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). Hydrochlorothiazide 12.5 mg daily should be added and/or the dose of losartan should be increased to 100 mg once daily followed by an increase in hydrochlorothiazide to 25 mg once daily based on blood pressure response [see CLINICAL STUDIES (14.2)].
The administration of 25 mg of hydrochlorothiazide (HCTZ) and 100 mg of losartan in a patient with hypotension is not recommended.
- The starting dose of losartan is 50 mg once daily, and a dose of 25 mg is recommended for patients with possible intravascular depletion.
- The use of HCTZ and losartan in combination is recommended to be started with a dose of 12.5 mg of HCTZ and 50 mg of losartan, with an increase to 25 mg of HCTZ and 100 mg of losartan based on blood pressure response.
- Since the patient has hypotension, the use of these medications may further decrease blood pressure, which could be harmful.
- Therefore, it is not safe to administer 25 mg of HCTZ and 100 mg of losartan in a patient with hypotension 1.
From the Research
It is not safe to administer 25 mg of hydrochlorothiazide (HCTZ) and 100 mg of losartan to a patient with hypotension, as this could further lower their blood pressure and increase the risk of symptoms like dizziness, lightheadedness, fainting, or falls. According to the most recent and highest quality study available, which is from 2020 2, hypotension is an important factor limiting the titration of heart failure treatments in routine practice. The study suggests that in patients with non-severe and asymptomatic hypotension, European and US guidelines recommend maintaining the same drug dosage, but in instances of symptomatic or severe persistent hypotension, it is recommended to first decrease blood pressure reducing drugs not indicated in heart failure with reduced ejection fraction (HFrEF) as well as the loop diuretic dose.
Key Considerations
- The patient's hypotension should be carefully evaluated and managed to avoid further lowering their blood pressure.
- The combination of losartan and hydrochlorothiazide can be effective in reducing blood pressure, but it may not be suitable for patients with hypotension.
- The decision to administer antihypertensive medications should be based on the patient's overall clinical picture, including their baseline blood pressure, symptoms, and medical history.
- Blood pressure should be monitored regularly, especially after any medication changes.
Alternative Approaches
- Consider holding the dose of losartan and hydrochlorothiazide and consulting with the patient's healthcare provider about dose adjustment or medication changes.
- Evaluate the patient's overall clinical picture, including their baseline blood pressure, symptoms, and medical history, to determine the best course of treatment.
- Monitor the patient's blood pressure regularly to avoid further lowering their blood pressure and to adjust their treatment plan as needed.
Note: The other studies provided, such as 3, 4, 5, and 6, are not directly relevant to the question of administering losartan and hydrochlorothiazide to a patient with hypotension, and therefore are not considered in this response.