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Losartan Uses, Dosage, Side Effects & Price | DrugsAtlas

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Therapeutic Class

Antihypertensive / Nephroprotective Agent

Subclass

Angiotensin II Receptor Blocker (ARB)

Speciality

Cardiology

Schedule (India)

Schedule H

Routes

Oral

Formulations

Tablets: 25 mg, 50 mg, 100 mg

Fixed-Dose Combinations (FDCs) Available:

Losartan + Hydrochlorothiazide (50/12.5 mg, 100/12.5 mg, 100/25 mg)
Losartan + Amlodipine (50/5 mg, 50/2.5 mg)
Losartan + Atenolol
Losartan + Chlorthalidone

Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Hypertension (Essential or Secondary)

Parameter	Dose
Starting dose	50 mg orally once daily
Titration	Increase after 2–4 weeks based on BP response
Usual maintenance dose	50–100 mg once daily (may be given in divided doses)
Maximum dose	100 mg/day

For Volume-Depleted Patients (on diuretics, salt restriction, diarrhoea):

Parameter	Dose
Starting dose	25 mg orally once daily
Titration	Increase gradually after correcting volume status
Usual maintenance dose	50–100 mg once daily
Maximum dose	100 mg/day

Clinical Notes:

First-line option per ICMR Hypertension Guidelines 2020 (along with CCBs, ACE inhibitors, thiazides)
Can be taken with or without food; no significant food interaction
May be combined with thiazide diuretics, CCBs, or beta-blockers for improved BP control
Active metabolite (E-3174) contributes significantly to antihypertensive effect; formed via CYP2C9
BP lowering effect evident within 1 week; maximum effect at 3–6 weeks

2. Diabetic Nephropathy in Type 2 Diabetes Mellitus (with Proteinuria and Hypertension)

Parameter	Dose
Starting dose	50 mg orally once daily
Titration	Increase to 100 mg once daily based on BP response and tolerability
Usual maintenance dose	100 mg once daily
Maximum dose	100 mg/day

Clinical Notes:

Evidence-based renoprotective effect: delays progression to ESRD (RENAAL trial)
Target dose of 100 mg/day recommended for maximal nephroprotection
Reduces proteinuria independent of BP lowering effect
Monitor serum creatinine and potassium closely (especially in first 1–3 months)
Acceptable up to 30% rise in creatinine from baseline if stabilises
May be combined with dihydropyridine CCB for additional BP control; avoid combining with ACE inhibitor routinely

3. Heart Failure with Reduced Ejection Fraction (HFrEF) — When ACE Inhibitor Not Tolerated

Parameter	Dose
Starting dose	12.5–25 mg orally once daily
Titration	Double dose every 1–2 weeks as tolerated based on BP, renal function, and potassium
Usual maintenance dose	50–100 mg once daily (or in divided doses)
Maximum dose	150 mg/day (some guidelines); typically 100 mg/day in Indian practice

Clinical Notes:

Use as alternative to ACE inhibitor when ACE inhibitor-induced cough or angioedema occurs
Combine with beta-blocker and diuretics per heart failure protocols
Not to be combined with ACE inhibitor and mineralocorticoid receptor antagonist together (triple RAAS blockade contraindicated)
Evidence from ELITE II and HEAAL trials
Monitor for symptomatic hypotension, worsening renal function, and hyperkalaemia

Secondary Indications – Adults (Off-label)

Indication	Dose	Duration	Supervision	Evidence Basis
Left Ventricular Hypertrophy (LVH) Regression with Hypertension (OFF-LABEL as specific indication)	50–100 mg once daily	Long-term	Not required	LIFE trial: losartan superior to atenolol for LVH regression and stroke prevention; Indian cardiology practice
Post-Myocardial Infarction (if ACE Inhibitor Not Tolerated) (OFF-LABEL)	Starting: 25–50 mg once daily; Target: 50–100 mg once daily	Long-term	Cardiology supervision recommended	OPTIMAAL trial; Indian specialist practice; alternative to captopril/ramipril in ACE-intolerant patients
Stroke Prevention in High CV Risk Patients with Hypertension (OFF-LABEL)	50–100 mg once daily	Long-term	Not required	LIFE trial: superior to atenolol for stroke prevention; some Indian cardiology protocols
Marfan Syndrome — Aortic Root Dilation Prevention (OFF-LABEL)	25 mg once daily; titrate to 50–100 mg once daily	Long-term	Specialist only (Cardiology/Genetics)	Limited RCT data; used in some Indian centres; alternative or adjunct to beta-blockers
Hyperuricaemia Associated with Hypertension (OFF-LABEL)	50–100 mg once daily	Long-term	Not required	Losartan uniquely promotes uric acid excretion among ARBs; may be preferred in hypertensive patients with gout/hyperuricaemia

Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

⚠️ Not recommended in children below 6 years of age. Safety and efficacy not established below this age.

