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07-SEPTEMBER-2008 03:17:44 - Losartan Losartan Systematic IUPAC name 1-2'-2H-tetrazol-5-ylbiphenyl-4-ylmethyl- 2-butyl-4-chloro-1H-imidazol-5-ylmethanol Identifiers CAS number 114798-26-4 ATC code C09CA01 PubChem 3961 DrugBank APRD00052 Chemical data Formula C22H23ClN6O Mol. mass 422.91 SMILES eMolecules PubChem Pharmacokinetic data Bioavailability 25-35% Metabolism Hepatic CYP2C9, CYP3A4 Half life 1.5-2 hours Excretion Renal 13-25%, biliary 50-60% Therapeutic considerations Pregnancy cat. DAU DUS Legal status ℞ Prescription only Routes Oral Losartan rINN pronounced /loʊˈsɑrtən/ is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure hypertension. Losartan was the first angiotensin II receptor antagonist to be marketed. It is currently marketed by Merck Co. under the trade name Cozaar. Contents 1 Clinical use 1.1 Combination with diuretic 2 Pharmacokinetics 3 Research 4 Mechanism of action pharmacological actions 5 References 6 See also Clinical use Main article: Angiotensin II receptor antagonist As with all angiotensin II receptor antagonists, losartan is indicated for the treatment of hypertension. Losartan may also delay progression of diabetic nephropathy and is also indicated for the reduction of renal disease progression in patients with type 2 diabetes, hypertension and microalbuminuria 30 mg/24 hours or proteinuria 900 mg/24 hours.1 Although angiotensin II receptor antagonists are not usually considered first-line, because of the proven effectivity and lower costs of thiazide diuretics and beta blockers, losartan may be used first-line in patients with increased cardiovascular risk. The LIFE study demonstrated that losartan was significantly superior to atenolol in the primary prevention of adverse cardiovascular events myocardial infarction or stroke, with a significant reduction in cardiovascular morbidity and mortality for a comparable reduction in blood pressure.2 Combination with diuretic Losartan is available in a combination formulation with a low dose thiazide diuretic, invariably hydrochlorothiazide, to counteract the increase in renin and to achieve an additive antihypertensive effect. The losartan/hydrochlorothiazide combination preparation is marketed by Merck under the trade name Hyzaar. Pharmacokinetics Losartan is well absorbed following oral administration and undergoes significant first-pass metabolism to produce 5-carboxylic acid metabolite, designated as EXP3174. This metabolite is long-acting 6 to 8 hr, noncompetitive antagonist at the AT1 receptor and contribute to the pharmacological effects of Losartan. It is 10-40 times more potent in blocking AT1 receptors than Losartan. Its bioavailability is about 32%. Research Losartan has been found to downregulate the expression of transforming growth factor beta TGF-β types I and II receptors in the kidney of diabetic rats, which may partially account for its nephroprotective effects.3 Effects on TGF-β expression may also account for its potential efficacy in Marfan syndrome and Duchenne muscular dystrophy DMD - losartan has been shown to prevent aortic aneurysm and certain pulmonary complications in a mouse model of the disease.4 Mechanism of action pharmacological actions Losartan is a selective, competitive Angiotensin II receptor type 1 AT1 receptor antagonist, reducing the end organ responses to angiotensin II. Losartan administration results in a decrease in total peripheral resistance afterload and cardiac venous return preload All of the physiological effects of angiotensin II, including stimulation of release of aldosterone, are antagonized in the presence of losartan. Reduction in blood pressure occurs independently of the status of the renin-angiotensin system. As a result of losartan dosing, plasma renin activity increases due to removal of the angiotensin II feedback. References ^ Rossi S, or. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3 ^ Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study LIFE: a randomised trial against atenolol. Lancet 2002;3599311:995-1003. PMID 11937178 ^ Guo ZX, Qiu MC. Losartan downregulates the expression of transforming growth factor beta type I and type II receptors in kidney of diabetic rat Zhonghua Nei Ke Za Zhi 2003;426:403-8. PMID 12895325 ^ Habashi JP, Judge DP, Holm TM, Cohn RD, Loeys BL, Cooper TK, et al. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome, and preserves muscle tissue architecture in DMD mouse models. Science 2006;3125770:117-21. PMID 16601194 See also Angiotensin II receptor antagonist v d e Merck Co., Inc. Corporate Directors: Richard Clark · Johnnetta Cole · William Harrison · William Kelley · Rochelle Lazarus · Thomas Shenk · Anne Tatlock · Samuel Thier · Wendell Weeks · Peter Wendell Products: Alendronate · Aprepitant · Ertapenem · Ezetimibe · Ezetimibe/simvastatin · Finasteride · Fosaprepitant · Indinavir · Losartan · Lovastatin · Montelukast · Raltegravir · Rizatriptan · Rofecoxib · Simvastatin · Sitagliptin · Vorinostat Publications: The Merck Index · The Merck Manual Annual Revenue: $22.9 billion USD ▲2% FY 2004 · Employees: 63,000 · Stock Symbol: NYSE: MRK · Website: www.merck.com v d e Agents acting on the renin-angiotensin system C09 ACE inhibitors Alacepril Benazepril Captopril Cilazapril Delapril Enalapril Fosinopril Imidapril Lisinopril Moexipril Perindopril Quinapril Ramipril Rentiapril Spirapril Temocapril Trandolapril Zofenopril Angiotensin II receptor antagonists AIIRA Azilsartan Candesartan Eprosartan Irbesartan Losartan Olmesartan Tasosartan Telmisartan Valsartan Renin inhibitors Aliskiren Remikiren Retrieved from http://en..org/wiki/Losartan Categories: Angiotensin II receptor antagonists | Tetrazoles | Imidazoles Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Italiano Magyar Nederlands Polski Português This page was last modified on 18 June 2008, at 12:32
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