From the FDA Drug Label
The usual starting dose of losartan is 50 mg once daily. A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy). The dose should be increased to 100 mg once daily based on blood pressure response
The medication and dose of an ARB that a 75-year-old black male with stage three chronic kidney disease should be started on is losartan at a dose of 50 mg once daily. However, if the patient has possible intravascular depletion, the starting dose should be 25 mg once daily. The dose can be increased to 100 mg once daily as needed to control blood pressure 1.
From the Research
For a 75-year-old Black male with stage three chronic kidney disease, I recommend starting with losartan at a dose of 25-50 mg once daily, as this lower initial dose is appropriate given the patient's advanced age and kidney impairment [ 2 ]. Losartan is a suitable ARB choice as it has good evidence for renoprotection in chronic kidney disease.
Key Considerations
- The patient's advanced age and kidney impairment require careful consideration of the initial dose to minimize the risk of adverse effects.
- Losartan has been shown to reduce proteinuria and slow CKD progression by blocking the renin-angiotensin-aldosterone system [ 3 ].
- Monitoring of the patient's blood pressure, serum potassium, and kidney function (BUN, creatinine, eGFR) within 1-2 weeks after initiating therapy is crucial to assess the effectiveness and safety of the treatment.
Dose Adjustment and Monitoring
- If the patient tolerates the medication well and additional blood pressure lowering is needed, the dose can be gradually increased to a maximum of 100 mg daily.
- Be vigilant for hyperkalemia and acute kidney injury, especially in this elderly patient with pre-existing kidney disease [ 4 ].
- If these adverse effects occur, dose reduction or medication change may be necessary.