Primary Indication: Hypertension in Children (≥6 years)

Weight-Based Dosing:

Weight	Starting Dose	Titration	Maximum Dose
20–50 kg	0.7 mg/kg once daily (approximately 25 mg)	Adjust based on BP response every 2–4 weeks	1.4 mg/kg/day OR 50 mg/day (whichever is lower)
>50 kg	50 mg once daily	Increase to 100 mg if needed after 2–4 weeks	100 mg/day

Parameter	Dose
Starting dose	0.7 mg/kg/day once daily (maximum initial dose: 50 mg)
Titration	Increase based on BP response every 2–4 weeks
Usual maintenance dose	0.7–1.4 mg/kg/day once daily
Maximum dose	1.4 mg/kg/day OR 100 mg/day (whichever is lower)

Safety Monitoring:

Serum creatinine and potassium at baseline, 1–2 weeks after initiation, and periodically thereafter
Blood pressure at each visit
Monitor for symptomatic hypotension (dizziness, fatigue)
Growth and development parameters

Clinical Notes:

Tablets may be crushed and mixed with water for administration if child cannot swallow whole tablets
Use with caution in children with renal impairment
Paediatric nephrology or cardiology supervision recommended

Secondary Indications – Paediatrics (Off-label)


Indication	Age	Dose	Duration	Supervision	Evidence Basis
Chronic Kidney Disease with Proteinuria (OFF-LABEL)	≥6 years	0.7–1.4 mg/kg/day once daily; Maximum: 100 mg/day	Long-term	Specialist only (Paediatric Nephrology)	Extrapolated from adult data; IAP nephrology practice
Alport Syndrome — Renoprotection (OFF-LABEL)	≥6 years	0.7–1.4 mg/kg/day once daily	Long-term	Specialist only (Paediatric Nephrology)	Limited evidence; used in some Indian paediatric nephrology centres

Age Restrictions:

Not recommended below 6 years of age
Use in younger children only in exceptional circumstances under paediatric nephrology or cardiology supervision
Contraindicated in neonates due to risk of severe hypotension and renal failure

Renal Adjustments

eGFR (mL/min/1.73 m²)	Recommendation
≥30	No dose adjustment required; monitor renal function and potassium
15–29	Start at lower dose (25 mg once daily); titrate cautiously; close monitoring of creatinine and potassium
<15 (including dialysis)	Start at 25 mg once daily; use with caution; monitor closely; not dialysable

Additional Notes:

Up to 30% rise in serum creatinine from baseline is acceptable if it stabilises; do not discontinue for modest creatinine rise unless progressive
Monitor potassium closely — hyperkalaemia risk increases with declining renal function
Not removed by haemodialysis (highly protein-bound); no supplemental dose required
Avoid combination with other RAAS blockers (ACE inhibitors, aliskiren) in patients with eGFR <60

Hepatic adjustment

Contraindications

Known hypersensitivity to losartan or any ARB
Pregnancy (especially 2nd and 3rd trimesters — fetotoxic; causes oligohydramnios, fetal renal failure, neonatal death)
Bilateral renal artery stenosis (or stenosis in solitary kidney)
Co-administration with aliskiren in patients with diabetes mellitus or eGFR <60 mL/min/1.73 m²
History of angioedema with ARB or ACE inhibitor use
Severe hepatic impairment without specialist supervision

Cautions

Volume depletion or dehydration (risk of symptomatic first-dose hypotension) — correct volume status before initiation
Unilateral renal artery stenosis — may precipitate acute renal failure
Chronic kidney disease (eGFR <60) — requires close monitoring of creatinine and potassium
Hyperkalaemia risk — avoid or use cautiously with potassium supplements, potassium-sparing diuretics, or aldosterone antagonists
Aortic stenosis or hypertrophic obstructive cardiomyopathy — may cause excessive hypotension
Elderly patients — more sensitive to hypotensive effects; start low
Concurrent NSAIDs — may reduce antihypertensive efficacy and worsen renal function
Concurrent lithium — increases lithium toxicity risk
Primary hyperaldosteronism — poor response expected
Black patients — may have reduced antihypertensive response (consider combination therapy)

