Does Losartan Lower Uric Acid and Help Gout?
Yes, but only a little. Losartan lowers uric acid by about 0.3 mg/dL compared with a placebo, and people who take it are diagnosed with gout about 19% less often than people who don’t. That makes it a good blood pressure choice if you have gout, but it is not strong enough to treat gout by itself.
Losartan (brand name Cozaar) is an angiotensin receptor blocker, or ARB, a common class of blood pressure pill. Uric acid is a waste product your body makes when it breaks down purines, which come from your own cells and from food. When too much builds up in the blood, it can form sharp crystals in a joint. That is gout. Losartan is the only drug in its class with a clear uric acid effect, and that matters most for people who need a blood pressure pill anyway.
What the Data Show
The best estimate comes from a 2026 meta-analysis of six randomized trials that compared losartan with a placebo in 1,119 people on losartan and 1,093 controls. Losartan lowered uric acid by about 0.29 mg/dL. The authors called the effect modest yet consistent, and a second analysis of UK Biobank records found a similar drop of about 0.35 mg/dL.
A placebo-controlled crossover trial of 55 adults with high blood pressure found almost the same thing. Four weeks of losartan lowered uric acid by 0.23 mg/dL. The drop was larger in people under 60 (0.33 mg/dL) than in people 60 and older.
The effect looks bigger in people who start with high uric acid. A meta-analysis of 31 Chinese trials with 2,754 patients who had both high blood pressure and high uric acid found that losartan lowered uric acid by 1.57 mg/dL more than other blood pressure drugs. Blood pressure fell by the same amount with each drug. Keep in mind that some of those other drugs raise uric acid, so part of that gap comes from the comparison drug moving the wrong way.
How Does Losartan Lower Uric Acid?
Your kidneys filter uric acid out of the blood, then pull most of it back in before it reaches the urine. A protein called URAT1 (urate transporter 1) does much of that pulling back. It sits in the small tubes of the kidney.
Losartan blocks URAT1, so more uric acid stays in the urine and leaves the body. A drug that works this way is called uricosuric. A study of 32 people with high blood pressure showed this directly: losartan lowered blood uric acid and raised how much the kidneys cleared, while candesartan, another ARB, changed neither. In people born with a broken URAT1 gene, losartan had no effect on uric acid at all, which points to URAT1 as the target.
Your genes can change how well this works. In a study of 101 people with high blood pressure and high uric acid, those carrying certain variants of the URAT1 gene had a smaller drop in uric acid after two weeks of losartan than those without the variants. So two people on the same dose can get very different results.
Does Losartan Lower the Risk of Gout?
The best data here are observational, which means they show a link, not proof. A UK study of 24,768 people with new gout and 50,000 matched controls looked at which blood pressure drugs people were taking. Among people with high blood pressure, those taking losartan had about 19% lower risk of a first gout diagnosis. People who had taken losartan for two years or more had about 29% lower risk.
No randomized trial has tested whether losartan prevents gout. The one large trial that tracked gout found no effect on it. In HEAAL, a trial of 3,834 people with heart failure, a high dose of losartan (150 mg a day) lowered uric acid by 0.27 mg/dL more than a low dose (50 mg) and cut new cases of high uric acid. It did not reduce new cases of gout.
Do Other Blood Pressure Medicines Raise Uric Acid?
Yes, several of them do, and this is where losartan stands out most. In the same UK gout study, diuretics (water pills) went with about 2.4 times the risk of gout among people with high blood pressure. Beta blockers went with about 48% higher risk, ACE inhibitors with about 24% higher risk, and ARBs other than losartan with about 29% higher risk. Calcium channel blockers, such as amlodipine, went with about 13% lower risk.
Other ARBs do not share losartan’s uric acid effect. In a randomized crossover trial of 13 people with gout and high blood pressure, losartan 50 mg lowered uric acid from 538 to 491 micromol/L (about 9.0 to 8.3 mg/dL), while irbesartan had no effect. A larger trial of 351 Chinese patients found the same pattern: after 8 weeks, uric acid fell by 63 micromol/L (about 1.1 mg/dL) on losartan and by 12 micromol/L on irbesartan, with the same drop in blood pressure.
| Blood pressure drug | Link with gout in the UK study |
|---|---|
| Losartan | About 19% lower risk |
| Calcium channel blockers (amlodipine and others) | About 13% lower risk |
| ACE inhibitors (lisinopril and others) | About 24% higher risk |
| Other ARBs | About 29% higher risk |
| Beta blockers | About 48% higher risk |
| Diuretics (water pills) | About 2.4 times the risk |
Can Losartan Offset a Water Pill?
Partly. Thiazide diuretics, such as hydrochlorothiazide, are a common first blood pressure drug, and they raise uric acid. In the COMFORT trial of 118 people already taking another ARB plus a diuretic, switching to a losartan and hydrochlorothiazide combination pill lowered uric acid by 0.44 mg/dL over 6 months, while it rose by 0.10 mg/dL in people who stayed on their old pills. Blood pressure control was the same.
The 2026 meta-analysis authors make the same point: a drop of about 0.3 mg/dL may be enough to help cancel out the rise caused by a diuretic.
