Losartan Dosing for Hypertension and Diabetic Nephropathy
For hypertension, the recommended starting dose of losartan is 50 mg once daily, with titration to a maximum of 100 mg once daily as needed. For diabetic nephropathy, the starting dose is 50 mg once daily, with titration to 100 mg once daily based on blood pressure response. 1
Dosing for Hypertension
Initial Dosing
- Standard starting dose: 50 mg once daily 1
- For patients with possible intravascular depletion (e.g., on diuretic therapy): 25 mg once daily 1
- For patients with mild-to-moderate hepatic impairment: 25 mg once daily 1
Dose Titration
- Can be increased to maximum 100 mg once daily based on blood pressure response 1
- For stage 2 hypertension (≥160/100 mmHg): Consider combining with another antihypertensive agent 2
- Losartan can be administered without regard to food 3
Dosing for Diabetic Nephropathy
Initial Dosing
- Starting dose: 50 mg once daily 1
Dose Titration
- Should be increased to 100 mg once daily based on blood pressure response 1
- Research indicates 100 mg daily is significantly more effective than 50 mg daily for renoprotection in diabetic nephropathy 4
- No additional benefit was observed when increasing from 100 mg to 150 mg daily 4
Special Considerations
Renal Protection
- For patients with diabetes, hypertension, and albuminuria, angiotensin II receptor blockers (ARBs) like losartan should be titrated to the highest approved dose that is tolerated 5
- The RENAAL study demonstrated that losartan 100 mg daily reduced the risk of end-stage renal disease by 28% in patients with type 2 diabetes and nephropathy 6
Left Ventricular Hypertrophy
- For hypertensive patients with left ventricular hypertrophy: Start with 50 mg once daily 1
- Consider adding hydrochlorothiazide 12.5 mg daily and/or increasing losartan to 100 mg once daily based on blood pressure response 1
Monitoring
- Check blood pressure 2-4 weeks after initiation or dose adjustment 2
- Monitor serum creatinine, estimated glomerular filtration rate, and potassium levels at baseline and at least annually 2
- More frequent monitoring is needed in patients with chronic kidney disease 2
Common Pitfalls
- Many clinicians use suboptimal doses of losartan (50 mg daily) when 100 mg daily provides greater benefits for both hypertension control and renoprotection 2, 4
- Avoid combining losartan with ACE inhibitors or direct renin inhibitors as this increases adverse effects without providing additional benefits 5, 2
- Losartan should not be used in pregnancy, particularly in the second and third trimesters, due to risk of fetal toxicity 3
- Losartan has not been studied in patients with severe hepatic impairment 1
By following these evidence-based dosing recommendations, clinicians can optimize the benefits of losartan therapy for patients with hypertension and diabetic nephropathy while minimizing potential adverse effects.