What is the proper dosing for losartan (angiotensin II receptor antagonist)?

From the Guidelines

Losartan should be initiated at 25-50 mg once daily for adults with hypertension, with the dose adjustable to 25-100 mg daily based on blood pressure response, as recommended by the most recent guidelines 1.

Key Considerations

• The dose of losartan can be titrated upward gradually to a target dose of 50-100 mg daily for patients with heart failure, with a starting dose of 25 mg once daily.
• For patients with hepatic impairment or volume depletion, a starting dose of 25 mg is recommended.
• Losartan works by blocking angiotensin II receptors, preventing vasoconstriction and aldosterone secretion, thereby lowering blood pressure.
• The medication can be taken with or without food, and the full antihypertensive effect typically develops within 3-6 weeks of consistent use.

Monitoring and Precautions

• Renal function and potassium levels should be monitored, especially when initiating therapy or adjusting doses, as losartan can affect kidney function and potassium balance.
• Patients should be advised that losartan may cause dizziness, particularly when standing up quickly, and to report persistent side effects to their healthcare provider.

Evidence-Based Recommendations

• The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends losartan 50-150 mg once daily as a target dose 1.
• The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure also recommend losartan 100 mg once daily as a target dose 1.
• However, the most recent and highest quality study, the 2022 AHA/ACC/HFSA guideline, is used as the basis for this recommendation 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)]. 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 proper 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)
• Hypertensive Patients with Left Ventricular Hypertrophy: 50 mg once daily
• Nephropathy in Type 2 Diabetic Patients: 50 mg once daily, with an 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 2

From the Research

Proper Dosing for Losartan

The proper dosing for losartan, an angiotensin II receptor antagonist, can be determined based on various studies.

• The recommended dose of losartan is 50 mg once daily, which has been shown to produce near maximum effects 3.
• A dose of 100 mg does not produce additional effects, but it can be used in patients who do not respond to the 50 mg dose 3.
• No initial dosage adjustment is necessary in the elderly and patients with renal impairment, including those on dialysis 3, 4.
• In patients with type 2 diabetes and nephropathy, losartan can be used at a dose of 50-100 mg once daily, in addition to conventional antihypertensive treatment 5.
• Losartan has been compared to other antihypertensive agents, such as captopril, and has been shown to be effective in reducing blood pressure in patients with mild to moderate essential hypertension 6.
• The antihypertensive effects of losartan have been characterized using ambulatory blood pressure monitoring, which has shown that losartan has a duration of action of 24 hours 7.

Key Findings

• Losartan 50 mg once daily is an effective treatment for patients with essential mild to moderate hypertension 3, 6, 7.
• Losartan 100 mg once daily can be used in patients who do not respond to the 50 mg dose 3.
• Losartan is well tolerated and has a low incidence of adverse events, including cough 3, 6, 7.
• Losartan can be used in combination with other antihypertensive agents, such as diuretics, to produce additional blood pressure reductions 5, 7.