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Cozaar (losartan) is used to lower high blood pressure, protect the kidneys from damage in type 2 diabetes, and to protect patients who have an enlarged heart from stroke. With modified dosing it can be used in children as young as 6 years old.

Cozaar is an angiotensin receptor blocker (ARB) that, ultimately, relaxes and widens blood vessels. This action lowers blood pressure, improves oxygen flow, and reduces the heart's overall workload.

Though a potent medication, Cozaar may not be enough to lower particularly high or resistant blood pressure; other antihypertensive treatments are commonly given along with Cozaar, either as separate products or in a combined tablet, such as Hyzaar, which includes a thiazide diuretic as well as Losartan.

Treating Hypertension

Cozaar tablets are taken just once per day, with or without food as desired. Treatment is very similar in treating adults who have hypertension:

• Start with 50 mg once per day.
• After two or three weeks, dosage may be increased to 100 mg per day.
• Do not exceed 100 mg per day. Adding another medication will provide more benefit.

In children age 6 and up dosage is based on weight:

• Administer 0.7 mg per kg of weight, taken once per day.
• Do not exceed 50 mg per day.

Patients who have liver impairment or low blood volume may be started on lower 12.5 or 25 mg doses; these lower doses are also good for children. Very young patients may prefer an oral solution rather than tablets. Otherwise healthy adults may have dosage decreased over time as blood pressure is controlled.

Those trying to manage high blood pressure should attend regular doctor checkups to ensure Cozaar is working correctly and to monitor for developing side effects.

Treatment will likely continue for the remainder of life unless actions are taken to address the underlying issue, which in most cases involves lifestyle changes such as exercise and salt regulation.

Protecting Kidneys

Type 2 diabetes can damage the small blood vessels in the kidneys, which, if untreated, can eventually lead to kidney failure. Those with type 2 diabetes usually have high blood pressure; those very rare patients who have type 2 diabetes but do not have high blood pressure do not need Cozaar, as it will lower blood pressure---hypotension is just as dangerous as hypertension.

Treatment is simple:

• Start with 50 mg once per day.
• After two or three weeks, dosage may be increased to 100 mg per day.

Treatment should continue for as long as it provides benefit, which may be for the remainder of life if lifestyle changes are not made or are not adequate.

Stroke Prevention

Cozaar will lower blood pressure regardless of what it's used for, so in stroke prevention it's given when the patient has both hypertension and left ventricular hypertrophy, an enlarged heart. These patients are at particular risk of stroke.

Treatment in this case also involves a diuretic, usually hydrochlorothiazide. Cozaar is available in combination with hydrochlorothiazide in the product Hyzaar, for those who prefer to take just one tablet, or the two can be taken individually.

Treatment is typically:

• Start with 50 mg losartan once per day.
• After several days, add 12.5 mg of hydrochlorothiazide.
• The end goal is 100 mg losartan and 25 mg hydrochlorothiazide per day, but depending on blood pressure this may not be attainable.

Black patients should note that this medication may be only marginally effective, or not effective at all. Beta-blockers like atenolol (brand name Tenormin) produced much better result for black patients in studies.

Side Effects

Serious side effects from Cozaar are rare, but they do unfortunately happen. Be alert for and seek medical attention if experiencing:

• Painful urination
• Difficulty breathing
• Chest pain
• Rapid, slow, or irregular heartbeat
• Loss of movement
• Severe weakness
• Confusion

Most side effects are much milder, and they typically stop occurring as the body adjusts to treatment:

• Dizziness
• Dry cough
• Stuffy nose
• Sore throat
• Mild back pain

Cozaar can cause harm to unborn babies, especially if taken in the second or third trimester. Pregnant women should avoid this product. Effects on nursing infants are unclear.

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Hyzaar (losartan, hydrochlorothiazide) is a combination medication used to treat high blood pressure when a single medication is not producing good results.

The two medications in this product are:

• Losartan is an angiotensin receptor blocker (ARB) that relaxes and widens blood vessels, improving blood flow and oxygen delivery to the heart.
• Hydrochlorothiazide, more commonly called HCTZ, is a thiazide diuretic that removes salts and excess fluid through urine. This lowers overall blood volume, which lowers blood pressure.

Together the two medications lower blood pressure, improve oxygen flow, and reduce the overall workload of the heart. Untreated, high blood pressure can lead to injury of blood vessels and the heart; ultimately it may lead to heart attack, stroke, kidney failure, and other unpleasant or potentially lethal conditions.

Hyzaar is usually prescribed in one of three scenarios:

• The patient is already taking HCTZ and losartan individually and wishes to combine them for convenience;
• The patient has already been taking either HCTZ or losartan and needs to add another medication to fully control blood pressure;
• The patient isn't taking anything for blood pressure but will likely need multiple medications to control it.

Regardless, Hyzaar will lower blood pressure, usually significantly so. Occasionally some individuals will need to add a third treatment.

Taking Hyzaar

Hyzaar comes in tablets, of which there are three dosage strengths to choose from:

• 50/12.5 mg losartan/HCTZ
• 100/12.5 mg losartan/HCTZ
• 100/25 mg losartan/HCTZ

The medication is taken just once per day, usually in the morning as it will increase urine output. Food is optional.

Treatment is typically as follows:

• Patients taking both losartan and HCTZ individually should start with the same doses of Hyzaar, or as close as possible.
• Patients taking one or the other medication individually should start with the same dose of the one being taken and the lowest dose of the new medication.
• Patients new to blood pressure treatment should be started on 50/12.5 mg losartan/HCTZ.

It takes about three weeks of treatment to see maximum benefit, and doctors will usually wait that long before adjusting dosage.

Individuals taking Hyzaar are usually encouraged to also make lifestyle changes; quitting smoking, regulating salt, exercise, and so forth. Some patients are able to successfully make and maintain these changes, eventually no longer needing to rely on medications like Hyzaar. Others are unable to make adequate changes, or lifestyle is not the problem; these individuals may need to rely on blood pressure medications for the remainder of life.

Warnings Before Use

Hyzaar is well-tolerated, but it will lower blood pressure. Patients may experience symptoms---particularly at the start of treatment or following dosage changes---of low blood pressure, including dizziness or lightheadedness when rising from a resting position. As long as these symptoms are mild they're not cause for concern, and should stop occurring in the first few weeks of Hyzaar use.

If also taking medications to lower cholesterol---particularly bile acid-binding resins such as cholestyramine or colestipol---Hyzaar should be taken at least 4 hours before or 4 to 6 hours after.

Black patients who have hypertension and left ventricular hypertrophy should be aware that Hyzaar may produce little to no benefit.

Rarely serious side effects will develop. Seek medical attention if experiencing:

• Fainting
• Eye pain
• Vision changes
• Muscle weakness
• Muscle cramps
• Rapid, slow, or irregular heartbeat
• Severe confusion
• Difficulty urinating

Hyzaar may cause harm to unborn babies; this medication is not preferred in pregnant women and only used in life-threatening scenarios when other medications are unavailable or cannot be used. It is unknown how it effects nursing infants.