Renal impairment losartan

Candesartan cilexetil, losartan, and olmesartan differ from the other compounds in several respects. They are the only compounds with active metabolites, and they have the highest renal elimination of all of the agents. Product labeling indicates that renal impairment does not require a dosage reduction for losartan, but area under the curve values are increased by 50% in patients with ... 

Indometacin may attenuate the antihypertensive effect of losar-tan, valsartan, or other angiotensin II receptor antagonists. However, low-dose aspirin does not appear to alter the antihypertensive effect of losartan. No clinically relevant pharmacokinetic interactions occur between telmisartan and ibuprofen or paracetamol (acetaminophen), or between valsartan and indometacin. The combination of an NSAID and angiotensin II receptor antagonist can increase the risk of renal impairment and hyperkalaemia. 

Angiotensin II receptor antagonists are potassium-sparing, via their effects on aldosterone, and their potential to cause clinically important hyperkalaemia is well established. The incidence of hyperkalaemia varies depending on the clinical indication and other disease conditions, being lowest in essential hypertension, and highest in heart failure, diabetes, and renal impairment. For example, the incidence of hyperkalaemia in clinical studies in patients with hypertension was 0.9% with eprosartan - and 1.5% with losartan in type II diabetic patients with nephropathy, the incidence was 9.9% with losartan and 18.6% with irbesartan and in those with heart failure the incidence was 6.3% with candesartan. ... 

Comparative studies In a double-blind comparison of losartan 50 and 150 mg/day in patients with heart failure, high-dose losartan had a beneficial effect on mortality and hospital admissions with heart failure [52 ]. However, hyperkalemia, hypotension, renal impairment, and angioedema were more common in the high-dose group. 

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