From the Guidelines
For a patient switching from Lisinopril 40mg to Losartan due to chronic cough, a reasonable starting dose is 100 mg once daily, as this is considered a target dose for most adults with hypertension, according to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. When making this switch, the Lisinopril should be discontinued completely before starting Losartan; there is no need for an overlap period.
- Blood pressure should be monitored closely during the first 1-2 weeks after switching, as individual responses to ARBs versus ACE inhibitors can vary.
- Losartan can be taken with or without food, and the timing should be consistent each day.
- This medication switch is appropriate because ARBs like Losartan provide similar cardiovascular and renal protection as ACE inhibitors but have a significantly lower risk of causing cough since they don't affect bradykinin metabolism, which is the mechanism behind ACE inhibitor-induced cough, as supported by the ACCP evidence-based clinical practice guidelines 1. The dose of Losartan can be adjusted based on the patient's response to the medication, with a goal of achieving optimal blood pressure control while minimizing the risk of adverse effects.
- The American Journal of Kidney Diseases also provides guidance on the doses of ACE inhibitors and ARBs for adults, including Losartan, which can be used to inform dosing decisions 1. It's essential to note that the patient's blood pressure and kidney function should be closely monitored after switching to Losartan, especially if they have any underlying kidney disease or are at risk for kidney disease progression.
- The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure provide target doses for Losartan, which can be used to guide dosing decisions in patients with heart failure 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 [see CLINICAL STUDIES (14.1)]. A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy).
A reasonable starting dose of Losartan for a patient switching from Lisinopril due to a chronic cough is 50 mg once daily.
- This dose can be adjusted based on blood pressure response.
- A lower starting dose of 25 mg may be considered for patients with possible intravascular depletion. 2
From the Research
Dose Recommendations for Losartan
When switching from Lisinopril to Losartan due to a chronic cough, it is essential to consider the appropriate starting dose of Losartan.
- The studies 3, 4 suggest that Losartan 50mg once daily is a common starting dose for patients with hypertension who have experienced a cough while taking ACE inhibitors like Lisinopril.
- Another study 5 also used Losartan 50mg as a starting dose, which was titrated upward as necessary to achieve the goal blood pressure.
Comparison of Losartan and Lisinopril
The decision to switch from Lisinopril to Losartan is often due to the cough side effect associated with ACE inhibitors.
- Studies 3, 4, 5 have shown that Losartan has a lower incidence of cough compared to Lisinopril, making it a suitable alternative for patients who experience this side effect.
- In terms of efficacy, Losartan has been shown to be as effective as Lisinopril in reducing blood pressure 6, 5.
Starting Dose Considerations
When determining the starting dose of Losartan, it is crucial to consider the patient's individual characteristics, such as their blood pressure levels and medical history.
- The studies provided do not offer a direct comparison of different starting doses of Losartan, but they do suggest that 50mg once daily is a common and effective starting dose 3, 4, 5.
- It is essential to monitor the patient's blood pressure and adjust the dose as necessary to achieve the desired therapeutic effect while minimizing potential side effects.