Losartan Dosing Recommendations
The standard dosing for losartan is 50 mg once daily as the starting dose, which can be increased to a maximum of 100 mg once daily as needed to control blood pressure. 1
Standard Dosing for Hypertension
- Initial dose: 50 mg once daily
- Maximum dose: 100 mg once daily
- Starting dose for patients with possible volume depletion: 25 mg once daily 1
Dosing for Special Populations
Patients with Left Ventricular Hypertrophy
- Start with 50 mg once daily
- May increase to 100 mg once daily based on blood pressure response
- Consider adding hydrochlorothiazide 12.5 mg if needed 1
Patients with Nephropathy in Type 2 Diabetes
- Start with 50 mg once daily
- Increase to 100 mg once daily based on blood pressure response 1
- Studies suggest 100 mg daily is optimal for renoprotection in diabetic nephropathy 2
Patients with Hepatic Impairment
- Mild to moderate impairment: Start with 25 mg once daily
- Severe impairment: Not studied, use with caution 1
Dosing Considerations
Efficacy
- Higher doses (100 mg) have shown greater benefit than lower doses (50 mg) in reducing cardiovascular events and heart failure hospitalizations 3
- For optimal renoprotection in diabetic nephropathy, 100 mg daily appears more effective than 50 mg daily 2
- In nondiabetic patients with nephrotic range proteinuria, 100 mg daily provides optimal antiproteinuric effect compared to 50 mg or 150 mg 4
Administration
- Can be administered without regard to food 5
- Pharmacokinetics are linear and dose-proportional 5
- Maximum effect is reached within 1-2 hours after oral administration 5
Monitoring
- Monitor blood pressure within 1-2 weeks after initiation or dose changes 6
- Evaluate renal function before initiation and periodically during treatment 6
Safety Considerations
- Losartan is generally well-tolerated with minimal side effects 5, 7
- Contraindicated in pregnancy 6
- Use with caution in patients with severe bilateral renal artery stenosis 6
- Avoid routine combined use with ACE inhibitors and aldosterone antagonists 6
Pediatric Dosing
- Starting dose: 0.7 mg/kg once daily (up to 50 mg total)
- Maximum dose: 1.4 mg/kg daily (not to exceed 100 mg)
- Not recommended for children under 6 years or with eGFR <30 mL/min/1.73 m² 1
The evidence consistently supports that while 50 mg daily is effective for blood pressure control, increasing to 100 mg daily provides additional benefits for cardiovascular and renal protection without significantly increasing adverse effects.