From the Guidelines
Losartan should be prescribed at a target dose of 100 mg once daily, as recommended by the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. The dose of Losartan can be adjusted based on individual patient needs, but the target dose of 100 mg once daily is the recommended starting point.
- Key considerations for Losartan dosing include:
- Initial dose: 100 mg once daily
- Maximum dose: 100 mg once daily, as per FDA-approved labeling
- Adjustment for kidney function or other comorbidities: may require dose reduction, but this is not explicitly stated in the provided evidence It's worth noting that the ACC/AHA Guidelines recommend a target dose of 150 mg, but the 100-mg dose is used in the performance measure due to current FDA-approved labeling 1.
- The therapeutic effects of Losartan may take several weeks to develop, and regular blood pressure monitoring is important to assess the effectiveness of treatment. Losartan works by blocking angiotensin II receptors, preventing blood vessel constriction and reducing blood pressure, and is typically well-tolerated, with common side effects including dizziness, fatigue, and occasional cough 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.
- A study suggests that the optimal dose of losartan is 100 mg daily for renoprotection and blood pressure reduction in type 1 diabetic patients with diabetic nephropathy 4.
- 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 5.
Special Considerations
- No initial dosage adjustment is necessary in the elderly and patients with renal impairment (even those on dialysis) 5, 6.
- Losartan can be used in patients with mild hepatic impairment or various degrees of renal insufficiency without dosage adjustment 3.
- Losartan is not removed during haemodialysis 3.
Efficacy and Tolerability
- Losartan has been shown to be effective in reducing blood pressure in hypertensive patients with chronic renal disease 6.
- Losartan reduces the progression to end-stage renal disease in diabetic patients with nephropathy 7.
- Losartan reduces cardiovascular morbidity and mortality and total mortality in hypertensive diabetic patients with left ventricular hypertrophy 7.