What is the recommended dosing for Losartan (Angiotensin II receptor antagonist)?

From the Guidelines

Losartan is typically started at 25-50 mg daily for adults with hypertension, with the dose adjustable to 25-100 mg daily based on blood pressure response, as recommended by the most recent guidelines 1.

Key Considerations

• The starting dose for patients with heart failure is lower at 25 mg once daily, which can be gradually increased to 50-150 mg daily.
• Patients with hepatic impairment or volume depletion should start at 25 mg daily.
• Losartan can be taken with or without food, and the timing should be consistent each day for optimal effect.

Mechanism of Action

• The medication works by blocking angiotensin II receptors, preventing blood vessel constriction and reducing blood pressure.
• It also decreases aldosterone secretion, which helps reduce fluid retention.

Monitoring and Side Effects

• Full therapeutic effects may take 3-6 weeks to develop, though some blood pressure reduction occurs within the first week.
• Common side effects include dizziness, hypotension, and elevated potassium levels.
• Kidney function and potassium levels should be monitored periodically, especially when initiating therapy or adjusting doses.

Special Considerations

• Losartan should not be used during pregnancy as it can cause fetal harm.
• The most recent guidelines recommend using the highest quality evidence available to guide dosing decisions, with a focus on minimizing morbidity, mortality, and improving quality of life 1.

Dosing Recommendations

• The recommended dosing for Losartan is based on the patient's individual response to the medication, with a goal of achieving optimal blood pressure control while minimizing side effects.
• The dose should be adjusted based on regular monitoring of blood pressure, kidney function, and potassium levels.
• The most recent study 1 provides the highest quality evidence for guiding losartan dosing decisions.

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). Pediatric Hypertension 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 [see DOSAGE AND ADMINISTRATION (2.5)]. The usual starting dose is 50 mg of losartan once daily. The dose should be increased to 100 mg once daily based on blood pressure response [see CLINICAL STUDIES (14.3)]. In patients with mild-to-moderate hepatic impairment the recommended starting dose of losartan is 25 mg once daily.

The recommended dosing for Losartan is:

• Adult Hypertension: 50 mg once daily, with a maximum dose of 100 mg once daily
• Pediatric Hypertension: 0.7 mg per kg once daily (up to 50 mg total)
• Hypertensive Patients with Left Ventricular Hypertrophy: 50 mg once daily
• Nephropathy in Type 2 Diabetic Patients: 50 mg once daily, with a dose increase to 100 mg once daily based on blood pressure response
• Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate impairment 2 Key considerations include:
• Starting dose: 25 mg for patients with possible intravascular depletion
• Dose adjustment: based on blood pressure response
• Maximum dose: 100 mg once daily for adult hypertension and nephropathy in type 2 diabetic patients

From the Research

Recommended Dosing for Losartan

The recommended dosing for Losartan, an Angiotensin II receptor antagonist, can vary depending on the patient's condition and response to treatment. Based on the available evidence, the following dosing information can be summarized:

• For patients with diabetic nephropathy, a dose of 100 mg daily is suggested for renoprotection and blood pressure reduction 3.
• In hypertensive patients with renal impairment, losartan can be effective at doses of 50 mg or 100 mg daily, with the option to increase the dose if blood pressure remains high 4.
• For patients with mild to moderate essential hypertension, a dose of 50 mg daily can be effective, with the option to increase to 100 mg daily if necessary 5.
• A meta-analysis of ambulatory blood pressure monitoring studies found that losartan 50 mg and 100 mg may have a lower antihypertensive efficacy compared to other Angiotensin Receptor Blockers (ARBs) at similar doses 6.
• An observational study found that losartan 100 mg, alone or in combination with hydrochlorothiazide 25 mg, was effective and well-tolerated in patients with essential arterial hypertension and cardiovascular risk factors 7.

Key Findings

• Losartan doses of 50 mg, 100 mg, and 150 mg have been studied in various patient populations.
• The optimal dose of losartan for renoprotection and blood pressure reduction in diabetic nephropathy is 100 mg daily 3.
• Losartan can be effective in hypertensive patients with renal impairment at doses of 50 mg or 100 mg daily 4.
• The antihypertensive efficacy of losartan may be lower compared to other ARBs at similar doses 6.

Dosing Considerations

• The dose of losartan should be individualized based on the patient's response to treatment and tolerability.
• Patients with renal impairment may require closer monitoring of blood pressure and renal function when taking losartan 4.
• Combination therapy with other antihypertensive agents, such as hydrochlorothiazide, may be necessary to achieve adequate blood pressure control in some patients 7.