What is the maximum recommended dose of losartan (angiotensin II receptor antagonist) for adults with hypertension?

Maximum Recommended Dose of Losartan for Adults with Hypertension

The maximum recommended dose of losartan for adults with hypertension is 100 mg once daily, as established by the FDA-approved labeling. 1

Dosing Guidelines for Losartan

Initial Dosing

• Standard starting dose: 50 mg once daily 1
• Lower starting dose (25 mg): Recommended for patients with possible intravascular depletion (e.g., those on diuretic therapy) 1

Dose Titration

• Dosage can be increased to the maximum dose of 100 mg once daily as needed to control blood pressure 1
• Titration should be based on blood pressure response
• Monthly follow-up is recommended after initiating or adjusting therapy until blood pressure control is achieved 2

Special Populations

• Hepatic impairment (mild to moderate): Starting dose should be reduced to 25 mg once daily 1
• Losartan has not been studied in patients with severe hepatic impairment 1
• No dosage adjustment is necessary for patients with various degrees of renal insufficiency 3

Clinical Applications of Losartan

Hypertension Management

• For stage 2 hypertension (BP ≥160/100 mmHg), losartan should be initiated as part of a two-drug combination regimen 2
• For resistant hypertension, losartan can be part of a multi-drug regimen including a diuretic 4

Heart Failure with Reduced Ejection Fraction

• Target dose for heart failure with reduced ejection fraction: 100 mg once daily 2
• Minimum effective dose: At least 50% of target dose (50 mg daily) 2

Nephropathy in Type 2 Diabetes

• Starting dose: 50 mg once daily
• Should be increased to 100 mg once daily based on blood pressure response 1
• Studies show that 100 mg daily provides greater renoprotective effects than 50 mg daily 5

Important Clinical Considerations

Drug Interactions

• Should not be combined with ACE inhibitors or direct renin inhibitors due to increased risk of adverse effects without additional benefit 4
• No clinically significant drug interactions with hydrochlorothiazide, warfarin, or digoxin 3

Monitoring

• Blood pressure should be monitored 2-4 weeks after initiation or dose adjustment 4
• Serum creatinine, estimated glomerular filtration rate, and potassium levels should be checked at baseline and at least annually 4

Common Pitfalls

• Many clinicians use suboptimal doses (50 mg daily) when 100 mg daily provides greater benefits for both hypertension control and renoprotection 4, 5
• Research shows that 100 mg daily is significantly more effective than 50 mg daily in reducing albuminuria and blood pressure in diabetic nephropathy 5

Combination Therapy

• When combined with hydrochlorothiazide, losartan provides greater blood pressure reduction than either drug alone 6
• In severe hypertension, combination therapy with losartan 100 mg and hydrochlorothiazide 25 mg has shown effectiveness 6

Losartan is generally well tolerated with a favorable side effect profile compared to other antihypertensive medications, with dizziness being the most commonly reported side effect 7.