What is the recommended dosing for Losartan (Angiotensin II Receptor Antagonist) HCTZ (Hydrochlorothiazide)?

From the Guidelines

The recommended dosing for Losartan/HCTZ combination therapy typically starts at 50 mg Losartan/12.5 mg HCTZ once daily for adults with hypertension. If blood pressure remains uncontrolled after 2-4 weeks, the dose may be increased to a maximum of 100 mg Losartan/25 mg HCTZ once daily. For elderly patients or those with renal impairment (creatinine clearance 30-50 mL/min), no initial dosage adjustment is necessary, but lower doses should be considered for those with more severe renal dysfunction. This medication should be taken at the same time each day, with or without food. Losartan works by blocking angiotensin II receptors, preventing blood vessel constriction, while HCTZ is a diuretic that reduces fluid volume. The combination provides enhanced blood pressure reduction through complementary mechanisms. Patients should be monitored for electrolyte imbalances, particularly potassium levels, and blood pressure should be checked regularly to ensure the medication is effective. If experiencing dizziness, especially when standing up, patients should rise slowly from sitting or lying positions.

Key Considerations

• The dosing strategy should be individualized based on patient response and tolerability 1.
• The American College of Cardiology/American Heart Association guidelines recommend starting with a low dose and titrating up to the maximum recommended dose 1.
• The combination of Losartan and HCTZ has been shown to be effective in reducing blood pressure and improving cardiovascular outcomes 1.
• Patients with renal impairment or hepatic dysfunction may require dose adjustments 1.

Monitoring and Follow-up

• Regular monitoring of blood pressure, electrolyte levels, and renal function is essential to ensure the safe and effective use of Losartan/HCTZ combination therapy 1.
• Patients should be educated on the importance of adherence to their medication regimen and the potential side effects of the medication 1.
• Follow-up appointments should be scheduled regularly to assess the patient's response to therapy and make any necessary adjustments to the treatment plan 1.

From the FDA Drug Label

The usual starting dose of losartan potassium and hydrochlorothiazide tablets is 50 mg/12.5 mg (losartan 50 mg/hydrochlorothiazide 12.5 mg) once daily. The dosage can be increased after 3 weeks of therapy to a maximum of 100 mg/25 mg (losartan 100 mg/hydrochlorothiazide 25 mg) once daily as needed to control blood pressure [see CLINICAL STUDIES (14. 2)].

The recommended dosing for Losartan (Angiotensin II Receptor Antagonist) HCTZ (Hydrochlorothiazide) is:

• Starting dose: 50 mg/12.5 mg (losartan 50 mg/hydrochlorothiazide 12.5 mg) once daily
• Maximum dose: 100 mg/25 mg (losartan 100 mg/hydrochlorothiazide 25 mg) once daily Key points to consider when dosing:
• Increase dosage after 3 weeks of therapy if blood pressure is not adequately controlled
• Initiate patients not adequately controlled with losartan 50 mg or 100 mg monotherapy with losartan potassium and hydrochlorothiazide tablets 50 mg/12.5 mg or 100 mg/12.5 mg once daily, respectively 2

From the Research

Dosing of Losartan HCTZ

The recommended dosing for Losartan (Angiotensin II Receptor Antagonist) HCTZ (Hydrochlorothiazide) is as follows:

• 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 3.
• Losartan/HCTZ can be administered in combination, with a typical starting dose of losartan 50 mg/HCTZ 12.5 mg, which can be increased to 100/25 mg if required to achieve blood pressure control 4.
• The combination of losartan and HCTZ has been shown to be effective in reducing blood pressure in patients with hypertension, with a significant reduction in systolic and diastolic blood pressure compared to losartan alone 5, 6.
• The antihypertensive efficacy of the concomitant administration of selected doses of HCTZ on a background of losartan 50 mg has been evaluated, with results showing that the addition of HCTZ 12.5 mg or 25 mg to losartan 50 mg produced effective control of blood pressure in a substantial majority of patients who only partially responded to losartan monotherapy 7.

Key Considerations

• The dose of losartan and HCTZ can be adjusted based on the patient's response to treatment and their individual needs.
• Losartan and HCTZ can be administered without regard to food, and there are no clinically significant effects of age, sex, or race on the pharmacokinetics of losartan 3.
• The combination of losartan and HCTZ has been shown to be well tolerated, with a low incidence of adverse events 4, 5, 6, 7.

Dosage Combinations

• Losartan 50 mg/HCTZ 12.5 mg: This is a common starting dose for patients with hypertension, which can be adjusted based on the patient's response to treatment 4.
• Losartan 100 mg/HCTZ 25 mg: This is a higher dose combination that can be used in patients who require more intensive blood pressure control 4, 6.