From the Guidelines
Losartan should be started at a dose of 50 mg once daily for adults with hypertension, with the option to increase to 100 mg daily if blood pressure control is inadequate after several weeks, as recommended by the most recent guidelines 1. The dosing for Losartan, an Angiotensin II receptor antagonist, is crucial for managing hypertension and other cardiovascular conditions.
- The starting dose is typically 50 mg once daily, which can be adjusted based on patient response and tolerance.
- For patients with heart failure or diabetic nephropathy, the starting dose may be lower, at 25 mg once daily, and can be gradually increased to 50-100 mg daily as needed.
- Elderly patients, those with hepatic impairment, or patients who are volume-depleted should generally start at 25 mg daily.
- Losartan can be taken with or without food at the same time each day to maintain consistent blood levels.
- It works by blocking angiotensin II receptors, preventing blood vessel constriction and reducing blood pressure.
- Patients should be monitored for side effects including dizziness, hypotension, hyperkalemia, and changes in kidney function, particularly when starting therapy or adjusting doses.
- Blood pressure, kidney function, and potassium levels should be checked periodically during treatment, as recommended by recent studies 1. The most recent and highest quality study, from 2020, provides the basis for these recommendations, emphasizing the importance of evidence-based dosing for optimal patient outcomes 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 A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy). 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 for pediatric patients. The usual starting dose is 50 mg of losartan once daily for hypertensive patients with left ventricular hypertrophy. The usual starting dose is 50 mg once daily for nephropathy in type 2 diabetic patients. In patients with mild-to-moderate hepatic impairment the recommended starting dose of losartan is 25 mg once daily.
The dosing for Losartan is as follows:
- Adult Hypertension: 50 mg once daily, increased to 100 mg once daily as needed
- 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
- Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate impairment 2
From the Research
Dosing for Losartan
- The recommended dose of losartan for hypertension 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 may be used in certain cases 3.
- In patients with diabetic nephropathy, a dose of 100 mg daily has been shown to be optimal for renoprotection and blood pressure reduction 4.
- Losartan 50 or 100 mg/day has been used in clinical trials for the treatment of diabetic nephropathy, with significant reductions in the incidence of doubling of serum creatinine, end-stage renal disease, and death 5, 6.
- No initial dosage adjustment is necessary in the elderly and patients with renal impairment, including those on dialysis 3, 7.
Special Populations
- In patients with renal impairment, losartan has been shown to be effective in reducing blood pressure, with doses of 50 or 100 mg once daily 7.
- In patients with diabetic nephropathy, losartan has been shown to reduce albuminuria and slow the progression of renal disease, with a dose of 100 mg daily being optimal 4, 6.
- In black patients, the mean response to losartan was lower, which may be due to the lesser activation of the renin-angiotensin system in this population 3.