renal failure, manifested by a reduction in the frequency of hypercreatininemia, the frequency of end-stage chronic renal failure requiring hemodialysis or kidney transplantation, mortality rates, as well as a reduction in proteinuria.

Chronic heart failure (as part of combination therapy, in case of intolerance or ineffectiveness of ACE inhibitor therapy).

ICD codes

Dosage Regimen

For arterial hypertension, initiate therapy with 50 mg administered orally once daily.

The antihypertensive effect is maintained for 24 hours.

If blood pressure control is insufficient, increase the dose to 100 mg once daily.

Alternatively, administer the 100 mg total daily dose as 50 mg twice daily.

For patients with intravascular volume depletion or those taking high-dose diuretics, initiate therapy with a lower initial dose of 25 mg once daily.

For nephropathy in type 2 diabetes with proteinuria, initiate therapy with 50 mg once daily.

Increase the dose to 100 mg once daily based on individual tolerability and blood pressure response.

For chronic heart failure, initiate therapy with 12.5 mg once daily.

Titrate the dose weekly, doubling it to a target maintenance dose of 50 mg once daily, as tolerated by the patient.

In patients with a history of hepatic impairment, use a lower initial dose.

For patients with severe hepatic impairment or cirrhosis, the recommended initial dose is 25 mg once daily.

Dosage adjustment may be necessary in patients with renal impairment, including those on dialysis.

Regularly monitor serum potassium levels and renal function during therapy.

Adverse Reactions

From the cardiovascular system dizziness, orthostatic hypotension.

From metabolism hyperkalemia.

Allergic reactions angioedema (including swelling of the face, lips, pharynx and/or tongue), urticaria.

From the digestive system diarrhea, increased ALT activity.

From the CNS headache.

Dermatological reactions pruritus.

Other renal function impairment, myalgia.

Contraindications

Pregnancy, lactation, childhood and adolescence under 18 years of age, hypersensitivity to losartan.

Use in Pregnancy and Lactation

Contraindicated for use during pregnancy and lactation.

Use in Hepatic Impairment

In patients with a history of liver disease, Losartan should be used in low doses. In liver cirrhosis, the plasma concentration of losartan increases significantly.

Use in Renal Impairment

In case of renal impairment, a dose reduction of losartan may be required.

Pediatric Use

The safety and efficacy of losartan in children have not been established.

Geriatric Use

In elderly patients, blood potassium levels should be regularly monitored during treatment.

Special Precautions

Use with caution in arterial hypotension, reduced circulating blood volume, water and electrolyte imbalance, bilateral renal artery stenosis or stenosis of the artery of a single kidney, in renal/hepatic insufficiency.

In patients with fluid and/or sodium deficiency, correction of water and electrolyte imbalances should be performed before starting treatment, or a lower initial dose should be used.

In patients with dehydration (e.g., those receiving high-dose diuretic therapy), symptomatic arterial hypotension may occur at the beginning of treatment with losartan.

In case of renal impairment, a dose reduction of losartan may be required.

In patients with a history of liver disease, Losartan should be used in low doses. In liver cirrhosis, the plasma concentration of losartan increases significantly.

Blood potassium levels should be regularly monitored during treatment, especially in elderly patients and in patients with renal impairment.

Concomitant use of losartan with potassium-sparing diuretics should be avoided.

The safety and efficacy of losartan in children have not been established.

Drug Interactions

With simultaneous use with diuretics in high doses, arterial hypotension is possible.

With simultaneous use with potassium preparations, potassium-sparing diuretics, the risk of hyperkalemia increases.

With simultaneous use with indomethacin, a decrease in the effectiveness of losartan is possible.

There is a report of lithium intoxication with simultaneous use with lithium carbonate.

With simultaneous use with orlistat, the antihypertensive effect of losartan decreases, which can lead to a significant increase in blood pressure and the development of a hypertensive crisis.

With simultaneous use with rifampicin, the clearance of losartan increases and its effectiveness decreases.

Storage Conditions

Store at 2°C (36°F) to 30°C (86°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.