From the Guidelines
The starting dose of losartan for adults with hypertension or diabetic nephropathy is typically 50 mg once daily. For patients with intravascular volume depletion (such as those taking diuretics), a lower initial dose of 25 mg once daily is recommended to reduce the risk of symptomatic hypotension 1. Losartan can be taken with or without food at any time of day, though taking it at the same time each day helps maintain consistent blood levels. The full antihypertensive effect is usually achieved within 3-6 weeks of treatment. If blood pressure is not adequately controlled at this dose, the dosage may be increased to a maximum of 100 mg once daily or divided into two doses. Losartan works by blocking angiotensin II receptors, preventing the hormone from binding and causing blood vessel constriction, thereby lowering blood pressure and reducing the workload on the heart. In diabetic nephropathy, it helps protect kidney function by reducing protein excretion and slowing disease progression.
Some key points to consider when prescribing losartan include:
- Monitoring of electrolyte balance and serum creatinine is recommended, especially in patients with chronic kidney disease 1.
- Losartan is generally well-tolerated, but may cause hyperkalemia, especially in patients with renal impairment or those taking other medications that increase potassium levels 1.
- The use of losartan in combination with other antihypertensive agents, such as ACE inhibitors, should be done with caution and close monitoring of blood pressure and renal function 1.
- Losartan has been shown to reduce the risk of cardiovascular events and slow the progression of kidney disease in patients with diabetic nephropathy 1.
Overall, losartan is a effective and well-tolerated medication for the treatment of hypertension and diabetic nephropathy, and can be used as a first-line agent in many patients. However, careful consideration of the patient's individual needs and close monitoring of their response to therapy are essential to optimize treatment outcomes.
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 usual starting dose is 50 mg of losartan once daily. The usual starting dose is 50 mg once daily.
The starting dose of losartan for adults with hypertension or diabetic nephropathy is 50 mg once daily. A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy) 2.
From the Research
Starting Dose of Losartan
The starting dose of losartan for adults with hypertension or diabetic nephropathy is typically 50 mg once daily.
- This dose can be adjusted based on patient response, with a maximum recommended daily dose of 100 mg [ 3, 4 ].
Dose Adjustment
- For patients with diabetic nephropathy, a dose of 100 mg daily has been shown to be effective in reducing albuminuria and blood pressure [ 5 ].
- In nondiabetic patients with nephrotic range proteinuria, a dose of 100 mg daily has also been found to be optimal for reducing proteinuria [ 6 ].
Combination Therapy
- Losartan can be used in combination with other antihypertensive agents, such as hydrochlorothiazide, to achieve greater blood pressure-lowering and antiproteinuric effects [ 7 ].