Does a Higher Dose of Losartan Lower Uric Acid More?
Only slightly. In the small gout crossover trial, raising losartan from 50 mg once a day to 50 mg twice a day did not lower uric acid any further. The authors also noted that the uric acid-flushing effect seemed to fade once uric acid settled at its new, lower level. In HEAAL, tripling the dose to 150 mg added only 0.27 mg/dL.
Can Losartan Replace Allopurinol for Gout?
For most people with gout, no. The 2020 American College of Rheumatology gout guideline strongly recommends urate-lowering therapy for people with tophi (lumps of uric acid crystals), joint damage from gout, or frequent flares. It names allopurinol as the preferred first drug and sets a uric acid target below 6 mg/dL.
The math explains why losartan cannot do that job alone. The people with gout in the losartan and irbesartan crossover trial started near 9 mg/dL, so they needed to drop about 3 points to reach that target. Losartan delivers a fraction of a point on average.
Taking the two together is common, but the effects may not fully add up. In a small study of 5 healthy people given allopurinol and then losartan, losartan raised the urinary loss of uric acid by up to 3.9 times and also flushed out oxypurinol, the active form of allopurinol. The authors suggested the combination may lower uric acid less than the sum of the two drugs, and that the extra uric acid in the urine could raise the chance of kidney stones. That stone risk was their suggestion, not something they measured.
Dr. Kumar’s Take
The useful way to think about losartan is as a better default, not a gout treatment. If you have high blood pressure and gout, or high uric acid, the choice of blood pressure pill matters. Diuretics, beta blockers, ACE inhibitors and most ARBs go with more gout. Losartan and amlodipine go with less. Picking a pill that pushes uric acid down instead of up is an easy win.
I would not expect losartan to fix an established gout problem. A drop of 0.3 mg/dL is real, but a person with tophi or repeated flares needs a much bigger change. And because genes change how well it works, the only way to know what losartan does for you is to check your uric acid before and after starting it.
Practical Takeaways
- Losartan lowers uric acid by about 0.3 mg/dL on average; people with high uric acid may see more.
- It works by blocking URAT1 in the kidney, so more uric acid leaves in the urine.
- Other ARBs tested head to head, irbesartan and candesartan, do not share this effect.
- Diuretics raise uric acid and gout risk the most; losartan can partly offset a thiazide.
- Going above 50 mg a day adds little extra uric acid lowering.
- Losartan does not replace allopurinol for frequent flares, tophi or joint damage. The usual target is below 6 mg/dL.
- Get a uric acid level before and a few weeks after starting losartan to see your own response.
- Never stop or switch a blood pressure medicine without talking to your doctor.
Related Studies and Research
Vitamin C, Coffee, Milk, and Alcohol: How Diet Impacts Gout Risk. How common foods and drinks shift uric acid and gout risk.
How Uric Acid Shaped Human Evolution and May Fuel High Blood Pressure Today. Why humans lost uricase and how uric acid ties into blood pressure.
The Glorification of Gout: When Pain Was Seen as Prestige. How gout was once portrayed as a disease of status.
Are Cherries Good for Gout and Uric Acid?. What the trials show about cherries and gout flares.
Is Coffee Bad for Gout and Uric Acid?. How coffee relates to uric acid levels and gout risk.
Does Alcohol Cause Gout and Trigger Flares?. Which drinks raise the risk of a gout attack.
Podcast: How to Make Gout Disappear from Your Life. A full look at modern and ancient gout science, and how to beat it.
FAQs
Is losartan good for people with gout?
Among blood pressure pills, it is one of the better choices. In a large UK study, people taking losartan had about 19% lower risk of a first gout diagnosis, while diuretics, beta blockers, ACE inhibitors and other ARBs went with higher risk.
Can losartan cause a gout flare?
None of the studies here reported losartan triggering flares. Any drug that changes uric acid quickly can, in theory, stir up crystals already in a joint, which is why guidelines pair new urate-lowering drugs with flare prevention. If a flare starts after a medication change, tell your doctor.
Do other ARBs lower uric acid like losartan does?
Not the ones that have been tested. In head-to-head trials, irbesartan had little or no effect on uric acid while losartan lowered it, and candesartan did not change it either. In the UK gout study, ARBs other than losartan went with about 29% higher gout risk.
How long does it take losartan to lower uric acid?
The effect shows up quickly. Trials saw drops within 2 to 8 weeks, and a study of healthy volunteers found more uric acid in the urine within a few hours of a dose.
Should I take losartan instead of allopurinol?
No, not for established gout. Gout guidelines name allopurinol as the first urate-lowering drug and aim for a uric acid level below 6 mg/dL, and losartan lowers uric acid by only a fraction of a point. Losartan makes sense when you need a blood pressure pill anyway.
Bottom Line
Losartan is the one common blood pressure pill that lowers uric acid, by about 0.3 mg/dL on average, and its users get gout less often than people on most other blood pressure drugs. It is a smart choice if you have high blood pressure plus gout or high uric acid, and it can partly offset a water pill. It is too weak to replace allopurinol for frequent flares or tophi, and since genes change the response, check your uric acid before and after starting it.
