Adult Dosing
Hypertension
- Starting dose: 50 mg PO Daily, 25 mg in patient with depletion of intravascular volume or history of hepatic impairment
- Usual dose: 25-100 mg PO qd-bid
- Max: 100 mg/day
Heart failure (Non-FDA Approved)
- Note that similar dosing to that used for hypertension is typically used for this indication
Stroke prevention and left ventricular hypertrophy
- Initial dose: 50 mg PO Daily
- May increase to 100 mg Daily and/or add hydrochlorothiazide 12.5 mg PO Daily, followed by increase in hydrochlorothiazide to 25 mg Daily, as per blood pressure response
- Usual dose: 50-100 mg PO Daily to bid
- Max: 100 mg/day
Diabetic nephropathy in type 2 diabetes mellitus
- 50 mg PO Daily, may increase up to 100 mg Daily based on BP response
Note:
- Decreased efficacy in Black patients on monotherapy
Pediatric Dosing
- Safety and effectiveness in pediatric patients <6years of age have not been established
Hypertension (>6 yrs)
- Initial: 0.7 mg/kg (up to 50 mg total) PO Daily
- Maintenance dose: 0.7-1.4 mg/kg/day
- Max: 1.4 mg/kg/day (or in excess of 100 mg)
[Outline]
See Supplemental Patient Information
- Drugs that act directly on the renin-angiotensin system has been associated with fetal and neonatal morbidity including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure and death, when administered during the second and third trimesters of pregnancy [US Black Box Warning]
- Closely observe the infants with histories of in utero exposure to an angiotensin II receptor antagonist, for hypotension, oliguria, and hyperkalemia. Provide support of blood pressure and renal perfusion if oliguria occurs
- Symptomatic hypotension has been reported after initiation of therapy especially in volume or salt-depleted patients. If hypotension occurs place the patient in supine position and give IV or normal saline, closely monitor the patient during the therapy
- In patients whose renal function may depend on the activity of the renin-angiotensin-aldosterone system (eg, severe CHF), use may be associated with oliguria, progressive azotemia, acute renal failure and death
- Increase in serum creatinine or blood urea nitrogen (BUN) have been reported in patient with unilateral or bilateral renal artery stenosis
- ACE inhibitor can cause hyperkalemia in type 2 diabetic patients with proteinuria
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Severe aortic stenosis
- Renal artery stenosis
- Volume depleted
- Severe CHF
Supplemental Patient Information
- Warn the female patient of childbearing age about the consequences of second and third trimester exposure to drug that act on the renin-angiotensin system. Advise these patients to report pregnancies to their physicians as soon as possible
Pregnancy Category:C (First trimester); D (Second and third trimester )
Breastfeeding: An alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 March 2011). Significant levels of losartan and its active metabolite are secreted in rat milk. Because of the potential for adverse effects on the nursing infant manufacturer recommends to discontinue nursing or to discontinue the treatment, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Cozaar 50 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $88.13
90 mg = $234.32 - Cozaar 25 MG TABS [Bottle] (MERCK SHARP & DOHME)
30 mg = $64.28
90 mg = $188.69
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
