Losartan Appetite & Cravings Changes: What the Evidence Actually Shows

Does Losartan Change Appetite or Food Cravings?

Losartan is an ARB labeled for hypertension, stroke risk reduction in hypertension with left ventricular hypertrophy, and diabetic nephropathy in type 2 diabetes with hypertension [1]. The label's adverse reactions section lists dizziness (3% vs 2% with placebo), upper respiratory infection (8% vs 7%), nasal congestion (2% vs 1%) and back pain (2% vs 1%) as reactions occurring in at least 2% of patients and more often than placebo [1]. No effect of losartan on appetite, increased hunger or food cravings is established.

What the Large Trials Reported

LIFE randomized 9,193 adults with hypertension and left ventricular hypertrophy to losartan-based or atenolol-based treatment [3]. The primary cardiovascular composite occurred in 508 losartan patients and 588 atenolol patients, a relative risk of 0.87 (95% CI 0.77 to 0.98, P=0.021) [3]. New-onset diabetes was less frequent with losartan [3].

RENAAL randomized 1,513 adults with type 2 diabetes and nephropathy to losartan 50 to 100 mg daily or placebo, each added to conventional antihypertensive treatment [4]. The primary composite of doubling of serum creatinine, end-stage renal disease or death occurred in 327 losartan patients and 359 placebo patients, a 16% risk reduction (P=0.02) [4]. These trials did not study appetite, hunger or cravings.

Insulin Sensitivity Trial

A small crossover trial compared losartan with lisinopril in 25 non-diabetic adults with mild to moderate hypertension [2]. After 6 weeks, losartan 50 mg once daily did not significantly change insulin sensitivity measured by euglycemic hyperinsulinemic clamp: glucose infusion rate rose by 0.42 mg/min/kg (not significant) [2]. Lisinopril 20 mg once daily raised glucose infusion rate by 1.5 mg/min/kg (P<0.05), and the difference between the drugs was statistically significant (P<0.05) [2]. This trial measured insulin sensitivity, not hunger or cravings.

What the Label Emphasizes Instead

The label says to monitor serum potassium periodically, to monitor renal function in susceptible patients, and to correct volume or salt depletion before starting because symptomatic hypotension can occur in volume- or salt-depleted patients [1].