Losartan Shortage: What Providers and Prescribers Need to Know in 2026

Losartan remains one of the most prescribed medications in the United States — over 56 million prescriptions were dispensed in 2023, making it the 8th most commonly prescribed drug nationally. For prescribers managing patients with hypertension, diabetic nephropathy, or left ventricular hypertrophy, losartan is a cornerstone therapy. But supply chain disruptions, nitrosamine recalls, and combination-product discontinuations continue to create challenges at the pharmacy level.

This guide gives prescribers and clinical staff a current picture of the losartan supply landscape and actionable guidance for managing patients who can't fill their prescription.

Current Supply Status (2026)

Plain losartan potassium tablets (25 mg, 50 mg, 100 mg) are not on the FDA Drug Shortage Database or ASHP shortage list as of early 2026. Multiple FDA-approved generic manufacturers remain in the market: Teva, Torrent, Aurobindo, Mylan/Viatris, Alembic, and MacLeods, among others.

The losartan/HCTZ combination (generic Hyzaar) is a different picture. Several manufacturers have discontinued their combination products. As of December 2025, Teva has the combination on intermittent back order, releasing supplies as available. Cadista and multiple others have fully exited this market. Prescribers should anticipate ongoing intermittent availability gaps for the combination product.

Nitrosamine Recall History and Current Regulatory Posture

The ARB recall crisis that began in 2018 had lasting effects on the losartan market. Key milestones:

• 2018–2019: Multiple manufacturers recalled losartan due to NDEA and NMBA nitrosamine contamination in the API, stemming primarily from overseas manufacturing facilities.
• 2019–2023: FDA implemented stricter API testing requirements and tighter acceptable intake limits for nitrosamines across all sartan-class drugs. Several manufacturers exited rather than reformulate.
• February 2025: Targeted recall of specific losartan lots from a mid-tier manufacturer. NMBA levels exceeded updated FDA thresholds. Patients were proactively notified by pharmacy chains.
• July 2025: FDA reaffirmed strict nitrosamine acceptable intake limits for all ARBs. Suppliers must now demonstrate compliance with enhanced purity standards and supply chain traceability.

Currently marketed losartan products have been cleared by the FDA. Patients who ask about safety should be reassured that their dispensed medication meets current standards unless they've received a specific recall notice.

ARB Dose Equivalence Reference for Prescribers

When substituting losartan for another ARB or vice versa, approximate antihypertensive dose equivalences (not validated for renal or heart failure endpoints) are as follows. These are starting points — titrate based on BP response and patient tolerance:

• Losartan 25 mg ≈ Valsartan 40 mg ≈ Irbesartan 75 mg ≈ Candesartan 4 mg ≈ Olmesartan 10 mg
• Losartan 50 mg ≈ Valsartan 80 mg ≈ Irbesartan 150 mg ≈ Candesartan 8 mg ≈ Olmesartan 20 mg
• Losartan 100 mg ≈ Valsartan 160 mg ≈ Irbesartan 300 mg ≈ Candesartan 16 mg ≈ Olmesartan 40 mg

Note: Telmisartan 40 mg is often considered equivalent to Losartan 50 mg for blood pressure, and telmisartan 80 mg to losartan 100 mg. Telmisartan has the longest half-life (~24 hours) of all ARBs and may be preferred in patients with adherence concerns.

Managing the Losartan/HCTZ Combination Shortage

For patients on losartan/HCTZ who can't find the combination pill, the most practical solution is to prescribe the components separately: generic losartan and generic hydrochlorothiazide. Both are widely available as individual generics, and this approach may actually:

• Cost less than the combination pill (two inexpensive generics vs. one less-generic combo)
• Allow more flexible HCTZ dosing if the patient's fluid status or electrolytes need adjustment
• Reduce back-order risk, since both components are manufactured by many more companies independently

Switching Between Generic Manufacturers: Clinical Considerations

All FDA-approved generic losartan products are AB-rated and considered therapeutically equivalent. Switching between manufacturers is safe and expected. However, some clinical nuances to be aware of:

• Subtle differences in excipients or tablet coatings may cause minor tolerability issues (GI symptoms, pill appearance changes) in sensitive patients — counsel them proactively to prevent confusion and unnecessary calls
• Patients on narrow therapeutic monitoring (elderly, renal impairment, or HF) should have BP rechecked after any manufacturer switch to confirm adequate control
• Document manufacturer switches in your EHR when possible for continuity of care

How medfinder Can Help Your Patients

medfinder for providers helps your patients locate which pharmacies near them have their specific medication in stock. When a patient calls your office because their pharmacy is out, instead of spending staff time calling pharmacies, you can direct the patient to medfinder. They provide their medication, dose, and location — medfinder calls pharmacies and texts the patient results.

See our companion article: How to Help Your Patients Find Losartan in Stock: A Provider's Guide.