From the Guidelines
The equivalent dose of losartan for a patient taking lisinopril 20 mg orally twice daily is losartan 100 mg once daily. This recommendation is based on the most recent and highest quality study available, which suggests that losartan 100 mg once daily is the target dose for patients with heart failure 1. When switching from lisinopril to losartan, it is recommended to start with losartan 50 mg once daily and monitor blood pressure response, potentially increasing to 100 mg once daily if needed for optimal blood pressure control.
Key Considerations
- Losartan is dosed once daily due to its longer duration of action compared to lisinopril.
- This substitution involves changing from an ACE inhibitor (lisinopril) to an ARB (losartan), which work similarly by affecting the renin-angiotensin system but through different mechanisms.
- ARBs like losartan may cause fewer side effects like cough compared to ACE inhibitors.
- When making this switch, monitor blood pressure closely for 1-2 weeks to ensure adequate control, and be aware that full effects may take 2-4 weeks to develop.
Monitoring and Adjustment
- Consult with your healthcare provider before making any medication changes, as individual factors may affect appropriate dosing.
- The goal is to achieve optimal blood pressure control while minimizing side effects and ensuring the patient's safety and well-being.
- The dose of losartan may need to be adjusted based on the patient's response to the medication and their individual characteristics, such as kidney function and other medical conditions.
Mechanism and Efficacy
- ACE inhibitors and ARBs are effective in slowing progression of kidney disease characterized by microalbuminuria in hypertensive patients with type 1 or type 2 diabetes 1.
- Higher levels of blood pressure are associated with more rapid progression of DKD, and ACE inhibitors and ARBs decrease urine albumin excretion, slow the increase in albumin excretion, and delay the progression from microalbuminuria to macroalbuminuria in kidney disease due to type 1 or type 2 diabetes 1.
From the Research
Equivalent Dose of Losartan for Lisinopril
To determine the equivalent dose of losartan for a patient taking lisinopril 20 milligrams (mg) orally twice daily, we need to consider the available evidence.
- The provided studies do not directly compare the doses of lisinopril and losartan 2, 3, 4, 5, 6.
- However, study 4 compares the effectiveness of twice-daily versus once-daily lisinopril and losartan for hypertension, but it does not provide a direct comparison of the doses.
- Study 6 compares the effect of twice-daily administration of perindopril and losartan on diurnal/nocturnal blood pressure ratio, but it does not provide information on the equivalent dose of losartan for lisinopril.
Available Information on Lisinopril and Losartan
- Lisinopril is an orally active angiotensin-converting enzyme (ACE) inhibitor, effective in lowering blood pressure in all grades of essential hypertension 2.
- Losartan is an angiotensin II receptor antagonist (ARB) used to treat hypertension 4, 6.
- The doses of lisinopril and losartan used in the studies vary, but there is no direct comparison of the equivalent doses 2, 3, 4, 5, 6.
Conclusion on Equivalent Dose
Based on the available evidence, there is no direct comparison of the equivalent dose of losartan for a patient taking lisinopril 20 mg orally twice daily 2, 3, 4, 5, 6.