Pregnancy

Parameter	Information
Overall Safety	Contraindicated — especially in 2nd and 3rd trimesters; fetotoxic
Risk	Fetal renal dysgenesis, oligohydramnios, anuria, pulmonary hypoplasia, skeletal deformities, neonatal hypotension, neonatal death
First Trimester	Avoid; if inadvertent exposure occurs, discontinue immediately and switch to safer alternative; fetal anomaly scan recommended
Preferred Alternatives	Labetalol (first-line for chronic hypertension in pregnancy); Nifedipine ER; Methyldopa
Monitoring (if exposure occurred)	Detailed fetal anomaly scan; amniotic fluid index; fetal renal function assessment; neonatal renal function and BP after delivery

Lactation

Parameter	Information
Compatibility	Insufficient data; avoid if possible during breastfeeding
Expected Drug Level in Milk	Unknown; likely low based on high protein binding
Preferred Alternatives	Enalapril (more breastfeeding data); Amlodipine; Nifedipine ER; Labetalol
Infant Monitoring	If exposure occurs: monitor for poor feeding, lethargy, hypotension (theoretical risks)
Recommendation	Use alternative antihypertensive with better lactation data; if essential, monitor infant closely

Elderly

Parameter	Recommendation
Starting dose	25 mg orally once daily
Titration	Increase gradually every 2–4 weeks based on BP response and tolerability
Maximum recommended	100 mg/day
Increased Risks	First-dose hypotension (especially if volume-depleted); falls; acute kidney injury; hyperkalaemia
Additional Precautions	Assess renal function and volume status before initiation; check electrolytes and creatinine within 1–2 weeks of starting; use with caution in those on multiple antihypertensives or diuretics

Major drug interactions

Interacting Drug	Mechanism	Effect	Management
Aliskiren (in diabetics or CKD)	Dual RAAS blockade	Increased risk of hyperkalaemia, hypotension, and acute kidney injury	Contraindicated in diabetic patients or those with eGFR <60
ACE Inhibitors (dual RAAS blockade)	Additive RAAS inhibition	Increased risk of hyperkalaemia, hypotension, and renal dysfunction without significant additional benefit	Avoid combination routinely; use only in specific heart failure situations under specialist supervision
Potassium supplements / Potassium-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene)	Additive potassium retention	Hyperkalaemia (potentially life-threatening)	Avoid combination if possible; if essential, monitor potassium frequently; reduce or stop potassium supplements
Lithium	Reduced renal lithium excretion	Lithium toxicity (tremor, ataxia, confusion, seizures)	Monitor lithium levels closely; may need lithium dose reduction; avoid if possible
NSAIDs (chronic use) — ibuprofen, diclofenac, naproxen	Inhibit prostaglandin-mediated renal vasodilation	Reduced antihypertensive efficacy; increased risk of acute kidney injury and hyperkalaemia	Avoid chronic NSAID use; if essential, monitor BP, renal function, and potassium

Moderate drug interactions

Interacting Drug	Effect	Management
Thiazide / Loop Diuretics	Additive hypotension (especially first-dose); beneficial for BP control	Start losartan at lower dose (25 mg) if already on diuretic; monitor for symptomatic hypotension
Rifampicin	CYP2C9 induction; reduced conversion to active metabolite; decreased antihypertensive efficacy	Monitor BP; may need higher losartan dose or alternative antihypertensive
Fluconazole	CYP2C9 inhibition; increased losartan and active metabolite levels	Monitor BP and for adverse effects; usually clinically manageable
Warfarin	Minor interaction; both metabolised by CYP2C9	Monitor INR when initiating or adjusting losartan; usually no significant change
Trimethoprim	Additive hyperkalaemia risk	Monitor potassium, especially in elderly or those with renal impairment
Antidiabetic Agents (insulin, sulfonylureas)	Potential enhanced hypoglycaemic effect	Monitor blood glucose, especially when initiating ARB
Digoxin	No significant pharmacokinetic interaction	No adjustment needed; safe combination

Common Adverse effects

Dizziness, lightheadedness
Fatigue, asthenia
Hyperkalaemia (especially with CKD or concurrent potassium-elevating drugs)
Mild creatinine elevation (usually transient)
Headache
Upper respiratory tract infection
Cough (less common than with ACE inhibitors; <1%)
Diarrhoea
Back pain, muscle cramps

