Can Losartan cause facial edema?

From the Guidelines

Losartan can potentially cause facial edema as a side effect, although it is a less common occurrence compared to angiotensin-converting enzyme inhibitors (ACE-Is) 1. Losartan is an angiotensin II receptor blocker (ARB) commonly used to treat high blood pressure and protect the kidneys in people with diabetes. While generally well-tolerated, it can cause fluid retention in some patients, which may manifest as swelling in various parts of the body, including the face. If you experience facial edema while taking Losartan, you should:

• Contact your healthcare provider immediately.
• Do not stop taking the medication abruptly without medical advice.
• Monitor for other signs of allergic reactions or angioedema, such as difficulty breathing or swelling of the throat. The mechanism behind this side effect is related to how ARBs affect the renin-angiotensin-aldosterone system. By blocking angiotensin II receptors, Losartan can sometimes lead to an imbalance in fluid regulation, resulting in edema. It's worth noting that the risk of angioedema associated with ARBs like Losartan is lower compared to ACE-Is, but still a possibility 1. Your doctor may need to adjust your dosage or switch you to an alternative medication if the facial edema persists or becomes severe. They will weigh the benefits of blood pressure control against the side effects to determine the best course of action for your individual case. In the context of drug-induced photosensitivity, Losartan is listed as one of the angiotensin receptor blockers that may be associated with this condition, along with other medications like Candesartan, irbesartan, olmesartan, telmisartan, and valsartan 1. However, this is not directly related to the question of facial edema.

From the FDA Drug Label

Hypersensitivity: Angioedema, including swelling of the larynx and glottis, causing airway obstruction and/or swelling of the face, lips, pharynx, and/or tongue has been reported rarely in patients treated with losartan; Yes, Losartan can cause facial edema, as it is associated with angioedema, which can cause swelling of the face, lips, pharynx, and/or tongue 2.

From the Research

Losartan and Facial Edema

• Losartan, an angiotensin II receptor blocker (ARB), has been associated with angioedema, a condition characterized by swelling of the skin or mucosa, in several case reports 3, 4, 5, 6.
• Facial edema, specifically, has been reported as a symptom of angioedema in patients taking losartan 3, 5, 6.
• The exact mechanism of losartan-induced angioedema is not fully understood, but it is thought to be related to the activation of the bradykinin-prostaglandin-nitric oxide cascade 6.
• Angioedema is a rare but potentially life-threatening side effect of losartan, and patients should be warned to look for early signs of swelling, particularly in the face, lips, and tongue 3, 4, 5, 6.
• In one case report, a patient who experienced facial angioedema after taking an ACE inhibitor was switched to losartan, which resolved the swelling 7. However, this does not necessarily mean that losartan is safe for all patients who have experienced angioedema with ACE inhibitors.

Key Findings

• Losartan can cause angioedema, including facial edema, in rare cases 3, 4, 5, 6.
• The onset of angioedema can occur within hours to months after starting losartan therapy 5, 6.
• Patients with a history of angioedema, particularly those who have experienced it with ACE inhibitors, should be cautious when taking losartan 5.