Topical Losartan in Medical Practice
Topical losartan is currently only used for corneal scarring fibrosis prevention and treatment in ophthalmology, and is not approved for any other medical conditions. 1
Ophthalmologic Applications
Topical losartan has shown promising results in ophthalmology, specifically for:
- Prevention and treatment of corneal scarring fibrosis
- Reduction of scarring after corneal injuries including:
- Descemetorhexis
- Alkali burns
- Photorefractive keratectomy injuries
- Surgical complications 1
The mechanism of action involves losartan's ability to impede transforming growth factor (TGF) beta signaling by inhibiting activation of extracellular signal-regulated kinase (ERK), which plays a key role in fibrotic processes in the eye 1.
Investigational Uses
Topical losartan is being investigated for potential use in:
- Conjunctival fibrotic diseases (ocular cicatricial pemphigoid, Stevens-Johnson syndrome)
- TGFBI-related corneal dystrophies
- Reduction of conjunctival bleb scarring after glaucoma surgery
- Treatment of intraocular fibrotic diseases 1
Systemic vs. Topical Losartan
While systemic (oral) losartan is well-established for:
- Hypertension management
- Diabetic nephropathy
- Left ventricular hypertrophy 2
The topical formulation represents a novel application that targets local tissue effects rather than systemic angiotensin II receptor blockade.
Current Status and Evidence
Topical losartan remains primarily investigational with:
- Successful animal studies in rabbits
- Limited human case reports following surgical complications
- No FDA approval for topical formulations 1
Clinical trials are still needed to fully establish the efficacy and safety profile of topical losartan for ocular conditions.
Clinical Implications
For clinicians considering topical losartan:
- Currently only available in research settings or as compounded preparations
- Not commercially available as a standard ophthalmic product
- Would require collaboration with compounding pharmacies for clinical use
- Should be considered experimental until more robust clinical data emerges
The systemic form of losartan (oral tablets) should not be applied topically as it is not formulated for this purpose and could potentially cause harm 2.