Losartan
Klassificering: AATC kod: C09CA01, C09DA01
Sammanfattning
Den blodtryckssänkande effekten av losartan är likvärdig hos kvinnor och män.
Biverkningsprofilen av losartan är likartad mellan könen.
Kunskapsunderlaget avseende skillnader mellan kvinnor och män är begränsat och motiverar inte olika dosering eller behandling.
Additional information
Pharmacokinetics and dosing
In a pharmacokinetic study, single oral and intravenous doses of losartan produced plasma concentrations of losartan that were two-fold higher in hypertensive women than in hypertensive men, due to reduced systemic clearance in women. However, plasma concentrations of the active metabolite of losartan, E 3174 (ten times more effective than the parent compound), were similar in men and women [1-4]. Even though some pharmacokinetic sex differences of losartan have been described, the clinical relevance of these has not been shown and therefore no dosage adjustment based on sex has been considered necessary [3].
Effects
A review evaluating clinical experience with losartan from worldwide, double-blind, controlled studies, confirm that the antihypertensive effect of losartan is similar in women and men [1, 3-6]. The large randomized, triple-blind LIFE study (4230 men, 4963 women) compared losartan with atenolol for reducing cardiovascular morbidity and mortality in patients, aged 55-80 years, with hypertension and left ventricular hypertrophy. Treatment effect of losartan (50 mg daily) was similar in men and women. A sex difference in the primary composite end point (cardiovascular mortality, stroke, and myocardial infarction) was observed, regardless of treatment with losartan or atenolol [7].
A clinical trial reported that women had less regression of electrocardiographic left ventricular hypertrophy than men during losartan therapy. Regression of ECG left ventricular hypertrophy is associated with improved prognosis. These findings suggest that women may derive less prognostic benefit [8].
Adverse effects
Reviews and meta-analysis consisting of several double-blind trials have reported that the overall incidence of adverse clinical events in losartan-treated patients was similar in men and women [5, 6]. In the LIFE study, women had more adverse events than men, regardless of treatment with losartan or atenolol. Serious adverse events (i.e. events causing hospitalization, prolongation of hospitalization, or death) did not differ between men and women (38.3% vs. 36.3%) [7].
Reproductive health issues
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept
Fler kvinnor än män hämtade ut tabletter innehållande losartan (ATC-kod C09CA01) på recept i Sverige år 2015, totalt 139 793 kvinnor och 126 459 män. Det motsvarar 29 respektive 26 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 70 år och äldre hos båda könen. I åldersgruppen yngre än 70 år var tabletter innehållande losartan i genomsnitt 1,3 gånger vanligare hos män medan i åldersgruppen 70 år och äldre var det i genomsnitt 1,1 gånger vanligare hos kvinnor [9].
Nästan lika många män och kvinnor hämtade ut tabletter innehållande kombination av losartan och hydroklortiazid (ATC-kod C09DA01) på recept i Sverige år 2015, totalt 56 334 män och 56 087 kvinnor. Det motsvarar 12 respektive 12 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 70-84 år hos båda könen. I åldersgruppen yngre än 75 år var tabletter innehållande kombination av losartan och hydroklortiazid i genomsnitt 1,7 gånger vanligare hos män och i åldersgruppen 75 år och äldre i genomsnitt 1,2 gånger vanligare hos kvinnor [9].
Uppdaterat: 2019-02-26
Litteratursökningsdatum: 2014-01-08
Referenser
- McIntyre M, Caffe SE, Michalak RA, Reid JL. Losartan, an orally active angiotensin (AT1) receptor antagonist: a review of its efficacy and safety in essential hypertension. Pharmacol Ther. 1997;74:181-94. PubMed
- Sica DA, Gehr TW, Ghosh S. Clinical pharmacokinetics of losartan. Clin Pharmacokinet. 2005;44:797-814. PubMed
- Cozaar (losartan potassium). DailyMed [www]. US National Library of Medicine. [updated 2013-10-01, cited 2014-01-08]. länk
- Cozaar (losartan). Summary of Product Characetristics. Medical Products Agency Sweden; 2015. länk
- Mallion JM, Goldberg AI. Global efficacy and tolerability of losartan, an angiotensin II subtype 1-receptor antagonist, in the treatment of hypertension. Blood Press Suppl. 1996;2:82-6. PubMed
- Goldberg AI, Dunlay MC, Sweet CS. Safety and tolerability of losartan compared with atenolol, felodipine and angiotensin converting enzyme inhibitors. J Hypertens Suppl. 1995;13:S77-80. PubMed
- Os I, Franco V, Kjeldsen SE, Manhem K, Devereux RB, Gerdts E et al. Effects of losartan in women with hypertension and left ventricular hypertrophy: results from the Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension. 2008;51:1103-8. PubMed
- Okin PM, Gerdts E, Kjeldsen SE, Julius S, Edelman JM, Dahlöf B et al. Gender differences in regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy. Hypertension. 2008;52:100-6. PubMed
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk
Faktagranskat av: Mia von Euler
Godkänt av: Karin Schenck-Gustafsson