Combining Losartan with Other Blood Pressure Medications

February 23, 2025/Andrew Le

High blood pressure poses a serious threat to your life, and in 2022, it was linked to 685,875 deaths in the US. You might worry about sudden changes in your health and the potential for side effects; however, there is hope. Combining losartan with other blood pressure medications offers a better way to lower your pressure.

There are a variety of possible combinations with Losartan. Some pairings help remove extra fluid, while others further protect your heart and kidneys. The combinations work on different levels to give you faster, safer control of your blood pressure. Different combinations may be required for different situations, but treatment can ultimately be suited to address individual needs.

In this article, you will learn how losartan works with diuretics, calcium channel blockers, beta-blockers, and more to manage your blood pressure and keep you safer.

🔑Key Takeaways

➤ Losartan-HCTZ combos can lower your systolic and diastolic numbers by over 20 mmHg, and older adults see remarkable gains from this approach.

➤ Add a beta-blocker like carvedilol if you want more heart protection after a heart attack. This combo can ease your heart’s workload and improve blood flow.

➤ Try amlodipine with losartan for a faster drop in your blood pressure. Fluid buildup from amlodipine often improves because losartan blocks certain effects.

➤ Lithium levels can increase if taken alongside losartan. This risk can lead to lithium toxicity, so ask your doctor first before using this combination.

➤ Steer clear of NSAIDs while you’re on losartan. They can raise your blood pressure or harm your kidneys.

➤ Food and herbs change how losartan works. Grapefruit juice slows how your body breaks down losartan, and Ginkgo biloba may affect your active drug levels.

➤ If you combine alcohol with losartan, you are at risk for your blood pressure to drop too much. You can feel dizzy or faint, so take extra care.

Common Combinations with Losartan

Combining losartan with other medications can significantly improve blood pressure management. Here are the most common combinations:

1. Diuretics

Losartan is commonly paired with diuretics to remove excess fluid and lower blood pressure effectively. Some work fast, while others help balance potassium levels.

Here’s a list of the most prescribed diuretics:

  • Hydrochlorothiazide (Microzide)
  • Chlorthalidone (Thalitone)
  • Indapamide (Lozol)
  • Metolazone (Zaroxolyn)
  • Furosemide (Lasix)
  • Bumetanide (Bumex)
  • Torsemide (Demadex)
  • Ethacrynic acid (Edecrin)
  • Spironolactone (Aldactone)
  • Eplerenone (Inspra)
  • Amiloride (Midamor)
  • Triamterene (Dyrenium)
  • Acetazolamide (Diamox)
  • Methazolamide (Neptazane)

Losartan is often used with hydrochlorothiazide (HCTZ) to treat high blood pressure. This is especially helpful for patients with blood pressure over 20/10 mmHg above their target. HCTZ activates the renin-angiotensin-aldosterone system, making losartan better at blocking the angiotensin II type 1 receptor. Plus, losartan can reduce some side effects of HCTZ, like the increased risk of elevated blood glucose.

This combination is great for long-term blood pressure control. In the ARCH study, patients who didn’t get enough control with just an ARB or an ARB plus a calcium channel blocker (CCB) were given losartan-HCTZ. After three months, their average blood pressure dropped from 158/88 mmHg to 138/78 mmHg. About 36% of patients reached their target blood pressure. These improvements lasted at least a year, showing the therapy is stable.

Older adults also benefit from this combination, especially those with morning hypertension, a major risk factor for heart and brain problems. A study found that in patients aged 75 and older, losartan-HCTZ lowered morning systolic blood pressure by 20.2 mmHg compared to just 7.1 mmHg with high-dose losartan alone. Younger elderly patients saw a drop of 18.1 mmHg with the combination versus 9.1 mmHg with high-dose losartan. More patients on the combination reached their blood pressure goals—40.6% in the very elderly and 55.1% in the younger elderly. Safety was also a key finding, with no major changes in kidney function or potassium levels.

2. Calcium Channel Blockers 

Doctors often prescribe Calcium Channel Blockers (CCBs) with Losartan to help lower high blood pressure more effectively. Here are the most commonly prescribed CCBs:

  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem, Tiazac)
  • Verapamil (Calan, Verelan)
  • Nifedipine (Procardia, Adalat CC)
  • Felodipine (Plendil)
  • Nicardipine (Cardene)
  • Isradipine (Dynacirc)
  • Nisoldipine (Sular)

You can combine losartan high blood medication like amlodipine to boost its effectiveness in lowering blood pressure. A study found this combination to be very effective for managing hypertension. It compared patients taking amlodipine and losartan together against those taking amlodipine alone in Korean patients with stage 2 hypertension, it included 148 adults. Some took amlodipine 5 mg with losartan 50 mg, while others took just amlodipine 5 mg. 

