From the Guidelines
If losartan IV is unavailable, an alternative IV antihypertensive medication is Enalaprilat, which can be administered as a 0.625-1.25 mg IV dose, as it is the most similar in mechanism to losartan, being an angiotensin-converting enzyme inhibitor, and has a relatively favorable profile with a duration of action of 4-6 hours 1. When considering alternatives to losartan, it's crucial to evaluate the patient's clinical situation and comorbidities.
- The choice of medication depends on factors such as heart rate, presence of heart failure, asthma, or bradycardia, as certain medications like beta-blockers (e.g., esmolol, metoprolol) or labetalol may be contraindicated or require cautious use in these conditions 1.
- Other options like nicardipine, clevidipine, or fenoldopam may be preferred in specific scenarios due to their distinct mechanisms of action, such as calcium channel blockade or direct vasodilation, and their respective durations of action and potential side effects 1.
- It's also important to note that medications like nitroglycerine or nitroprusside, although effective, may require close monitoring due to potential adverse effects like headache, reflex tachycardia, or cyanide intoxication 1.
- Ultimately, the selection of an alternative to losartan should prioritize the patient's safety, the medication's efficacy in lowering blood pressure, and its potential impact on morbidity, mortality, and quality of life, with Enalaprilat being a viable option due to its similarity in mechanism to losartan and its established use in hypertensive emergencies 1.
From the Research
Alternative to Losartan
If Losartan, an Angiotensin II receptor antagonist, is not available, alternative intravenous (IV) medications can be considered for managing hypertensive crises.
- The traditional drug of choice for therapy of hypertensive emergencies is sodium nitroprusside 2.
- Intravenous labetalol produces a prompt, controlled reduction in blood pressure and is a promising alternative 2.
- Other agents used for hypertensive emergencies include diazoxide, trimethaphan camsylate, hydralazine, nitroglycerin, and phentolamine, although these have disadvantages such as unpredictable antihypertensive effects and potential adverse effects 2.
- For patients with essential hypertension, combinations of antihypertensive drugs like lisinopril, losartan, or valsartan with hydrochlorothiazide, or in combination with amlodipine, have been found to be effective in reducing blood pressure and improving arterial stiffness 3.
- Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, has been compared to losartan in several studies, showing comparable efficacy in reducing blood pressure and atherosclerosis, but with a different side effect profile 4, 5, 6.
- Enalapril/nitrendipine combination has been found to have a similar antihypertensive efficacy to losartan/hydrochlorothiazide, with a higher office systolic blood pressure control rate but more mild adverse events 5.