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There is no sufficient therapeutic experience with losartan in patients with heart failure and concomitant severe renal impairmentin patientswith severe heart failureNYHA class IVas well as in patients with heart failure and symptomatic life-threatening cardiac arrhythmiasThereforelosartan should be used with caution in these patient groupsThe combination of losartan with a beta-blocker should be used with cautionsee section 5.1
When angiotensin II antagonists are administered simultaneously with NSAIDsi.eselective COX-2 inhibitorsacetylsalicylic acid at anti-inflammatory doses and non-selective NSAIDsattenuation of the antihypertensive effect may occurConcomitant use of angiotensin II antagonists or diuretics and NSAIDs may lead to an increased risk of worsening of renal functionincluding possible acute renal failureand an increase in serum potassiumespecially in patients with poor pre-existing renal functionThe combination should be administered with cautionespecially in the elderlyPatients should be adequately hydrated and consideration should be given to monitoring renal function after initiation of concomitant therapyand periodically thereafter.
In elderly hypertensive patients the plasma concentrations of losartan and its active metabolite do not differ essentially from those found in young hypertensive patients.
Losartan is also not recommended in children with hepatic impairmentsee also section 4.4
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