Typical Starting Dose for Losartan in Adults
The usual starting dose of losartan for adult hypertension is 50 mg once daily, with the option to increase to a maximum dose of 100 mg once daily as needed to control blood pressure. 1
Standard Dosing Recommendations
- The FDA-approved starting dose for losartan in adult hypertension is 50 mg once daily 1
- A lower starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., those on diuretic therapy) 1
- Losartan can be administered without regard to food, as there are no clinically significant effects on its absorption 2
- The dose can be titrated up to a maximum of 100 mg once daily based on blood pressure response 1
Special Conditions Dosing
- For hypertensive patients with left ventricular hypertrophy, the usual starting dose is also 50 mg once daily 1
- For nephropathy in type 2 diabetic patients, start with 50 mg once daily and increase to 100 mg once daily based on blood pressure response 1
- In patients with mild-to-moderate hepatic impairment, a reduced starting dose of 25 mg once daily is recommended 1
- No dosage adjustment is necessary for patients with various degrees of renal insufficiency 2, 3
Target Dosing for Optimal Outcomes
- For heart failure patients with reduced ejection fraction (HFrEF), the target dose of losartan is 100 mg once daily 4
- According to the American College of Cardiology/American Heart Association guidelines, the 50% of target dose threshold for losartan is 50 mg daily 4
- Clinical studies support that higher doses of losartan (100 mg daily) provide better cardiovascular outcomes than lower doses 5
Titration Considerations
- Therapy should be adjusted no more frequently than every 2 weeks to target doses or maximally tolerated doses 4
- The European Society of Cardiology guidelines also recommend losartan 50 mg as the starting dose with 150 mg as the target dose 4
- Most patients (87%) are maintained on the 50 mg dose in clinical practice 6
Clinical Pearls
- Losartan is rapidly absorbed, reaching maximum concentrations 1-2 hours after administration 2
- Approximately 14% of a losartan dose is converted to the pharmacologically active E-3174 metabolite, which is 10-40 times more potent than the parent compound 2
- The long half-life (6-9 hours) of the active metabolite contributes to the extended duration of action, allowing for once-daily dosing 2, 7
- Losartan is generally well-tolerated with dizziness being the most commonly reported drug-related adverse effect 8, 7
Common Pitfalls to Avoid
- Avoid simultaneous use of ACE inhibitors and losartan, as this combination increases the risk of hyperkalemia and renal dysfunction 5
- First-dose hypotension is uncommon with losartan, possibly due to its slower onset of action compared to ACE inhibitors 7
- Monitor potassium levels, particularly in patients with renal impairment, as hyperkalemia can occur (though it's relatively rare) 3
- Losartan should be avoided during pregnancy, especially in the second and third trimesters, due to potential fetal toxicity 2