Losartan Equivalent Dose to Lisinopril 10 mg
The equivalent dose of losartan to lisinopril 10 mg is 50 mg daily. 1
Dosing Equivalence Table
- According to the American Heart Association, American College of Cardiology, and Heart Failure Society of America guidelines, the following dosing equivalence is recommended 1:
- Lisinopril 2.5-5 mg = Losartan 25-50 mg
- Lisinopril 10-20 mg = Losartan 50 mg
- Lisinopril 20-40 mg = Losartan 100 mg
Clinical Considerations
- Losartan is typically administered once daily at 50 mg for hypertension management, with titration to 100 mg daily if needed for blood pressure control 1
- For heart failure patients, the target dose of losartan is 100 mg daily to achieve maximum cardiovascular benefits 2
- Higher doses of losartan (100-150 mg daily) have been shown to provide better cardiovascular outcomes than lower doses in clinical trials 2, 1
Pharmacological Considerations
- Losartan is rapidly absorbed after oral administration, reaching maximum concentrations 1-2 hours post-administration 3
- Approximately 14% of losartan is converted to its active metabolite E-3174, which is 10-40 times more potent than the parent compound 3
- Unlike ACE inhibitors like lisinopril, losartan (an ARB) has a lower risk of angioedema and cough, making it a suitable alternative for patients who experience these side effects 1
Dosing in Special Populations
- For patients with heart failure, uptitration to target doses (losartan 100 mg) is recommended to achieve maximum mortality and morbidity benefits 1
- In diabetic nephropathy, losartan 100 mg daily has been shown to be more effective than 50 mg daily in reducing albuminuria and blood pressure, with no additional benefit at 150 mg 4
- No dosage adjustment is necessary for losartan in patients with mild hepatic impairment or various degrees of renal insufficiency 3
Important Precautions
- Avoid simultaneous use of ACE inhibitors (like lisinopril) and ARBs (like losartan), as this combination increases the risk of hyperkalemia and renal dysfunction without additional benefit 2, 1
- When converting between medications, ensure adequate blood pressure monitoring during the transition period 1
- For optimal blood pressure control, the FDA label for losartan indicates that doses of 50-100 mg once daily provide statistically significant decreases in blood pressure 5
Efficacy Considerations
- Clinical trials have shown that losartan 50-100 mg once daily produces systolic/diastolic mean decreases in blood pressure of 5.5-10.5/3.5-7.5 mmHg compared to placebo 5
- Twice-daily dosing of losartan at the same total daily dose may provide consistently larger trough responses than once-daily dosing, but recent research does not support improved effectiveness of BID dosing 5, 6