What is the dosage for Losartan in treating hypertension?

Losartan Dosage for Hypertension Treatment

The standard dosage of losartan for treating hypertension in adults is 50 mg once daily initially, which can be increased to a maximum of 100 mg once daily as needed to achieve blood pressure control. 1

Adult Dosing Guidelines

• The usual starting dose is 50 mg once daily for most adults 1
• A lower starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., those on diuretic therapy) 1
• Dosage can be titrated up to a maximum of 100 mg once daily based on blood pressure response 1
• Losartan can be administered without regard to food 2

Special Population Considerations

• In patients with mild-to-moderate hepatic impairment, the recommended starting dose is 25 mg once daily 1
• Losartan has not been studied in patients with severe hepatic impairment 1
• No dosage adjustment is necessary for patients with various degrees of renal insufficiency 2
• Losartan is not removed during hemodialysis 2

Efficacy and Pharmacokinetics

• Losartan is rapidly absorbed after oral administration, reaching maximum concentrations within 1-2 hours 2
• Approximately 14% of losartan is converted to its active metabolite E3174, which is 10-40 times more potent than losartan 2
• The terminal half-life of the active metabolite ranges from 6-9 hours, allowing for once-daily dosing 2
• Doses of 50-100 mg produce statistically significant systolic/diastolic mean decreases in blood pressure compared to placebo 1
• The 100 mg dose provides greater blood pressure reduction than 50 mg without significant differences between 100 mg and 150 mg doses 3

Clinical Outcomes and Benefits

• In the LIFE study, losartan demonstrated a lower risk for cardiovascular endpoints and all-cause mortality compared to atenolol in patients with hypertension and left ventricular hypertrophy 4
• In patients with diabetic nephropathy, losartan at doses of 50-100 mg daily reduced the risk of end-stage renal disease by 28% and proteinuria by 35% in the RENAAL trial 5, 6
• Studies have shown that losartan 100 mg daily is significantly more effective than 50 mg daily in reducing albuminuria in patients with diabetic nephropathy 3

Combination Therapy

• If blood pressure goals are not achieved with losartan monotherapy, additional antihypertensive medications may be added 4
• The addition of a low dose of hydrochlorothiazide (12.5 mg) to losartan 50 mg once daily has been shown to result in greater blood pressure reductions 1
• Losartan does not have clinically significant drug interactions with hydrochlorothiazide, warfarin, or digoxin 2

Monitoring and Follow-up

• Blood pressure should be monitored regularly to assess response to therapy 4
• In patients with diabetes and nephropathy, monitoring of renal function and proteinuria is recommended 4
• Target blood pressure should be <130/80 mmHg for patients with diabetes or chronic kidney disease 4

Pediatric Dosing

• For children 6 years and older, the usual starting dose is 0.7 mg/kg once daily (up to 50 mg total) 1
• Dosage should be adjusted according to blood pressure response, with doses up to 1.4 mg/kg (not exceeding 100 mg) daily 1
• Losartan is not recommended for children under 6 years of age or those with estimated GFR <30 mL/min/1.73 m² 1