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Losartan is an angiotensin receptor blocker (ARB) approved by the US Food and Drug Administration (FDA) for the treatment of several medical conditions, including hypertension and diabetic nephropathy. Losartan inhibits angiotensin II–induced vasopressin release, adrenal catecholamine release, rapid and slow pressor responses, thirst, cellular hypertrophy and hyperplasia, noradrenergic neurotransmission, and sympathetic tone increase. In addition, losartan inhibits angiotensin II–induced vasoconstriction and the effects of aldosterone, thereby lowering blood pressure. ARBs exhibit renoprotective effects in type 2 diabetes. In hypertension with left ventricular hypertrophy, losartan inhibits angiotensin II-induced cardiac remodeling, consequently reducing the risk of stroke in these patients. This activity reviews the use of losartan, including indications, mechanism of action, contraindications, pharmacokinetics, adverse event profiles, eligible patient populations, and monitoring. This activity also highlights the critical role of the interprofessional healthcare team in managing hypertension and diabetic nephropathy with losartan. Objectives: Identify appropriate indications for losartan therapy, including hypertension and diabetic nephropathy, based on patient-specific clinical presentations and guidelines. Implement appropriate dosing strategies for losartan based on patient-specific factors, such as renal function and comorbidities. Apply knowledge of potential adverse effects of losartan, including hyperkalemia and angioedema, to promptly recognize and manage adverse reactions. Collaborate with other healthcare team members to ensure comprehensive care for patients prescribed losartan when managing complex cases involving losartan therapy to optimize patient outcomes. Access free multiple choice questions on this topic.

In a recent case report, a female patient aged 34 with a medical history of asthma, hypertension, and chronic respiratory failure had an overdose of losartan. She intentionally ingested 30 tablets of 25 mg of losartan in a suicide attempt. Illicit substance use was ruled out through a negative urine drug screen. During her hospitalization, the patient developed acute kidney injury and hyperkalemia. Based on the patient's complaint of diffuse abdominal pain, elevated lipase levels (161 U/L), and computed tomography (CT) imaging findings, acute pancreatitis was diagnosed. Supportive care, including fluid resuscitation, pain management, and continuous monitoring of laboratory parameters, was provided, gradually improving her condition. The healthcare team should be mindful of the possibility of drug-induced acute pancreatitis following an overdose of losartan from acute kidney injury and hyperkalemia.[27] No consensus recommendation for overdosing on ARBs exists. The chronic use of ARBs at standard doses can block the renin-angiotensin and sympathetic nervous systems, leading to shock that may not respond to catecholamines. In cases of refractory shock, vasopressin can be considered.[28] No antidote for losartan is available, and hemodialysis is ineffective in removing losartan from circulation due to the high PPB, as mentioned in pharmacokinetics. Supportive care should be instituted for overdose cases.

Although any clinician can prescribe losartan for hypertension and diabetic nephropathy, regular monitoring of renal function and blood pressure by the interprofessional healthcare team is essential. Input from heart failure specialists or cardiologists regarding GDMT is recommended for evidence-based treatment. Losartan is effective for hypertension and can be incorporated into long-term therapy plans, but its optimal use still necessitates the participation of an interprofessional team to optimize treatment outcomes. When initially prescribed, a pharmacist must verify appropriate dosing, conduct medication reconciliation, and counsel the patient regarding losartan. Nursing staff also play a crucial role in offering valuable patient counseling, addressing inquiries, and evaluating therapeutic effectiveness during subsequent visits. The pharmacist or nursing staff should promptly communicate any concerns to the prescriber to facilitate timely therapeutic adjustments through shared decision-making. In cases of overdose, consultation with a medical toxicologist is recommended. An interprofessional team approach, fostering open communication among physicians, advanced practice practitioners, specialists, nurses, pharmacists, and toxicologists, is pivotal in optimizing patient outcomes while mitigating potential adverse effects associated with losartan therapy.