Losartan for gout. The anti-hypertensive that's also good for gout





This page about Losartan for gout was last reviewed or updated on 7 December  2017

One brand name: COZAAR. Also available as a generic.


WHY LOSARTAN IN GOUT TREATMENT? 

Losartan is not a top-flight gout medicine for lowering uric acid or alleviating pain, It is primarily an anti-hypertensive for controlling high blood pressure, a member of the class of drugs known as angiotensin II receptor blockers (ARB’s). 

Losartan and uric acid  I have included it in our gout drugs’ pages because, unlike anti-hypertensives such as diuretics, beta blockers, ACE Inhibitors, calcium channel blockers, and non-losartan ARB’s, all of which can raise uric acid, losartan can lower blood uric acid. This property makes it a unique anti-hypertensive. It does this by blocking the kidneys from re-absorbing uric acid and so they excrete more. By enough, in fact, to reduce the blood uric acid level. That's the rationale for losartan for gout.

Because so many people with gout also have high blood pressure, you can see why losartan is useful. To repeat, it can lower both high blood pressure and uric acid.

But Losartan does not lower uric acid by large amounts. It isn’t allopurinol, febuxostat, probenecid or another specifically uric acid lowering med. But it can reduce uric acid by an amount useful enough to give it a role in some gout therapy cases. And if you simply have hyperuricaemia (that is high uric acid above 7.0 mg/dL  (0.416 mmol/L) plus high blood pressure, but not gout, and you live in a country where drugs are used for hyperuricaemia without gout, you might be prescribed it. 

In a Spanish study (1) losartan was used to control uric acid in patients who had lowered uric acid to below 6.0 mg/dL and who were monitored to see if their uric acid would subsequently rise above 7.0 mg/dL, the level around which gout trouble often begins.

Losartan was used by some patients in one group who did not have a repeat gout attack for 2¾ years because they kept uric acid below 7.0 mg/dL, after they had successfully lowered it to a crystal dissolving level.

In a Chinese study (2) in patients who received 50 mg of losartan daily for six months, serum (blood) uric acid fell continuously through the study. Even in the 6th month it still fell, although in another study it was seen that reductions eventually stabilise (stabilize).

And in number crunching of the very large United Kingdom general practice database (3) – involving 24,768 patients in whom gout first developed, between 2001 and 2007, compared with 50,000 non-gout patients, those taking losartan were found to have a lower risk of gout. (And calcium channel blockers also showed a lower risk of gout, by almost the same amount as losartan). 

The longer losartan was taken, and the higher the dose, the lower the risk compared with all the other anti-hypertensives mentioned in this article’s first paragraph. The risk of gout was lowered by approximately a third to a quarter less than the risk of a gout attack in those who didn’t take losartan, and compared to those who took other hypertensives.

On the other hand, the risk of gout from diuretics was twice as likely.

Losartan has one more gout interesting effect. It may also raise the pH of urine, (achieving more alkaline urine) an effect similar to that caused by potassium citrate. What is useful about this is that elevated urine pH increases the solubility of uric acid, which it is thought aids its excretion. 

In a 2011 Japanese study, acidic urine reduced uric acid excretion. (6) And in another study, (in 2010) alkaline urine (achieved by eating a more alkaline diet) raised uric acid excretion by about 37%. (7)

Dosage  How much losartan for gout? One 50 mg tablet daily for four weeks has been found to lower blood uric acid by – 0.79 mg/dL (0.470 mmol/L) from 9.05 mg/dL(0.538 mmol/l) to 8.26 mg/dL  (0.491 mmol/L). (4) In another study it decreased serum (blood) uric acid by – 0.70 mg/dL from 5.9 to 5.2 mg/dL. That is nearly 12% (5). It has done somewhat better than this in other studies and it might for you.

It is also available in 25 mg and 100 mg tablets. Losartan tablets are swallowed with a glass of water.

To put these results in context. Someone who has gout will usually have a blood uric acid level above 7.0 mg/dL (e.g. 8.5 or 12 or even 14+) and needs to reduce it to below 6.0 mg/dL. So losartan is useful in controlling uric acid once it’s been lowered to MSU crystal dissolving levels, and perhaps in treating gout cases where uric acid is not elevated or is only slightly elevated. There are better drugs than this to reduce uric acid and gout attacks. 

But if you have hypertension and gout, or hypertension and an elevated risk of gout, (e.g. it runs in the family), your doctor may prescribe it. It might also be prescribed to offset the uric acid raising properties of other anti-hypertensives you might take.

Side effects and interactions  Losartan’s side effects in people with hypertension are infections (colds, flu), dizziness, congestion of the nose, even back pain. All these are in a small percentage of takers. A fuller description of its side effects is at this web page.

Its inter-actions with other drugs are described here.




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References

(1)  Fernando Perez-Ruiz, Ana Maria Herrero-Beites, Loreto Carmona. A Two-Stage Approach to the Treatment of Hyperuricemia in Gout: The “Dirty Dish” Hypothesis. Arthritis & Rheumatism. Vol. 63 No.12, December 2011. Pages 4002-4006.

(2)  Abstract. Zhu X, Chen J, Han F, Cheng M, Xu L, Zhang L, Ding X, Le Y. Efficacy and safety of losartan in treatment of hyperuricemia and posttransplantation erythrocytosis: results of a prospective, open randomized, case-control study. Transplantation Proceedings. 2009 Nov;41(9):3736-42.

(3)  Hyon K Choi, Lucia Cea Soriano, Yuqing Zhang, Luis A García Rodríguez Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. British Medical Journal (BMJ) 2012;344:d8190 doi: 10.1136/bmj.d8190 (Published 12 January 2012)

(4) Abstract. Würzner G, Gerster JC, Chiolero A, Maillard M, Fallab-Stubi CL, Brunner HR, Burnier M. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia and gout. Journal of Hypertension. 2001 Oct;19(10):1855-60.

(5)  Abstract. Hamada T, Hisatome I, Kinugasa Y, Matsubara K, Shimizu H, Tanaka H, Furuse M, Sonoyama K, Yamamoto Y, Ohtahara A, Igawa O, Shigemasa C, Yamamoto T. Effect of the angiotensin II receptor antagonist losartan on uric acid and oxypurine metabolism in healthy subjects. Internal Medicine, Tokyo. 2002 Oct;41(10):793-7.

(6) Abstract. A. Kanbara and I. Seyama Effect of Urine pH on Uric Acid Excretion by Manipulating Food Materials. Nucleosides, Nucleotides and Nucleic Acids. 2011 December; 30(12):1066-71.

(7) Aya Kanbara, Masayuki Hakoda, Issei Seyama. Urine alkalization facilitates uric acid excretion. Nutrition Journal 2010, 9:45

Alternative Health Research/Flamasil™


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