Cozaar: Effective Blood Pressure Control and Kidney Protection
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Cozaar (losartan potassium) is an angiotensin II receptor blocker (ARB) prescribed for the management of hypertension (high blood pressure) and for the treatment of diabetic nephropathy in patients with type 2 diabetes and a history of hypertension. It works by blocking the action of certain natural substances that tighten the blood vessels, allowing the blood to flow more smoothly and the heart to pump more efficiently. This medication is a cornerstone in cardiovascular and renal protective strategies, offering a well-tolerated profile for long-term use. Clinical evidence supports its role in reducing the risk of stroke in patients with hypertension and left ventricular hypertrophy.
Features
- Active Ingredient: Losartan Potassium
- Drug Class: Angiotensin II Receptor Blocker (ARB)
- Available Strengths: 25 mg, 50 mg, 100 mg film-coated tablets
- Administration: Oral
- Bioavailability: Approximately 33%
- Half-life: Approximately 2 hours (and 6-9 hours for active metabolite)
- Time to Peak Plasma Concentration: 1 hour (losartan); 3-4 hours (active metabolite)
- Excretion: Primarily via bile (35%) and urine (35%) as metabolites
Benefits
- Effectively lowers high blood pressure, reducing strain on the cardiovascular system.
- Demonstrates nephroprotective properties, slowing the progression of kidney disease in type 2 diabetic patients.
- Lowers the risk of stroke in hypertensive patients with left ventricular hypertrophy.
- Generally well-tolerated with a lower incidence of cough compared to ACE inhibitors.
- Provides 24-hour hemodynamic control with once-daily dosing for most patients.
- Offers a favorable side effect profile for long-term antihypertensive therapy.
Common use
Cozaar is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents such as thiazide diuretics. It is also approved for the reduction of renal disease progression in patients with type 2 diabetes and elevated serum creatinine and proteinuria (macroalbuminuria). Furthermore, it is used in the management of hypertensive patients with left ventricular hypertrophy to reduce the risk of stroke, as demonstrated in the LIFE (Losartan Intervention For Endpoint reduction in hypertension) study. Off-label uses may include heart failure management, though this is not a primary FDA-approved indication.
Dosage and direction
The dosage of Cozaar must be individualized based on the patient’s condition and response. For hypertension, the usual starting dose is 50 mg once daily. The dosage can be increased to 100 mg once daily based on blood pressure response. For volume-depleted patients (e.g., those treated with high-dose diuretics), a starting dose of 25 mg once daily is recommended. For nephropathy in type 2 diabetic patients, the usual starting dose is 50 mg once daily, which can be increased to 100 mg once daily based on blood pressure response. Cozaar may be administered with or without food. Tablets should be swallowed whole with a glass of water.
Precautions
Patients should be monitored for hypotension, especially after initiation or dosage increase. Renal function should be assessed prior to initiation and periodically during treatment, particularly in patients with renal artery stenosis, heart failure, or volume depletion. Serum potassium should be monitored, especially in patients with renal impairment or diabetes, and those taking potassium supplements or potassium-sparing diuretics. Use with caution in patients with hepatic impairment; consider a lower starting dose. Cozaar should not be used during pregnancy due to the risk of fetal injury and death. Caution is advised in patients with a history of angioedema.
Contraindications
Cozaar is contraindicated in patients with known hypersensitivity to losartan or any component of the formulation. It is contraindicated in patients with a history of angioedema related to previous treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker. Cozaar is contraindicated in combination with aliskiren in patients with diabetes. Its use is contraindicated during the second and third trimesters of pregnancy due to the risk of fetal harm.
Possible side effect
The most common adverse reactions occurring in >1% of patients treated with Cozaar and more frequently than placebo include:
- Dizziness
- Upper respiratory infection
- Nasal congestion
- Back pain
- Fatigue Less common but serious side effects may include:
- Hypotension (especially in volume-depleted patients)
- Hyperkalemia
- Impaired renal function
- Angioedema (rare)
- Increases in blood urea nitrogen (BUN) and serum creatinine
Drug interaction
Cozaar may interact with several medications, potentially requiring dosage adjustments or increased monitoring:
- Potassium-sparing diuretics (e.g., spironolactone), potassium supplements, or salt substitutes containing potassium: Increased risk of hyperkalemia.
- NSAIDs (e.g., ibuprofen, naproxen): May reduce antihypertensive effect and increase risk of renal impairment.
- Lithium: Increased lithium concentrations and toxicity.
- Other antihypertensive agents: Additive hypotensive effects.
- Aliskiren: Contraindicated in patients with diabetes due to increased risk of renal impairment, hyperkalemia, and hypotension.
- Rifampin: May decrease losartan concentrations.
Missed dose
If a dose of Cozaar is missed, it should be taken as soon as remembered on the same day. If it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one. Consistency in dosing is important for maintaining stable blood pressure control.
Overdose
The most likely manifestation of overdose with Cozaar is hypotension and tachycardia; bradycardia could occur from parasympathetic (vagal) stimulation. If symptomatic hypotension occurs, supportive treatment should be instituted. Treatment should involve correction of dehydration and electrolyte imbalances. Losartan and its active metabolite are not removed by hemodialysis due to high protein binding. Management should focus on hemodynamic support, including intravenous fluids and vasopressors if necessary, with continuous monitoring of vital signs and electrolyte status.
Storage
Cozaar tablets should be stored at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). The medication should be kept in its original container, tightly closed, and protected from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not flush medications down the toilet or pour them into a drain unless instructed to do so.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. Individual patient responses to medication may vary.
Reviews
Clinical trials and post-marketing surveillance demonstrate that Cozaar is generally well-received by both clinicians and patients. Physicians appreciate its efficacy in blood pressure control and its renal protective benefits in diabetic patients, noting its favorable side effect profile compared to some other antihypertensive classes. Patients often report satisfactory blood pressure management with minimal side effects, though some note dizziness, particularly upon initiation. The once-daily dosing regimen is frequently cited as convenient for adherence. Long-term studies, such as the LIFE trial, provide robust evidence for its cardiovascular protective effects, reinforcing its position in treatment guidelines.