From the Guidelines
The maximum recommended dose of losartan for adults is 100 mg once daily. Treatment typically starts at a lower dose of 25-50 mg once daily, which can be gradually increased based on blood pressure response. For patients with hepatic impairment or volume depletion (such as those on diuretics), a lower starting dose of 25 mg is recommended. Losartan is an angiotensin II receptor blocker (ARB) that works by blocking the binding of angiotensin II to its receptors, thereby relaxing blood vessels and lowering blood pressure. The full antihypertensive effect is usually seen within 3-6 weeks of starting treatment. When increasing the dose, it's essential to monitor blood pressure, kidney function, and potassium levels, as higher doses may increase the risk of side effects such as hypotension, hyperkalemia, and renal dysfunction. Doses exceeding 100 mg daily have not shown to provide additional benefit in controlling blood pressure but may increase the risk of adverse effects, as noted in the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1.
Some studies suggest that higher doses of losartan, up to 150 mg daily, may be beneficial in certain patients, such as those with heart failure 1. However, the current FDA-approved labeling recommends a maximum dose of 100 mg daily 1. The 2022 AHA/ACC/HFSA guideline for the management of heart failure also recommends losartan 50-150 mg once daily, but notes that the maximum approved dose is 100 mg daily 1.
Key points to consider when prescribing losartan include:
- Starting with a lower dose and gradually increasing as needed
- Monitoring blood pressure, kidney function, and potassium levels
- Being aware of potential side effects, such as hypotension, hyperkalemia, and renal dysfunction
- Considering the patient's individual needs and medical history when determining the optimal dose.
It's also important to note that losartan is often used in combination with other medications, such as ACE inhibitors, beta blockers, and diuretics, to manage conditions like heart failure and hypertension 1.
In terms of specific patient populations, losartan may be used at the same doses in patients with diabetes, but careful monitoring of kidney function and potassium levels is essential 1.
Overall, while higher doses of losartan may be beneficial in certain situations, the maximum recommended dose for most adults is 100 mg once daily, and careful monitoring and individualized treatment are essential to minimize the risk of adverse effects.
From the FDA Drug Label
The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure Doses above 1.4 mg per kg (or in excess of 100 mg) daily have not been studied in pediatric patients
The maximum dose of losartan that can be administered is 100 mg once daily 2.
From the Research
Maximum Dose of Losartan
- The maximum dose of losartan that can be administered is 100 mg once daily, as stated in the study 3.
- In dose-ranging studies, 50 mg once daily has generally been shown to produce near maximum effects, and a dose of 100 mg does not produce additional effects 3.
- Losartan dosages primarily ranged from 10 to 150 mg once daily, with most patients receiving 50 to 100 mg per day, as reported in the study 4.
- The antihypertensive effects of losartan 50 to 100 mg once daily were similar to those of other classes of antihypertensive agents, such as felodipine, enalapril, and atenolol 3, 5.
- A study compared the efficacy and tolerability of once-daily, fixed-dose combinations of losartan and hydrochlorothiazide, with losartan doses of 50 mg and 100 mg, and found that both combinations were effective and well-tolerated 6.
- Another study found that combination therapy with losartan 100 mg and hydrochlorothiazide 12.5 mg was more effective in reducing blood pressure and proteinuria than losartan 100 mg alone in hypertensive patients with stage 3 chronic kidney disease 7.