After two weeks, patients with systolic blood pressure over 140 mmHg had their dose increased to amlodipine 10 mg with losartan 50 mg or amlodipine 10 mg alone. By week six, the group taking both drugs saw their systolic blood pressure drop by an average of 36.5 mmHg. This was better than the 31.6 mmHg reduction in the amlodipine-only group. More patients in the combination group reached their blood pressure goals at two weeks (52.1% versus 33.3%). However, by weeks six and eight, the difference was not significant.

Why does this combination work so well? Amlodipine causes blood vessels to widen, sometimes leading to swelling in the capillaries. Losartan helps prevent this side effect. Moreover, CCBs activate the renin-angiotensin system, which losartan blocks, strengthening the blood pressure-lowering effect.

3. Beta-Blockers

Beta-blockers are also used with Losartan to lower blood pressure by reducing heart rate and easing the heart’s workload.

Here are the most commonly prescribed ones:

  • Carvedilol (Coreg)
  • Metoprolol (Lopressor, Toprol XL)
  • Atenolol (Tenormin)
  • Propranolol (Inderal, Inderal LA)
  • Bisoprolol (Zebeta)
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)
  • Labetalol (Trandate, Normodyne)

Losartan is combined with beta-blockers such as carvedilol to manage high blood pressure and heart conditions. 

A study found that both drugs cut systolic and diastolic blood pressure over 24 weeks. Losartan lowered central systolic blood pressure by 14.3 mmHg, while carvedilol did so by 13.6 mmHg. The central diastolic blood pressure dropped by 7.6 mmHg with losartan and by 9.0 mmHg with carvedilol. Yet, losartan improved the augmentation index by 5.0%, whereas carvedilol barely made a difference.

Another study examined how carvedilol and losartan, alone or together, affect the heart after a heart attack in rats. They divided 100 rats into four groups: a control group, a carvedilol group, a losartan group, and a group taking both. The control rats showed worse heart pressures, volumes, weights, and thickness. Both losartan and carvedilol improved these heart measures. Interestingly, the rats taking both drugs had even better heart improvements, suggesting that using them together might be more effective.

4. Direct Renin Inhibitors

Aliskiren (Tekturna) is the only FDA-approved Direct Renin Inhibitor for high blood pressure.

Direct Renin Inhibitors can boost the effectiveness of Losartan in managing high blood pressure. DRIs target the renin-angiotensin system right from the beginning. They stop the body from making angiotensin I, producing less angiotensin II. Since angiotensin II tightens blood vessels and raises blood pressure, blocking its production helps lower your blood pressure.

It has been proven that aliskiren effectively lowers blood pressure. In a phase III clinical trial, participants taking aliskiren alone experienced a significant drop in blood pressure across several dosage levels, so you can see that the effect increases with dosage. Moreover, even after discontinuing the medication, the reduction in blood pressure lasted for 24 hours without a rebound.

The AVOID trial found that adding aliskiren to losartan therapy in patients with high blood pressure reduced systolic pressure by 2 mmHg and diastolic pressure by 1 mmHg compared to placebo. In another study on non-diabetic CKD patients, all treatment groups—aliskiren alone, losartan alone, and the combination—reached blood pressure goals. After three years, their systolic pressure dropped to about 130 mmHg and diastolic pressure to 85 mmHg. These results suggest that an aliskiren helps maintain stable blood pressure over time.

Other Drug Interactions

When you take losartan, it’s important to watch for other drug interactions that can cause serious side effects.

1. Lithium

Losartan can cause a sharp rise in your blood lithium levels. This quick spike may lead to lithium toxicity and sometimes even become life-threatening. It can require hospitalization, especially if you are older or have kidney problems, heart failure, sodium restrictions, or dehydration.

If you take both drugs, you should speak with your doctor. They may suggest alternatives or change your dose. You might notice signs such as:

  • Drowsiness
  • Dizziness
  • Confusion
  • Diarrhea
  • Vomiting
  • Muscle weakness
  • Tremors
  • Blurry vision
  • Ringing in the ears
  • Strong thirst
  • Increased urination

If these symptoms appear, seek medical help right away. It is also important to tell your doctor about any other medications, vitamins, or herbal supplements you use.

A case study showed this risk clearly. A 61-year-old man with bipolar disorder, high blood pressure, and diabetes developed lithium toxicity after taking 50 mg of losartan along with his usual 1,350 mg daily lithium dose. He had used these drugs together before without any issues. However, dehydration likely triggered the toxicity. He experienced irritability, tremors, confusion, and disorientation. Lab tests confirmed a high lithium concentration, hyponatremia, and small increases in serum creatinine and blood urea nitrogen.

