Repace

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What Is Repace?

Repace is an oral 25 / 50 mg losartan tablet from Sun Pharma, supplied in 30-180 tablets. The first ARB approved for clinical use (DuPont Merck 1995, as Cozaar) — the reference agent of the class. Losartan is a prodrug activated by CYP2C9 and CYP3A4 to its active metabolite E-3174 (EXP-3174). The parent drug has half-life ~2 hours; the active metabolite has half-life 6-9 hours.

How Losartan Lowers Blood Pressure

ARBs block the angiotensin II type 1 (AT₁) receptor directly, preventing angiotensin II from binding and exerting its vasoconstrictor and aldosterone-releasing effects. This is one receptor downstream of where ACE inhibitors act (which block angiotensin II formation) and produces equivalent clinical effects:

• Direct arterial vasodilation — lower systemic vascular resistance = lower blood pressure
• Reduced aldosterone secretion — less sodium and water retention
• Reduced sympathetic nervous system activation
• Improved endothelial function and reduced ventricular remodelling — the vascular-protective mechanism beyond simple BP lowering
• NO bradykinin accumulation — this is the key clinical difference from ACE inhibitors. ARBs do NOT cause the dry cough that affects up to 20% of ACEi users, because they don’t interfere with bradykinin metabolism.

Clinical consequence of this mechanism: ARBs achieve equivalent BP control to ACE inhibitors with lower rates of cough (0-3% vs 20% for ACEi) and angioedema (roughly 30-50% lower than ACEi, though not zero).

Approved and Evidence-Based Uses

• Hypertension — primary indication; first-line per international guidelines
• Hypertension with gout or hyperuricaemia — uniquely uricosuric
• Diabetic nephropathy in type 2 diabetes — RENAAL trial
• Hypertension with left-ventricular hypertrophy — LIFE trial
• Heart failure with reduced ejection fraction — alternative to ACE inhibitor when cough is intolerable
• Intolerance to ACE inhibitors (cough, less commonly angioedema) — standard switch target

Pivotal trial evidence: LIFE trial (2002) — losartan-based therapy reduced stroke, CV death, and MI by 13% vs atenolol-based therapy in hypertension with left-ventricular hypertrophy, establishing the modern preference for ARBs over older beta-blockers in HTN. RENAAL + IDNT — renoprotection in diabetic nephropathy. HEAAL — high-dose losartan (150 mg) vs low-dose (50 mg) in HF-REF; high-dose reduced hospitalisation.

Repace Dosage

Hypertension:

• Starting dose: 50 mg once daily (25 mg in elderly, volume-depleted, or hepatic impairment)
• Target dose: 50-100 mg once daily (divided into 50 mg twice daily in some patients)
• Maximum: 100 mg/day
• Titrate every 2-4 weeks; full antihypertensive effect at 3-6 weeks

Heart failure: Start 12.5 mg once daily, titrate weekly to 50-150 mg once daily (HEAAL target)

Administration: once daily, with or without food. Take at the same time each day for stable BP control.

Monitoring:

• Baseline: urea, electrolytes (particularly potassium), creatinine, eGFR. Home BP baseline.
• After 1-2 weeks: repeat U&E. Small rise in creatinine (up to 30%) is expected and acceptable. Small rise in potassium is common.
• After dose increase: repeat U&E at 1-2 weeks.
• Ongoing: annual U&E once stable.
• Stop and investigate: creatinine rise >30%, eGFR fall >25%, potassium >5.5, symptomatic hypotension.

Discontinuation: no withdrawal syndrome; however, abrupt stop causes BP rebound over days. Taper over 1-2 weeks when stopping.

Side Effects

Common (>1%, usually mild):

• Dizziness, postural hypotension (usually mild; more common at start of therapy)
• Mild hyperkalaemia
• Expected small creatinine rise (up to ~30% is acceptable; intrarenal haemodynamic change, not nephrotoxicity)
• Fatigue, headache
• Upper respiratory symptoms, nasopharyngitis
• Back pain, muscle cramps

Uncommon but important:

• Angioedema — lower rate than with ACE inhibitors but still possible. Incidence ~0.1%. Do NOT use an ARB if the patient has a documented history of angioedema to an ACE inhibitor in the first 4 weeks; longer-term cautious use often acceptable.
• Severe hyperkalaemia — particularly with potassium-sparing diuretics (spironolactone), potassium supplements, NSAIDs, or CKD
• Acute kidney injury in bilateral renal artery stenosis — same mechanism as ACE inhibitors
• First-dose hypotension in volume-depleted patients (e.g. on high-dose diuretics, severe HF)

Contraindications

• Pregnancy — ABSOLUTE contraindication at all trimesters. Same teratogenic profile as ACE inhibitors. Stop immediately on pregnancy; switch to labetalol, methyldopa, nifedipine, or hydralazine.
• History of angioedema with any ACE inhibitor or ARB (within 4 weeks)
• Bilateral renal artery stenosis or stenosis in a single functioning kidney
• Severe hepatic impairment (Child-Pugh C) — particularly for prodrug ARBs
• Hyperkalaemia >5.5 mmol/L at baseline
• Concurrent use of sacubitril/valsartan (Entresto) — 36-hour washout required when switching
• Concurrent aliskiren in diabetes or CKD (ALTITUDE trial harm)
• Concurrent ACE inhibitor — ONTARGET trial harm without benefit
• Hypersensitivity to losartan

Breastfeeding: avoid in the first weeks after delivery of a premature infant. Long-term use in established breastfeeding is generally considered acceptable given low milk transfer, but alternative antihypertensives (propranolol, nifedipine) are preferred when possible.

