03 February 2026
: Case report 
Drug-Induced Liver Injury Associated With the Angiotensin II Receptor Blocker Losartan in a 59-Year-Old Woman With Hypertension: A Case Report
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy
Ahmad Al-Ajaj
BDE 1*, Wissem Melki E 1
DOI: 10.12659/AJCR.949256
Am J Case Rep 2026; 27:e949256
Table 3 Published case reports of losartan-induced liver injury.
| Source: Author, year [ref] | Losartan dose | Age (y)/sex | Onset | Symptoms and signs | Liver enzyme values | Investigations | Treatment and outcome |
|---|---|---|---|---|---|---|---|
| Björnsson, 2016 []9 | Range 50–150 mg/day | 46/M; 77/F | 3 weeks; 5 months | Pain, jaundice, dark urine | AST, 115–5677 IU/L; ALT, 272–4137 IU/L | Viral hepatitis and autoimmune hepatitis; MRCP, normal | Discontinued losartan; full recovery |
| Al-Halawani et al, 2014 []17 | 50 mg once daily | 65/F | 4 months | Right upper quadrant pain, nausea | AST, 1018 IU/L; ALT, 1184 IU/L; ALP, 142 IU/L; TBili, 2.7 μmol/L | Viral hepatitis and autoimmune hepatitis; pancreatic enzymes; hepatobiliary iminodiacetic acid scan, normal; MRCP, normal; liver biopsy (day 8), normal hepatic tissue without abnormal findings. | Discontinued losartan; full recovery |
| Midtvedt et al, 1996 []18 | 50 mg/day | 47/M | 2 weeks | Malaise, fatigue, jaundice, dark urine, anorexia, right upper quadrant discomfort | ALT, 2260 U/L; AST, 1610 U/L; ALP, 540 U/L; gamma-glutamyl transferase, 432 U/L; TBili, 210 μmol/L; PT, mildly reduced but no liver failure | Viral serologies, negative; autoimmune markers, negative; metabolic diseases, excluded; ultrasound, normal; liver biopsy, consistent with drug-induced hepatocellular injury | Discontinue losartan; N-acetylcysteine given; full recovery |
| Nygaard and Strandgaard, 1996 []19 | 50 mg once daily for both cases | 55/F; 46/F | 3 weeks; a few months | Case 1: Thoracic and interscapular pain; mild jaundiceCase 2: Retrosternal chest pain | Case 1: ALT, 650 U/L; AST, 635 U/L; ALP, 396 U/L; bilirubin, 23 μmol/L Case 2: ALT, 311 U/L; AST, 300 U/L; LDH, 984 U/L; AST, 5,232 U/L; ALT, 3,444 U/L | Viral serologies, negative; autoimmune markers, negative; imaging, normal | Discontinued losartan; N-acetylcysteine and supportive care given; full recovery |
| Patti et al, 2019 []20 | 100 mg × 2 doses | 61/F | 16 days (re-challenge) | Lethargy, nausea, fever | AST, 5232 U/L; ALT, 3444 U/L | Viral hepatitis and autoimmune hepatitis; pancreatic enzymes; abdominal computed tomography scan; serum alpha-1 antitrypsin and ceruloplasmin, all normal | Discontinued losartan; full recovery |
| Diogo et al, 2021 []21 | 50 mg once daily | 66/M | 3 weeks (after restart) | Abdominal pain, asthenia, nausea | ALT, 3603 IU/L; AST, 2522 IU/L; ALP, 184 IU/L | Viral hepatitis and autoimmune hepatitis; pancreatic enzymes; serum alpha-1 antitrypsin and ceruloplasmin; MRCP, normal; liver biopsy (day 8), normal hepatic tissue without abnormal findings | Losartan discontinued; liver tests improved rapidly; complete normalization occurred within 6 weeks |
| ALT – alanine aminotransferase; AST – aspartate aminotransferase; ALP – alkaline phosphatase; MRCP – magnetic resonance cholangiopancreatography; PT – prothrombin time; TB – total bilirubin. | |||||||