Losartan potassium 50 MG Tab (Cozaar)

Losartan potassium 50 MG Tab (Cozaar)

Non-Formulary Use Criteria: 1. Documentation that patient was unable to tolerate ACE Inhibitor due to cough or angioedema. 2. Combination therapy with an ACE Inhibitor after failure to control or treat proteinuria ( remains greater than 1 gm/day) with an ACE Inhibitor alone at the maximum
recommended dose and compliance documented. 3. Check “Yes” if noted. The ARB of choice for non-formulary approval will be the most cost effective at the time the original non-formulary request is submitted. Institutions
should attempt to select the most cost effective ARB when renewing previously approved non-formulary requests.

Dr. M Blatstein

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