Recommended Dosage of Losartan for Adults with Hypertension
The recommended starting dose of losartan for adults with hypertension is 50 mg once daily, with titration to a maximum dose of 100 mg once daily as needed to control blood pressure. 1
Initial Dosing Considerations
- For most adults with hypertension, start with 50 mg once daily
- For patients with possible intravascular depletion (e.g., those on diuretic therapy), a lower starting dose of 25 mg is recommended 1
- Losartan can be administered without regard to food 2
- For patients with mild-to-moderate hepatic impairment, the recommended starting dose is 25 mg once daily 1
Dose Titration
- Blood pressure should be monitored 2-4 weeks after initiation or dose adjustment 3
- If blood pressure control is not achieved with the initial 50 mg dose, increase to the maximum dose of 100 mg once daily 1
- For stage 2 hypertension (BP ≥160/100 mmHg), combination therapy with two antihypertensive agents of different classes should be considered 4
Special Populations
Patients with Diabetic Nephropathy
- Start with 50 mg once daily
- Increase to 100 mg once daily based on blood pressure response 1
- Studies show that 100 mg daily is more effective than 50 mg daily for renoprotection and blood pressure reduction in diabetic nephropathy 5
Patients with Left Ventricular Hypertrophy
- Start with 50 mg once daily
- Consider adding hydrochlorothiazide 12.5 mg daily and/or increasing losartan to 100 mg once daily based on blood pressure response 1
Patients with Heart Failure
- Target dose is 100 mg once daily
- A minimum of at least 50% of the target dose (50 mg daily) is recommended for clinical benefit 4
- Therapies must be titrated to maximally tolerated doses in patients with heart failure with reduced ejection fraction 4
Efficacy and Safety
- Losartan doses of 50-100 mg once daily provide statistically significant systolic/diastolic mean decreases in blood pressure compared to placebo 1
- The 100 mg dose has been shown to be more effective than 50 mg in reducing albuminuria and blood pressure in patients with diabetic nephropathy 5
- Losartan is generally well-tolerated with minimal serious adverse events 3
- The most common side effect is dizziness, which occurs at a similar rate to placebo 6
Monitoring Recommendations
- Check blood pressure 2-4 weeks after initiation or dose adjustment 3
- Monitor serum creatinine, estimated glomerular filtration rate (eGFR), and potassium levels at baseline and at least annually 3
- More frequent monitoring is recommended for patients with chronic kidney disease or those on medications affecting potassium levels 3
Important Precautions
- Do not use losartan in combination with ACE inhibitors or direct renin inhibitors due to increased risk of adverse effects 4
- Avoid use during pregnancy, particularly in the second and third trimesters, due to risk of fetal toxicity 2
- Losartan has not been studied in patients with severe hepatic impairment 1
By following these dosing recommendations and monitoring parameters, losartan can effectively control blood pressure in adults with hypertension while minimizing potential adverse effects.