Maximum Recommended Dose of Losartan for Adults with Hypertension

The maximum recommended dose of losartan for adults with hypertension is 100 mg once daily. 1

Dosing Guidelines for Losartan in Hypertension

The usual starting dose of losartan for adult hypertension is 50 mg once daily 1
The dose can be titrated up to a maximum of 100 mg once daily as needed to control blood pressure 1, 2
A lower starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., those on diuretic therapy) 1
For patients with mild-to-moderate hepatic impairment, the recommended starting dose is 25 mg once daily 1

For patients with heart failure with reduced ejection fraction (HFrEF), losartan is considered part of guideline-directed medical therapy (GDMT) 2
The target dose for losartan in heart failure patients is 100 mg once daily 2
At minimum, patients should receive at least 50% of the target dose (50 mg daily) to achieve clinical benefits 2

The usual starting dose is 50 mg once daily 1
The dose should be increased to 100 mg once daily based on blood pressure response 1

The usual starting dose is 50 mg once daily 1
The dose may be increased to 100 mg once daily based on blood pressure response 1

Studies suggest that higher doses of losartan (100 mg daily) provide greater clinical benefits than lower doses 2
The HEAAL trial demonstrated that 150 mg daily of losartan was superior to 50 mg daily in heart failure patients, with a 10% relative risk reduction in death or heart failure hospitalization 2
Some experts suggest that losartan should preferably be prescribed at the dose of 100 mg/day or higher for maximal benefits 3
The FDA-approved maximum dose remains 100 mg daily, despite some clinical trials using higher doses 2, 1

Losartan is generally well-tolerated across the dosing range 4, 5
The most common adverse effects include dizziness, headache, upper respiratory tract infection, and asthenia/fatigue 4
Unlike ACE inhibitors, losartan has a low incidence of cough, similar to placebo 5
Losartan can be safely administered in hypertensive patients with concomitant illnesses including diabetes mellitus, renal impairment, or heart failure 4, 6

Losartan can be administered without regard to food 7
The pharmacokinetics are linear and dose-proportional 7
For stage 2 hypertension (BP ≥160/100 mm Hg), prompt treatment with combination therapy is recommended, which may include losartan as one component 2
Monthly follow-up is recommended after initiation or adjustment of antihypertensive medications until blood pressure control is achieved 2

Underdosing is common in clinical practice, with many patients not reaching target doses that have been proven effective in clinical trials 2
Physicians often hesitate to uptitrate due to concerns about hypotension or worsening renal function, but the most dramatic decreases in blood pressure typically occur with the initial dose rather than subsequent increases 2
Losartan should be avoided in pregnancy, particularly in the second and third trimesters, due to risk of fetal toxicity 7
Concomitant use with other medications that affect the renin-angiotensin system (such as ACE inhibitors or direct renin inhibitors) is not recommended 2