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

From the Guidelines

Losartan should be initiated at a dose of 25-50 mg daily, with a maximum daily dose of 100 mg, as this range has been shown to be effective in reducing blood pressure and slowing the progression of kidney disease, while minimizing the risk of adverse effects. The dosing of Losartan can be adjusted based on blood pressure response, with the goal of achieving optimal blood pressure control while minimizing the risk of adverse effects 1. For patients with volume depletion or those taking diuretics, a lower starting dose of 25 mg is recommended, while patients with liver impairment should also start at 25 mg daily 1. The evidence suggests that higher doses of Losartan, up to 100 mg daily, may be more effective in reducing the risk of cardiovascular events and slowing the progression of kidney disease, but may also increase the risk of adverse effects 1. Some key points to consider when dosing Losartan include:

• Starting dose: 25-50 mg daily
• Maximum daily dose: 100 mg
• Dose adjustment: based on blood pressure response
• Special considerations: lower starting dose for patients with volume depletion or liver impairment, and close monitoring of patients with renal impairment. It is also important to monitor blood pressure, kidney function, and potassium levels regularly, especially when initiating therapy or adjusting doses, to minimize the risk of adverse effects and optimize treatment outcomes 1.

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)]. Dosage should be adjusted according to blood pressure response. Doses above 1.4 mg per kg (or in excess of 100 mg) daily have not been studied in pediatric patients [see CLINICAL PHARMACOLOGY (12.3), CLINICAL STUDIES (14.1), and WARNINGS AND PRECAUTIONS (5.2)].

The appropriate dosing for Losartan is as follows:

• 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)
• Patients with possible intravascular depletion: 25 mg once daily
• Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate hepatic impairment, with no recommendation for severe hepatic impairment 2

From the Research

Dosing Information for Losartan

• The recommended dosage of losartan is 50 mg/day, which can be administered without regard to food 3.
• The maximum recommended daily dose of losartan is 100mg, which can be given as a once-daily dose or by splitting the same total daily dose into two doses 3.
• In patients with type 2 diabetes and nephropathy, losartan has been studied at doses of 50 to 100 mg once daily 4, 5, 6, 7.
• Losartan has been shown to reduce the incidence of doubling of serum creatinine, end-stage renal disease, or death in patients with type 2 diabetes and nephropathy at doses of 50 to 100 mg/day 4, 5, 6, 7.

Special Considerations

• No dosage adjustment is necessary in patients with mild hepatic impairment or various degrees of renal insufficiency 3.
• Losartan is not removed during haemodialysis 3.
• Losartan should be avoided in pregnancy, as it is associated with serious fetal toxicity when given in the second and third trimester 3.