From the Guidelines
The recommended starting dose of losartan for hypertension or diabetic nephropathy is 50 mg once daily, which can be increased to a maximum of 100 mg once daily based on blood pressure response and proteinuria reduction. For patients with volume depletion, such as those on diuretics, a lower starting dose of 25 mg once daily is recommended to prevent hypotension. Losartan can be taken with or without food at any time of day, but it's best taken consistently at the same time each day to maintain steady blood levels. According to the most recent guideline evidence 1, renin-angiotensin system inhibitors, such as losartan, slow the progression of kidney disease in persons with albuminuria and hypertension independent of their effects on blood pressure. The dose of losartan should be titrated to the maximal tolerated dose, with close monitoring of serum potassium and serum creatinine levels within 2 to 4 weeks of initiation of or change in dose.
Some key points to consider when prescribing losartan include:
- Monitoring for hyperkalemia, especially in patients with kidney impairment or those taking potassium supplements or potassium-sparing medications
- Avoiding combination therapy with ACE inhibitors and ARBs, as it can be harmful in patients with diabetes and CKD
- Considering the use of mineralocorticoid receptor antagonists, such as spironolactone and eplerenone, for resistant hypertension
- Being aware of the potential for losartan to provide renoprotective effects beyond blood pressure control by reducing proteinuria and slowing progression of kidney disease.
It's also important to note that the recommended dose and frequency of losartan may vary depending on the individual patient's needs and medical history, and should be determined in consultation with a healthcare provider. The evidence from 1 and 1 supports the use of losartan in patients with hypertension or diabetic nephropathy, but the most recent and highest quality evidence from 1 should be prioritized when making treatment decisions.
From the FDA Drug Label
The usual starting dose of losartan potassium tablet 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 The usual starting dose is 50 mg of losartan potassium tablet once daily. Hydrochlorothiazide 12.5 mg daily should be added and/or the dose of losartan potassium tablets should be increased to 100 mg once daily The usual starting dose is 50 mg once daily. The dose should be increased to 100 mg once daily based on blood pressure response Usual adult dose: 50 mg once daily. Usual pediatric starting dose: 0.7 mg per kg once daily (up to 50 mg). Usual starting dose: 50 mg once daily. Add hydrochlorothiazide 12.5 mg and/or increase losartan potassium tablets to 100 mg followed by an increase to hydrochlorothiazide 25 mg if further blood pressure response is needed. Usual dose: 50 mg once daily. Increase dose to 100 mg once daily if further blood pressure response is needed.
The recommended dose and frequency for losartan in patients with hypertension or diabetic nephropathy is:
- Adults: 50 mg once daily, with a maximum dose of 100 mg once daily as needed to control blood pressure.
- Pediatric patients: 0.7 mg per kg once daily (up to 50 mg). In patients with left ventricular hypertrophy, the usual starting dose is 50 mg once daily, with the option to add hydrochlorothiazide 12.5 mg and/or increase losartan to 100 mg once daily. In patients with diabetic nephropathy, the usual dose is 50 mg once daily, with the option to increase to 100 mg once daily based on blood pressure response 2, 2, 2.
From the Research
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.
- For patients with diabetic nephropathy, the optimal dose of losartan is 100 mg daily for renoprotection and blood pressure reduction 4.
- Losartan can be used in patients with hypertension, with a dose of 50-100 mg once daily 5, 6.
- In patients with type 2 diabetes and nephropathy, losartan (50 to 100 mg once daily) has been shown to reduce the risk of doubling of the serum creatinine concentration, end-stage renal disease, and hospitalization for heart failure 7.
Special Considerations
- No dosage adjustment is necessary in patients with mild hepatic impairment or various degrees of renal insufficiency 3.
- Losartan is not removed during haemodialysis 3.
- In elderly patients, the incidence of treatment-related adverse events associated with once daily losartan is similar to other antihypertensive agents 5.
- No dosage adjustment is required in elderly patients or in patients with mild to moderate renal dysfunction 5.