From the Guidelines
The maximum recommended dose of Losartan is 100 mg once daily for adults with hypertension or heart failure. This dose is supported by the most recent and highest quality study, which is the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. Treatment typically starts at a lower dose of 25-50 mg once daily, which can be gradually increased based on blood pressure response. For patients with volume depletion (such as those on diuretics) or hepatic impairment, a lower starting dose of 25 mg is recommended. In children 6 years and older, the maximum dose is weight-based, generally not exceeding 1.4 mg/kg daily up to 100 mg. Losartan works by blocking angiotensin II receptors, preventing the hormone from binding and causing blood vessel constriction. This mechanism helps lower blood pressure by promoting vasodilation and reducing aldosterone secretion. Patients should take Losartan at the same time each day, with or without food, and should not discontinue the medication without consulting their healthcare provider, as sudden discontinuation can lead to rebound hypertension.
Some key points to consider when prescribing Losartan include:
- Monitoring serum creatinine/estimated glomerular filtration rate and serum potassium levels at least annually in patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic 1
- Avoiding combinations of ACE inhibitors and angiotensin receptor blockers, as well as combinations of ACE inhibitors or angiotensin receptor blockers with direct renin inhibitors 1
- Using Losartan as a first-line treatment for hypertension in patients with diabetes and urinary albumin-to-creatinine ratio ≥300 mg/g creatinine or 30–299 mg/g creatinine 1
It's also important to note that the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults recommends a target dose of 50-100 mg once daily for Losartan 1. However, the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure recommends a target dose of 100 mg once daily 1, which is the most recent and highest quality study.
Overall, the maximum recommended dose of Losartan is 100 mg once daily, and it should be used in accordance with the patient's individual needs and medical history.
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
The maximum recommended dose of Losartan is 100 mg once daily 2.
- For adult hypertension, the maximum dose is 100 mg once daily.
- For pediatric hypertension, doses above 1.4 mg per kg (or in excess of 100 mg) daily have not been studied.
- The maximum dose for hypertensive patients with left ventricular hypertrophy and nephropathy in type 2 diabetic patients is also 100 mg once daily.
From the Research
Maximum Recommended Dose of Losartan
The maximum recommended dose of Losartan is discussed in several studies:
- The study 3 states that the maximum recommended daily dose of losartan is 100mg, which can be given as a once-daily dose or by splitting the same total daily dose into two doses.
- Another study 4 mentions that in dose-ranging studies, 50 mg once daily has generally been shown to produce near maximum effects and a dose of 100 mg does not produce additional effects.
- Study 5 also supports the idea that the maximum recommended dose is 100mg, but does not provide additional information on the dosing frequency.
Key Points
- The maximum recommended daily dose of losartan is 100mg.
- This dose can be given as a once-daily dose or split into two doses.
- Doses above 100mg do not produce additional effects.
- No initial dosage adjustment is necessary in the elderly and patients with renal impairment.
Dosage Considerations
- Losartan can be administered without regard to food.
- No dosage adjustment is necessary in patients with mild hepatic impairment or various degrees of renal insufficiency.
- Losartan is not removed during haemodialysis.