What is the appropriate dosing for Losartan (Angiotensin II receptor antagonist)?

From the Guidelines

Losartan should be initiated at a dose of 50 mg once daily for adults with hypertension, with the goal of titrating up to a maximum dose of 100 mg daily as needed and tolerated, based on the most recent and highest quality evidence from the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1.

Key Considerations for Losartan Dosing

• The starting dose for patients with heart failure is 25 mg once daily, which can be increased every 1-2 weeks to a target dose of 50-100 mg daily as tolerated.
• Patients with hepatic impairment or volume depletion should start with a dose of 25 mg daily.
• Losartan can be taken with or without food, and it is essential to maintain consistent blood levels by taking the medication at the same time each day.

Mechanism of Action and Side Effects

• Losartan works by blocking angiotensin II receptors, which prevents blood vessel constriction and reduces blood pressure.
• Common side effects include dizziness, hypotension, and elevated potassium levels.

Monitoring and Precautions

• Regular monitoring of blood pressure, kidney function, and potassium levels is crucial, especially when initiating therapy or adjusting doses.
• Patients should avoid taking potassium supplements and salt substitutes containing potassium while on losartan, and should not discontinue the medication without consulting their healthcare provider.

Evidence-Based Recommendations

• The 2020 ACC/AHA guidelines recommend a target dose of 100 mg daily for losartan in adults with heart failure, although the FDA-approved labeling lists the maximum dose as 100 mg daily 1.
• The American Journal of Kidney Diseases also provides guidance on the dosing of ACE inhibitors and ARBs, including losartan, for adults with hypertension and chronic kidney disease 2.

From the FDA Drug Label

The usual starting dose of losartan is 50 mg once daily. The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure [see CLINICAL STUDIES (14.1)]. A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy). Pediatric Hypertension The usual recommended starting dose is 0.7 mg per kg once daily (up to 50 mg total) administered as a tablet or a suspension [see DOSAGE AND ADMINISTRATION (2.5)]. The usual starting dose is 50 mg of losartan once daily. The dose should be increased to 100 mg once daily based on blood pressure response [see CLINICAL STUDIES (14.3)]. In patients with mild-to-moderate hepatic impairment the recommended starting dose of losartan is 25 mg once daily.

The appropriate dosing for Losartan is:

• Adult Hypertension: 50 mg once daily, with a maximum dose of 100 mg once daily
• Pediatric Hypertension: 0.7 mg per kg once daily (up to 50 mg total)
• Hypertensive Patients with Left Ventricular Hypertrophy: 50 mg once daily
• Nephropathy in Type 2 Diabetic Patients: 50 mg once daily, with a dose increase to 100 mg once daily based on blood pressure response
• Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate impairment, with no recommendation for severe hepatic impairment 3

From the Research

Dosing Information for Losartan

• The initial dose of losartan is typically 50 mg once daily, which can be increased to 100 mg once daily if necessary 4, 5, 6, 7, 8.
• In patients with hypertension, the dose of losartan can be titrated upwards to achieve optimal blood pressure control, with some studies suggesting that doses up to 100 mg per day may be effective 4, 7, 8.
• Losartan can be used in combination with other antihypertensive agents, such as diuretics, to enhance its blood pressure-lowering effects 7, 8.
• The dosing regimen for losartan may need to be adjusted in patients with renal impairment, with some studies suggesting that lower doses may be necessary to avoid adverse effects 4.

Specific Patient Populations

• In patients with type 2 diabetes and nephropathy, losartan has been shown to be effective in reducing the incidence of doubling of serum creatinine, end-stage renal disease, and death, with a typical dose of 50-100 mg once daily 5, 6.
• In patients with hypertension and renal insufficiency, losartan has been shown to be effective in reducing blood pressure and slowing the progression of renal disease, with a typical dose of 50-100 mg once daily 4.
• In patients with moderate hypertension, losartan can be used in combination with hydrochlorothiazide to enhance its antihypertensive effects, with a typical dose of 50 mg losartan/12.5 mg hydrochlorothiazide once daily 8.