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If dual blockade therapy is considered absolutely necessarythis should only occur under specialist supervision and subject to frequent close monitoring of renal functionelectrolytes and blood pressureACE-inhibitors and angiotensin II receptor blockers should not be used concomitantly in patients with diabetic nephropathy.
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As a consequence of inhibiting the renin-angiotensin systemchanges in renal function including renal failure have been reportedin particularin patients whose renal function is dependent on the reninangiotensin-aldosterone system such as those with severe cardiac insufficiency or pre-existing renal dysfunctionAs with other medicinal products that affect the renin-angiotensin-aldosterone systemincreases in blood urea and serum creatinine have also been reported in patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidneythese changes in renal function may be reversible upon discontinuation of therapyLosartan should be used with caution in patients with bilateral renal artery stenosis or stenosisof the artery to a solitary kidney.
Losartan is a synthetic oral angiotensin-II receptortype AT 1antagonistAngiotensin IIa potent vasoconstrictoris the primary active hormone of the renin/angiotensin system and an important determinant of the pathophysiology of hypertensionAngiotensin II binds to the AT 1 receptor found in many tissuese.gvascular smooth muscleadrenal glandkidneys and the heartand elicits several important biological actionsincluding vasoconstriction and the release of aldosteroneAngiotensin II also stimulates smooth muscle cell proliferation.
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