What is the recommended dosing for Losartan (angiotensin II receptor antagonist)?

Losartan Dosing Recommendations

The recommended starting dose of losartan is 50 mg once daily, which can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure. 1

Standard Dosing for Different Indications

Hypertension

• Initial dose: 50 mg once daily 1
• Maximum dose: 100 mg once daily 1
• Starting dose for patients with possible intravascular depletion (e.g., on diuretic therapy): 25 mg once daily 1

Hypertensive Patients with Left Ventricular Hypertrophy

• Initial dose: 50 mg once daily 1
• Titration: Can increase to 100 mg once daily based on blood pressure response 1
• Additional therapy: Hydrochlorothiazide 12.5 mg daily can be added and increased to 25 mg daily if needed 1

Nephropathy in Type 2 Diabetic Patients

• Initial dose: 50 mg once daily 1
• Maximum dose: 100 mg once daily based on blood pressure response 1
• Evidence suggests: 100 mg daily may be more effective than 50 mg for renoprotection 2

Special Population Considerations

Hepatic Impairment

• Mild to moderate impairment: Starting dose of 25 mg once daily 1
• Severe hepatic impairment: Not studied, use with caution 1

Renal Impairment

• No dosage adjustment is necessary for various degrees of renal insufficiency 3
• Losartan has been shown to be effective and well-tolerated in patients with chronic renal disease, including those on hemodialysis 4

Pediatric Patients

• Starting dose: 0.7 mg/kg once daily (up to 50 mg total) 1
• Maximum dose: 1.4 mg/kg daily (not to exceed 100 mg) 1
• Not recommended in pediatric patients less than 6 years of age or with eGFR < 30 mL/min/1.73 m² 1

Optimal Dosing Considerations

• Evidence suggests that 100 mg daily may be more effective than 50 mg for both blood pressure reduction and renoprotection 2, 5
• For heart failure patients, higher target doses of losartan (up to 150 mg daily) may provide greater benefits in reducing mortality and heart failure hospitalizations 6
• The HEAAL trial showed that 150 mg daily of losartan was superior to 50 mg daily for heart failure outcomes 7

Administration Guidelines

• Losartan can be administered without regard to food 3
• The pharmacokinetics of losartan are linear and dose-proportional 3
• After oral administration, losartan is rapidly absorbed, reaching maximum concentrations in 1-2 hours 3
• Approximately 14% of a losartan dose is converted to the active E3174 metabolite, which is 10-40 times more potent than losartan 3

Monitoring Recommendations

• Monitor blood pressure within 1-2 weeks after initiation or dose changes 6
• Evaluate renal function before initiation and periodically during treatment 6
• Monitor for potential hyperkalemia, especially when combined with other medications affecting the renin-angiotensin system 6

Important Precautions

• Contraindicated in pregnancy 6
• Avoid routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist as it is potentially harmful 6
• Use with caution in patients with severe bilateral renal artery stenosis 6

Losartan is generally well-tolerated with a favorable side effect profile compared to other antihypertensive medications, making it a valuable option for patients who cannot tolerate ACE inhibitors due to cough 8.