2. NSAIDs

NSAIDs like ibuprofen and naproxen help with pain and fever, but using them with losartan can be risky. Losartan works to protect your kidneys, yet it may also affect them. When combined with NSAIDs, the chance of kidney problems goes up, especially if you are older, take diuretics, or already have kidney issues.

Ibuprofen can also raise your blood pressure, which makes it harder for losartan to work. This interaction is moderate, but frequent use can harm kidney function. Symptoms include:

  • Nausea
  • Vomiting
  • Changes in urination
  • Swelling

These symptoms should prompt you to contact your doctor. 

Furthermore, NSAIDs may also block the effects of blood pressure drugs by lowering prostaglandins, which are needed to keep your kidney blood flow steady. This can lead to acute kidney injury, marked by low urine output and leg swelling. 

3. Rifampin

Losartan is changed by enzymes CYP2C9 and CYP3A4 into an active form called E3174, which lowers blood pressure. At the same time, rifampin speeds up the removal of both losartan and E3174 from your body, changing how they work.

A study with ten healthy volunteers showed that rifampin lowered the area under the concentration-time curve of losartan by 35% and of E3174 by 40%. Losartan was cleared 44% faster, and the half-life of both compounds dropped by 50%. 

While rifampin is an uncommon medication, taking it with losartan may lessen losartan’s effects. You should tell your healthcare provider about every medication you use, including vitamins and herbs, and do not start or stop any medicine without advice. 

Other Interactions

It’s important to know various herbs, foods, and alcohol that may affect how losartan works. Here’s what you need to know:

Herbals

Some herbal agents can change how well losartan works. For example, Ginkgo biloba and Berberine have been shown to potentially lessen losartan’s effect. This means a dose adjustment of losartan may be required when taking Ginkgo biloba or Berberine. 

Nigella sativa, or black cumin, works a bit differently. It increases the amount of losartan in the blood, boosting blood pressure lowering power. In tests with rats, Nigella sativa made losartan work even better than when used alone. 

Food

Losartan interacts with some foods. If you take losartan, you should avoid foods high in potassium, like certain salt substitutes or potassium supplements, unless your doctor advises otherwise. Too much potassium can build up in your blood and lead to problems such as:

  • Weakness
  • Irregular heartbeat
  • Confusion
  • Tingling
  • Heavy legs

If these symptoms appear, seek help immediately.

Grapefruit juice is another food to watch. It can slow down how your body processes losartan and may lower the drug’s effectiveness. A study with volunteers showed that grapefruit juice delays the conversion of losartan into its active form. This means you might not get the full benefit of your medication.

Alcohol

Losartan and alcohol have a moderate drug interaction that can lower your blood pressure more than expected. When you take both, they may work together to reduce your blood pressure. This effect can lead to:

  • Headaches
  • Dizziness
  • Lightheadedness
  • Fainting
  • Changes in your pulse or heart rate

These problems are most common when you start treatment, after a dose increase, or restart the medicine after a break.

The NIAA warns that mixing alcohol with medications can also increase the risk of:

  • Internal bleeding
  • Heart problems
  • Breathing difficulties

Alcohol may even make some medications less effective or harmful to your body. Therefore, you should avoid alcohol while taking losartan to help keep you safe and ensure the medicine works well.

Wrap Up

Combining losartan medication for high blood can help you control your blood pressure better. You use it with diuretics to remove extra fluid and with calcium channel blockers to open up your blood vessels. It also works with beta-blockers. You might take losartan with hydrochlorothiazide or amlodipine. The mix can lower blood pressure and protect your heart. 

However, some combinations may cause side effects. You should avoid mixing losartan with drugs like lithium or NSAIDs because they harm your kidneys. 

Always talk with your doctor before adding any medicine. Your health matters, so check your progress and follow advice. This plan keeps you safe.

Frequently Asked Questions

Can you take losartan and metoprolol together?

Yes, losartan and metoprolol can be taken together with proper medical supervision. They are safe to combine, even if prescribed for different conditions.

Can you take losartan with a potassium supplement?

No, you should not take losartan with a potassium supplement or salt substitutes containing potassium without consulting your doctor or pharmacist. Mixing them may increase your potassium levels.

Can you take losartan with aspirin for heart health?

You should talk to your doctor before taking losartan with aspirin for heart health. Combining these medications may reduce losartan’s effectiveness in lowering blood pressure, but there could be protective qualities from aspirin that outweigh the risks. 

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