What is the recommended dose and frequency of Losartan (Angiotensin II receptor antagonist)?

From the Guidelines

Losartan should be prescribed at an initial dose of 50 mg once daily for adults with hypertension, and the dose can be increased to a maximum of 100 mg once daily if blood pressure remains uncontrolled after about 2-4 weeks of treatment, as recommended by the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1.

Key Considerations

• The dose of losartan can be adjusted based on the patient's response to treatment and tolerability, with a goal of achieving optimal blood pressure control.
• Losartan works by blocking angiotensin II receptors, preventing blood vessel constriction and reducing blood pressure.
• It's best taken at the same time each day to maintain consistent blood levels, and can be taken with or without food.
• Patients should not stop taking losartan suddenly without consulting their healthcare provider, as this could cause a dangerous spike in blood pressure.

Important Side Effects and Monitoring

• Common side effects include dizziness, especially when standing up quickly, and elevated potassium levels.
• Regular blood pressure monitoring and kidney function tests are important while taking this medication.

Evidence-Based Recommendations

• The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure recommend losartan 100 mg once daily as the target dose 1.
• The ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 also support the use of losartan at a dose of 150 mg once daily, although this is not the currently recommended target dose 1.

From the FDA Drug Label

The usual starting dose of losartan is 50 mg once daily. The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy). The usual recommended starting dose is 0.7 mg per kg once daily (up to 50 mg total) administered as a tablet or a suspension The usual starting dose is 50 mg of losartan once daily. Hydrochlorothiazide 12. 5 mg daily should be added and/or the dose of losartan should be increased to 100 mg once daily The usual starting dose is 50 mg once daily. The dose should be increased to 100 mg once daily based on blood pressure response In patients with mild-to-moderate hepatic impairment the recommended starting dose of losartan is 25 mg once daily.

The recommended dose of losartan is:

• 50 mg once daily as the usual starting dose for adult hypertension
• 25 mg once daily for patients with possible intravascular depletion
• 0.7 mg per kg once daily (up to 50 mg total) for pediatric hypertension
• The dose can be increased to 100 mg once daily as needed to control blood pressure 2 The dosage frequency is once daily.

From the Research

Losartan Dose and Frequency

• The optimal dose and frequency of losartan have not been explicitly stated in the provided studies, but the studies do provide information on the dosages used in various clinical trials 3, 4, 5, 6, 7.
• In the study published in 2000, losartan was administered at a dose of 100 mg/day for 7 days to patients with end-stage renal disease 7.
• Another study published in 2000 compared the effects of losartan and enalapril on kidney function in hypertensive type 2 diabetics with early nephropathy, and losartan was administered alone or in combination with hydrochlorothiazide and other antihypertensive agents 6.
• The study published in 2014 compared the renal function in diabetic hypertensive chronic kidney disease patients receiving enalapril or losartan, but the dosage of losartan was not specified 4.
• The study published in 1995 discussed the potential renal protective efficacy of losartan, but did not provide information on the optimal dose and frequency 5.
• The study published in 2004 discussed the beneficial effects of losartan in diabetic patients with chronic nephropathy, but did not provide information on the optimal dose and frequency 3.

Renal Function and Losartan

• Losartan has been shown to have beneficial effects on renal function in patients with diabetic nephropathy 3, 6.
• The Reduction of End points in Noninsulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) trial demonstrated that losartan slowed the progression of overt Type 2 diabetic nephropathy 3.
• However, another study found that enalapril was more renoprotective than losartan in diabetic hypertensive chronic kidney disease patients 4.

Pharmacokinetics and Pharmacodynamics

• The pharmacokinetics of losartan and its active metabolite E-3174 were not significantly altered in patients with end-stage renal disease 7.
• Losartan administration resulted in a decline in plasma aldosterone level and an increase in plasma renin activity, as well as a decline in plasma uric acid level 7.