From the Guidelines
Losartan can be given at a dose of 50 mg twice daily (bid) in certain clinical situations, though this is not the typical starting regimen. The standard initial dose is usually 50 mg once daily, with a maintenance dose range of 25-100 mg daily, as indicated in the KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease 1. However, dividing the total daily dose into twice daily administration (50 mg bid for a total of 100 mg daily) may be appropriate for patients who need better 24-hour blood pressure control or who experience symptoms of blood pressure fluctuation with once-daily dosing. This approach provides more consistent angiotensin II receptor blockade throughout the day, which is supported by the 2022 AHA/ACC/HFSA guideline for the management of heart failure, where losartan is recommended at a dose of 25-50 mg once daily, with a target dose of 50-150 mg once daily 1. When initiating this regimen, monitor blood pressure, kidney function, and potassium levels, especially in patients with kidney impairment, heart failure, or those taking other medications that affect potassium levels. Side effects to watch for include dizziness, hypotension, hyperkalemia, and cough. Ensure patients understand to take the medication at approximately 12-hour intervals for optimal effect. It's also important to note that the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 support the use of ARBs, including losartan, in patients with heart failure, and recommend targeting higher doses to achieve optimal benefit 1.
From the Research
Dosage of Losartan
- The standard dosage of losartan is 50 mg once daily, as seen in studies 2, 3.
- However, some studies suggest that a higher dosage of 100 mg daily may be more effective in certain cases, such as in patients with diabetic nephropathy 4, 5.
- The dosage of losartan can also be administered twice daily, with 50 mg given in the morning and evening, as shown in a study comparing once-daily and twice-daily administration 6.
Efficacy of Losartan 50 mg BID
- There is evidence to suggest that losartan 50 mg twice daily may be effective in treating hypertension, as seen in a study comparing the antihypertensive efficacy and safety of once-daily losartan to twice-daily captopril 3.
- Another study found that twice-daily administration of losartan 50 mg was more effective in eliminating the non-dipper phenomenon compared to once-daily evening administration 6.