Losartan is contraindicated in pregnancy. It should be discontinued when pregnancy is diagnosed. It should be used with caution in patients with renal artery stenosis. Losartan is excreted in urine and in bile and reduced doses may therefore be required in patients with renal impairment and should be considered in patients with hepatic impairment. Patients with volume depletion (e.g. those who have received high-dose diuretic therapy) may experience hypotension; volume depletion should be corrected before starting therapy, or a low initial dose should be used. Since hyperkalemia may occur, serum potassium concentrations should be monitored, especially in the elderly patients with renal impairment, and the concomitant use of potassium-sparing diuretics should generally be avoided. Losartan should be used with caution in diabetic with reduced awareness of hypoglycemia.
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