Serious Adverse effects

Adverse Effect	Clinical Action
Angioedema (rare but potentially life-threatening; involves face, lips, tongue, larynx)	Unidentified
Severe Hyperkalaemia (>6.0 mEq/L)	Discontinue or reduce dose; ECG monitoring; treat hyperkalaemia urgently; identify contributing factors
Acute Kidney Injury (especially in bilateral renal artery stenosis, severe heart failure, or volume depletion)	Discontinue or reduce dose; IV fluids if volume-depleted; investigate cause
Severe Hypotension (especially first-dose)	Supportive care (supine position, IV fluids); reduce dose or discontinue temporarily
Hepatotoxicity (rare; transaminase elevation)	Monitor LFTs if symptoms; discontinue if significant elevation
Rhabdomyolysis (very rare)	Discontinue; check CK; supportive care

Monitoring requirements

Timing	Parameters
Baseline	Serum creatinine, eGFR, serum potassium, blood pressure; urine protein (if diabetic nephropathy)
1–2 weeks after initiation or dose increase	Serum creatinine, potassium; blood pressure
First 3 months	Creatinine and potassium monthly if high-risk (CKD, elderly, concurrent diuretics/potassium-sparing agents)
Long-term (every 3–6 months)	Serum creatinine, potassium, blood pressure; annual urine protein if diabetic nephropathy
Special Situations	More frequent monitoring in elderly, CKD, concurrent NSAIDs, diuretics, or potassium-affecting drugs

Brands in India

Monotherapy:

Losar™ (Unichem) — 25 mg, 50 mg, 100 mg
Repace™ (Torrent) — 25 mg, 50 mg, 100 mg
Cosart™ (Cipla) — 25 mg, 50 mg, 100 mg
Losacar™ (Cadila) — 25 mg, 50 mg
Losartan™ (Various generics) — 25 mg, 50 mg, 100 mg
Angizaar™ (Micro Labs) — 25 mg, 50 mg
Lorsave™ (Alkem) — 50 mg

Fixed-Dose Combinations (Examples):

Repace-H™ (Losartan + Hydrochlorothiazide) — 50/12.5 mg, 100/12.5 mg
Losar-H™ (Losartan + HCTZ) — 50/12.5 mg
Cosart-H™ (Losartan + HCTZ) — 50/12.5 mg, 100/25 mg
Arbitel-L™ (Losartan + Amlodipine)
Repace-AM™ (Losartan + Amlodipine)

Price range (INR)

25 mg tablet	₹0.80–₹2.50 per tablet	—
50 mg tablet	₹1.20–₹4.00 per tablet	NLEM listed
100 mg tablet	₹2.50–₹7.00 per tablet	—
FDC with HCTZ (50/12.5 mg)	₹2.50–₹6.00 per tablet	—
FDC with HCTZ (100/25 mg)	₹4.00–₹8.00 per tablet	—

Regulatory: Listed under NLEM 2022 (50 mg tablet); NPPA price controlled for scheduled strengths; widely available in government supply

Clinical pearls

Preferred ARB in diabetic nephropathy — Losartan (at 100 mg/day target dose) has the strongest evidence base for renoprotection in Type 2 DM with proteinuria (RENAAL trial); use full dose for maximal nephroprotective benefit
Unique uricosuric effect — Unlike other ARBs, losartan promotes uric acid excretion; preferred choice in hypertensive patients with concurrent gout or hyperuricaemia
Cough advantage over ACE inhibitors — Cough incidence <1% compared to 5–15% with ACE inhibitors; excellent alternative in patients with ACE inhibitor-induced cough
First-dose hypotension prevention — In volume-depleted patients or those on high-dose diuretics, start at 25 mg to avoid symptomatic hypotension; correct volume depletion before initiating
Avoid dual RAAS blockade — Do not routinely combine losartan with ACE inhibitors or aliskiren; increases hyperkalaemia and AKI risk without mortality benefit (ONTARGET trial)
CYP2C9 metaboliser considerations — Losartan is a prodrug; poor CYP2C9 metabolisers may have reduced response; rifampicin reduces efficacy; fluconazole may increase levels

Version

RxIndia v1.0 — 26 Apr 2025

Reference

CDSCO Product Information
Indian Pharmacopoeia (IP)
National List of Essential Medicines (NLEM) 2022
API Textbook of Medicine
ICMR Guidelines for Management of Hypertension 2020
AIIMS Antihypertensive Treatment Protocols
Harrison's Principles of Internal Medicine
Goodman & Gilman's The Pharmacological Basis of Therapeutics
RENAAL Trial (diabetic nephropathy evidence)
LIFE Trial (LVH regression and stroke prevention evidence)
ELITE II, HEAAL Trials (heart failure evidence)
ONTARGET Trial (dual RAAS blockade evidence)
IAP Guidelines (paediatric dosing support)
WHO Essential Medicines List (paediatric supportive reference)

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This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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