Brand Name and Prescription Information for Losartan-Amlodipine Combination
Azor is not the correct brand name—Azor contains olmesartan and amlodipine, not losartan and amlodipine. There is no FDA-approved fixed-dose combination product containing losartan and amlodipine together, so you must prescribe these medications separately 1.
How to Prescribe for Hypertension with Diabetic Nephropathy
Step 1: Start with Losartan (Generic Name)
Losartan should be initiated first as the cornerstone of therapy because ACE inhibitors or ARBs are recommended first-line treatment for hypertensive patients with diabetes and albuminuria, particularly when urine albumin-to-creatinine ratio is ≥300 mg/g 2.
Prescription format:
- Starting dose: Losartan 50 mg PO once daily 1
- Target dose: Titrate to losartan 100 mg PO once daily based on blood pressure response and tolerability 1, 3
- The 100 mg daily dose is optimal for both renoprotection and blood pressure reduction in diabetic nephropathy 3
Step 2: Add Amlodipine if Blood Pressure Target Not Met
Add amlodipine only after optimizing losartan dose if blood pressure remains above target (<130/80 mmHg) 2, 4, 5.
Prescription format:
- Starting dose: Amlodipine 5 mg PO once daily 6
- Target dose: Titrate to amlodipine 10 mg PO once daily if needed after 4-6 weeks 6
Complete Prescription Example
Rx #1:
- Losartan 50 mg tablets
- Sig: Take 1 tablet by mouth once daily
- Disp: #30 tablets
- Refills: 3
- (Titrate to 100 mg after 2-4 weeks if tolerated and BP not at goal)
Rx #2 (if needed after losartan optimization):
- Amlodipine 5 mg tablets
- Sig: Take 1 tablet by mouth once daily
- Disp: #30 tablets
- Refills: 3
- (Titrate to 10 mg after 4-6 weeks if BP not at goal)
Critical Clinical Considerations
Why This Sequence Matters
- Losartan provides renoprotection beyond blood pressure lowering by reducing proteinuria by 48% at 100 mg daily and decreasing risk of doubling serum creatinine and progression to ESRD 3, 7
- Amlodipine does not provide renoprotection and is inferior to ACE inhibitors/ARBs for preventing progressive kidney function loss in diabetic nephropathy 8, 5
- Combination therapy is often necessary as multiple-drug therapy is generally required to achieve blood pressure targets in diabetic patients with nephropathy 2
Monitoring Requirements
- Check serum creatinine and potassium within 7-14 days after initiating or titrating losartan 2
- Monitor blood pressure to ensure target <130/80 mmHg is achieved 2
- Assess urine albumin-to-creatinine ratio at least annually 2
Important Contraindications
- Never combine losartan with an ACE inhibitor as dual RAS blockade increases risk of hyperkalemia, syncope, and acute kidney injury without added cardiovascular benefit 2
- Use 25 mg starting dose of losartan if patient has possible intravascular depletion (e.g., on diuretic therapy) 1
When Amlodipine Addition is Most Effective
Adding amlodipine to losartan monotherapy achieves blood pressure goal in 27.5% of patients versus 12.5% with placebo, reducing BP by an additional 8.1/5.4 mmHg 6. This combination is safe and well-tolerated in diabetic patients with hypertension 6.