Can losartan (angiotensin II receptor antagonist) cause tingling hands?

Can Losartan Cause Tingling Hands?

Losartan is not a recognized cause of tingling hands based on FDA labeling and clinical trial data, though paresthesia (abnormal sensations including tingling) has been reported as a less common adverse reaction. 1

Evidence from FDA Drug Labeling

The FDA-approved prescribing information for losartan documents paresthesia as a less common adverse reaction in clinical trials involving over 3,300 patients with hypertension. 1 However, this was not among the most frequent adverse events (≥2% incidence), which included:

• Dizziness (3%) 1
• Upper respiratory infection (8%) 1
• Nasal congestion (2%) 1
• Back pain (2%) 1

Clinical Trial Safety Data

Large-scale clinical trials demonstrate losartan's favorable tolerability profile:

• Overall discontinuation rate due to adverse events was only 2.3%, actually lower than placebo (3.7%). 1
• In the RENAAL study of 1,513 patients with diabetic nephropathy, adverse event rates were similar between losartan and placebo groups. 1
• Losartan is devoid of significant adverse effects according to comprehensive pharmacokinetic reviews. 2

Distinguishing Losartan from Other Causes

Important clinical pitfall: Tingling hands has multiple common etiologies that should be investigated before attributing symptoms to losartan:

• Peripheral neuropathy (diabetic, metabolic, or nutritional causes)
• Carpal tunnel syndrome or other nerve compression
• Electrolyte disturbances (particularly hyperkalemia, which can occur with ARBs) 1
• Cervical radiculopathy

Monitoring Recommendations

If a patient on losartan reports tingling hands:

• Check serum potassium levels, as losartan can cause hyperkalemia which may present with paresthesias. 3
• Assess kidney function, as recommended for all patients on ARBs. 3
• Evaluate for alternative causes of paresthesias before discontinuing effective antihypertensive therapy. 1

Comparative Context

Unlike ACE inhibitors which commonly cause cough (10-20% incidence), losartan has a cough incidence similar to placebo (17-29% vs 25-35% for placebo/hydrochlorothiazide). 1 This demonstrates that when losartan does cause side effects, they are well-documented in clinical trials—and tingling hands is not a prominent feature.

Clinical Bottom Line

While paresthesia is listed as a possible adverse reaction to losartan, it is uncommon and should prompt investigation for other causes rather than automatic drug discontinuation. 1 The excellent overall tolerability profile of losartan (withdrawal rate <2.3%) suggests that if symptoms are truly drug-related and bothersome, they would be unusual. 1, 4