Is a dose of 100 milligrams of Losartan (losartan) considered high intensity?

From the Guidelines

Losartan 100 mg is not considered a high-intensity dose, as the concept of "high intensity" is more commonly applied to statin therapy for cholesterol management rather than to blood pressure medications like losartan. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, the target dose for losartan is 50-150 mg once daily, with 100 mg being a common dose used in clinical practice. The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure also recommend losartan 150 mg as the target dose, but note that the 100-mg dose is used in the performance measure due to current FDA-approved labeling 1.

Key Points

• Losartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure and protect the kidneys in people with diabetes.
• The typical starting dose is 50 mg once daily, with 100 mg being the maximum recommended daily dose for most patients.
• This maximum dose provides optimal blood pressure control for many patients without significantly increasing side effect risks.
• The concept of "high intensity" is more commonly applied to statin therapy for cholesterol management rather than to blood pressure medications like losartan.

Clinical Implications

• If you're taking losartan 100 mg, this indicates your doctor has determined you need the full therapeutic dose to adequately control your blood pressure or provide kidney protection.
• However, this does not mean the treatment approach is unusually aggressive or intensive, as losartan 100 mg is a standard dose used in clinical practice.

From the FDA Drug Label

The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure Doses above 1.4 mg per kg (or in excess of 100 mg) daily have not been studied in pediatric patients Hydrochlorothiazide 12.5 mg daily should be added and/or the dose of losartan should be increased to 100 mg once daily The dose should be increased to 100 mg once daily based on blood pressure response

The FDA drug label does not answer the question.

From the Research

Losartan Dosage

• The dosage of losartan can vary depending on the condition being treated and the patient's response to the medication.
• Studies have compared the effects of different dosages of losartan, including 50 mg and 150 mg per day 2, 3.
• The HEAAL study found that 150 mg of losartan per day had favorable effects compared to the currently recommended dose of 50 mg per day 2.
• Another study found that 150 mg of losartan per day led to a greater reduction in estimated glomerular filtration rate (eGFR) compared to 50 mg per day, but this difference was driven by early changes and was not significant after 4 months 3.

High-Intensity Losartan

• There is no clear definition of "high-intensity" losartan, but it can be inferred that higher dosages, such as 150 mg per day, may be considered high-intensity.
• The study by 3 compared the effects of 50 mg and 150 mg of losartan per day and found that the higher dosage was associated with a greater reduction in eGFR, but also with a reduced risk of death or hospitalization for heart failure.
• It is not clear if 100 mg of losartan per day would be considered high-intensity, as this dosage was not specifically studied in the available evidence.
• However, based on the available evidence, it can be inferred that 100 mg of losartan per day may be considered a moderate to high dosage, but more research is needed to determine its effects and whether it can be considered high-intensity 2, 3.