Losartan Side Effects: Tremor and Unbearable Dry Eyes

Nearly half of all American adults (120 million people) are now labeled hypertensive. That’s according to the CDC. For most, that will mean blood pressure medications. One of the most prescribed antihypertensive drugs is losartan (Cozaar). At last count over 14 million people fill 56 million prescriptions of losartan every year. For the overwhelming majority, losartan side effects are tolerable. But sometimes what seems like a minor side effect turns into a major misery. Readers share their stories about losartan side effects below.

Tremor: An Unrecognized Losartan Side Effect?

Q. I have been taking losartan for 25 years to control blood pressure. Recently I developed a hand tremor, so my doctor prescribed a beta blocker to help with the tremor. Could long-term use of losartan have led to the tremor?

A. Prescribing information for losartan, a popular medication for hypertension, does not warn of tremor as a side effect. We found one case report in the medical literature, but that man developed the problem early in treatment (Cureus, Dec. 13, 2019).

The most prescribed blood pressure medicine in the US is lisinopril (18.5 million Americans purchased 76 million prescriptions at last count). Like losartan, it acts on the renin-angiotensin system to relax blood vessels and lower blood pressure. We have received a number of reports from people who have experienced hand tremor associated with lisinopril.

One reader wrote:

“I have been taking lisinopril for the last six months and started having hand tremors. They are most noticeable when I pick up something like a cup of coffee or a glass of water. It’s very uncomfortable and annoying. I mentioned this to my doctor, but he completely ignored me.”

We could find no reference to hand tremor in the official prescribing information for lisinopril, however. On the other hand, here is a link to an article we have written on this topic that you and your doctor may find relevant:

“ACE Inhibitors Like Lisinopril and Hand Tremors”

You don’t say if you are still taking losartan. If you and your doctor will be considering a different antihypertensive drug, you may want to read our eGuide to Blood Pressure Solutions. This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.

Losartan and Dry Eyes:

Q. I was on losartan for a total of 2 months and for 7 weeks of that time, I was miserable with extremely dry eyes.  I was on it for so long because my Dr. didn’t believe the losartan was causing the problem.

Finally I convinced him to prescribe a different blood pressure medicine and my eyes became much better very quickly once I was off the losartan.  I have only seen a few comments about this side effect, though.

A. Losartan (Cozaar) belongs to a class of medicines called ARBs (angiotensin receptor blockers). Other ARBs include: candesartan (Atacand), irbesartan (Avapro), olmesartan (Benicar), telmisartan (Micardis) and valsartan (Diovan).

Dry eyes are not a commonly reported side effect of ARBs. In fact we were not able to find a reference to this complication in the prescribing information, despite the fact that dry mouth, dry skin and dry cough are listed as losartan side effects. Other ARBs have been reported to cause similar adverse reactions.

Readers Share Their Stories:

Myriame also experienced dry eyes with an ARB:

“I have been on valsartan for years and now have terrible dry eye. I went off it last month for four weeks. I tried to control my bp naturally without success.

“All month my eyes were wonderfully moist and the first pill I took when I went back on it; dry eyes!! I will see my doctor this week and try another category of drugs as from what I’ve read most ARBs do it.

“I also discovered that valsartan (and probably all ARBs) cause the lower esophageal sphincter (LES) valve in your esophagus to relax leading to reflux. My gastroenterologist confirmed that is true.

“Also, through my own experience, I discovered that acid-suppressing drugs can also cause dry eye! I am sick of side effects of drugs! If anyone has had success with a bp med not causing dry eye, please state what it is! Thanks.”

Carol in Florida had a similar losartan side effect experience:

“I am taking losartan with HCTZ. I noticed that my eyes have been extremely dry and my vision becomes blurry about 30 – 40 mins after taking this medication. There’s no confusion, but there’s drowsiness, which I know is a side effect.

“My eyes will be just fine until I take this particular medication. I then have to keep my eyes squinted in order to see. On some occasions, I have to hold my eyes and gently press them closed for a few minutes to create some comfort.

“I have been watching it for a while now. The results are usually the same. Therefore losartan manufacturers can now add dry-eye to the list of side effects, or thoroughly investigate this clinical finding. I am a living proof.”

Dry Eyes Can Be Disastrous:

Dry eyes may not be a side effect that is perceived as serious. As a result it could easily be overlooked in clinical trial data collection. We would be interested to know whether other people have experienced losartan side effects like dry eyes.

Serious skin reactions linked to another ARB (Diovan aka valsartan) include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TENS), erythema multiforme, pemphigus and pemphigoid. Any rash deserves immediate medical attention!

It comes as a surprise to many patients to learn that their medicine might be contributing to their symptoms of dry eyes (the medical term for this condition is a tongue twister: xerophthalmia). A large number of diverse drugs can cause this problem. They include:

DRUGS THAT CAUSE DRY EYES ():

• Accutane (isotretinoin)
• Advair (fluticasone & salmeterol)
• Alphagan P (brimonidine)
• Alrex (loteprednol)
• Betimol (timolol)
• Catapres (clonidine)
• Combigan (brimonidine)
• Concerta (methylphenidate)
• Depakote (divalproex)
• Doxil (doxorubicin)
• Effexor (venlafaxine)
• Enablex (darifenacin)
• Enbrel (etanercept‎)
• Flonase (fluticasone)
• Geodon (ziprasidone)
• Intron A (interferon alfa-2b)
• Klonopin (clonazepam)
• Lexapro (escitalopram)
• Lumigan (bimatoprost)
• Requip (ropinirole)
• Soriatane (acitretin)
• Timoptic (timolol)
• Toprol XL (metoprolol)
• Toviaz (fesoterodine)
• VESIcare (solifenacin)
• Visudyne (verteporfin)
• Zyprexa (olanzapine)

Other Losartan Side Effects and Adverse ARB Reactions:

Arb-Related Side Effects 

• Dizziness, fatigue, low blood pressure
• Cough
• Headache
• Upper respiratory tract infections, sinusitis, stuffy nose,
• Digestive discomfort, diarrhea, stomach pain, back pain
• Joint pain, arthritis
• Swelling of the face, lips, mouth, tongue or throat (Requires immediate emergency medical treatment )
• Potassium retention and buildup (hyperkalemia)
• Kidney damage, liver damage
• Hair loss

Share your own experience with ARBs or other blood pressure medications below. If you have taken such drugs safely and achieved good results we would like to hear your story. If you have experienced losartan side effects, please let us know. And if you would like to know more about natural approaches to controlling blood pressure, check out The People’s Pharmacy Quick & Handy Home Remedies: Q&As for Your Common Ailments, and/or our eGuide to Blood Pressure Solutions in the Health Guides Library.

If you know someone with high blood pressure, please share this article with them. Side effects such as dry eyes or tremor are considered so minor that they may not be easily detected or mentioned.