Drug Interactions

• Potassium-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene) — additive hyperkalaemia; monitor closely
• Potassium supplements and salt substitutes — hyperkalaemia risk
• NSAIDs — reduce antihypertensive effect and increase AKI risk (particularly the “triple whammy”: ARB + diuretic + NSAID)
• Lithium — ARBs reduce lithium clearance; monitor levels
• ACE inhibitors — do NOT combine (ONTARGET harm)
• Sacubitril/valsartan (Entresto) — do not combine; 36-hour washout
• Aliskiren — avoid in diabetes or CKD (ALTITUDE harm)
• Fluconazole — reduces losartan activation to E-3174 (CYP2C9 inhibition); may reduce BP effect

ARB Class at a Glance

ARB vs ACE Inhibitor — When to Choose an ARB

ACE inhibitors (ramipril, enalapril, lisinopril, perindopril) and ARBs act on the same renin-angiotensin pathway and produce equivalent BP-lowering and cardiovascular protection. Choose an ARB when:

• ACE-inhibitor cough has appeared (up to 20% of users; most common reason for switch)
• Past ACE-inhibitor angioedema (use an ARB cautiously, not within 4 weeks of the angioedema episode)
• Some patients prefer the once-daily profile of long-acting ARBs like telmisartan for smooth 24-hour control
• Specific molecule indications — losartan for HTN+gout, irbesartan for type 2 diabetic nephropathy, valsartan as a precursor to ARNI in HF

Do NOT combine ARB + ACE inhibitor. ONTARGET trial (2008) showed the combination produces MORE adverse events (hyperkalaemia, AKI, hypotension) without any additional cardiovascular benefit. If a patient is on both, stop one.

Storage

Store Repace below 25°C in the original blister pack. Keep out of reach of children.

Frequently Asked Questions

How long does Repace take to lower blood pressure?

Initial BP drop within 1-2 hours; full antihypertensive effect at 3-6 weeks. Measure home BP at the same time each day to track response. If BP has not come to target at 6 weeks, either increase dose or add a second-class agent (CCB or thiazide are the standard add-ons to an ARB).

I switched from an ACE inhibitor because of cough — will my cough go away?

Yes. The ACE-inhibitor cough is caused by bradykinin accumulation; ARBs do not raise bradykinin. The cough typically resolves within 1-4 weeks of stopping the ACE inhibitor. If your cough persists beyond 6 weeks after switching to Repace, investigate an alternative cause (reflux, postnasal drip, asthma).

Can I take Repace in pregnancy?

No — ARBs are absolutely contraindicated in pregnancy, same as ACE inhibitors. They cause fetal renal agenesis, oligohydramnios, pulmonary hypoplasia, and skull defects. Stop immediately if pregnancy occurs. Women of childbearing potential should use reliable contraception; for those planning pregnancy, switch to labetalol, methyldopa, or nifedipine pre-conception.

My creatinine went up a bit after starting Repace — should I stop?

A creatinine rise of up to 30% within the first 1-2 weeks is expected and acceptable. It reflects normal intrarenal haemodynamic adjustment as angiotensin-II-mediated efferent arteriolar tone is removed. A rise >30% suggests bilateral renal artery stenosis, volume depletion, or NSAID interaction and requires investigation (stop the drug, get renal imaging, review concurrent medication).

Should I avoid potassium-rich foods on Repace?

Moderate intake of potassium-rich foods (bananas, oranges, spinach, avocado, potatoes) is fine for most users. Avoid potassium supplements (slow-K) and potassium-containing salt substitutes unless specifically prescribed — these can cause dangerous hyperkalaemia when combined with ARBs, particularly in CKD or with potassium-sparing diuretics.

Can I combine Repace with my other BP medications?

Yes — ARBs combine well with calcium-channel blockers (amlodipine), thiazide diuretics (HCTZ), and beta-blockers (bisoprolol, metoprolol succinate). Do NOT combine an ARB with an ACE inhibitor (ramipril, lisinopril, etc.) — ONTARGET trial showed harm without benefit.

Can I take ibuprofen with Repace?

Occasional short-term use is usually acceptable; chronic daily NSAIDs (ibuprofen, diclofenac, naproxen) reduce the antihypertensive effect of ARBs AND substantially raise the AKI risk — particularly when combined with a diuretic (the “triple whammy”). For chronic pain, paracetamol is safer; for inflammation, discuss alternatives.

Is Repace lifelong?

For most patients with essential hypertension, yes — antihypertensive therapy is lifelong because stopping returns BP to pre-treatment levels within days to weeks. Some patients lose their hypertension through significant weight loss, reduced alcohol intake, or better sleep; their physician may then trial a careful taper under BP monitoring. Never stop Repace without medical advice.

What if I miss a dose?

Take the missed dose as soon as you remember, unless it is nearly time for the next dose — in that case skip the missed dose and continue your normal schedule. Do not double up. A single missed dose will not meaningfully affect long-term BP control.

Where can I buy Repace online?

You can buy Repace (losartan 25 / 50 mg, 30-180 tablets) from MedsBase with discreet packaging and worldwide shipping.

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