From the Guidelines
Losartan should be prescribed at a dose of 100 mg once daily, as this is the recommended target dose according to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend losartan 150 mg as the target dose, but due to the current FDA-approved labeling, the 100-mg dose is used in the performance measure 1. Some key points to consider when prescribing losartan include:
- The medication can be taken with or without food at the same time each day to maintain consistent blood levels.
- Dose adjustments may be necessary for elderly patients, those with hepatic impairment, or patients who are volume-depleted.
- Losartan works by blocking angiotensin II receptors, preventing the hormone from binding and causing blood vessel constriction, thereby lowering blood pressure.
- This medication typically takes 3-6 weeks to reach its full therapeutic effect, though some blood pressure reduction may be observed within the first week of treatment. It's essential to note that the dosing frequency and amount may vary depending on the specific patient population and clinical context, such as heart failure, hypertension, left ventricular hypertrophy, or diabetic nephropathy 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).
The recommended dose and frequency of Losartan is:
- 50 mg once daily as the usual starting dose for adult hypertension
- 25 mg once daily as the starting dose for patients with possible intravascular depletion
- The dosage can be increased to a maximum of 100 mg once daily as needed to control blood pressure 2
From the Research
Recommended Dose and Frequency of Losartan
- The recommended dosage of losartan is 50 mg/day, which can be administered without regard to food 3.
- 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 50 mg once daily has generally been shown to produce near maximum effects, and a dose of 100 mg does not produce additional effects 4.
- For renoprotection and blood pressure reduction in type 1 diabetic patients with diabetic nephropathy, the optimal dose of losartan is 100 mg daily 5.
- Losartan 50 or 100 mg/day was significantly more effective than placebo in reducing the incidence of a doubling of serum creatinine, end-stage renal disease (ESRD) or death in patients with type 2 diabetes mellitus and proteinuria 6.
Special Considerations
- No initial dosage adjustment is necessary in the elderly and patients with renal impairment (even those on dialysis) 3, 4, 7.
- Losartan is well tolerated in patients with chronic renal disease, including those on hemodialysis 7.
- Losartan should be avoided in pregnancy, as it is often associated with serious fetal toxicity 3.