What is the appropriate dosing for Losartan (Angiotensin II receptor antagonist)?

From the Guidelines

Losartan should be initiated at a dose of 25-50 mg daily and titrated to a goal dose of 25-100 mg daily in 1-2 divided doses, as supported by the KDOQI clinical practice guidelines 1. The dosing of Losartan, an Angiotensin II receptor antagonist, is crucial in managing hypertension and slowing the progression of kidney disease.

• The starting dose of Losartan can be either 25 mg or 50 mg daily, depending on the patient's condition and response to the medication.
• The goal dose should be at the higher end of the dose range, which is 25-100 mg daily in 1-2 divided doses, as recommended by the KDOQI guidelines 1.
• It is essential to monitor blood pressure, kidney function, and potassium levels regularly, especially when initiating therapy or adjusting doses, to ensure the optimal effect of the medication and minimize potential side effects.
• Losartan works by blocking angiotensin II receptors, preventing blood vessel constriction and reducing blood pressure, and also decreases aldosterone secretion, which helps reduce fluid retention.
• The medication can be taken with or without food, and the timing should be consistent each day for optimal effect.
• Potential side effects of Losartan include dizziness, hypotension, and elevated potassium levels, which should be closely monitored, especially in patients with hepatic impairment or volume depletion, who should start at a lower dose of 25 mg daily.

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 [see CLINICAL STUDIES (14.1)]. A starting dose of 25 mg is recommended for patients with possible intravascular depletion (e.g., on diuretic therapy). Pediatric Hypertension 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 [see DOSAGE AND ADMINISTRATION (2.5)]. The usual starting dose is 50 mg of losartan once daily. The dose should be increased to 100 mg once daily based on blood pressure response [see CLINICAL STUDIES (14.3)]. In patients with mild-to-moderate hepatic impairment the recommended starting dose of losartan is 25 mg once daily.

The appropriate dosing for Losartan is:

• Adult Hypertension: 50 mg once daily, with a maximum dose of 100 mg once daily
• 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, with a dose increase to 100 mg once daily based on blood pressure response
• Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate impairment, with no recommendation for severe hepatic impairment 2

From the Research

Dosing for Losartan

• The appropriate dosing for Losartan, an Angiotensin II receptor antagonist, has been studied in various clinical trials 3, 4, 5.
• A study published in 2010 found that 150 mg of losartan had favorable effects compared to the currently recommended dose of 50 mg per day 3.
• Another study published in 1995 compared the efficacy of losartan at doses of 50 mg once daily, 100 mg once daily, and 50 mg twice daily, and found that all three dosages were significantly more effective than placebo at decreasing systolic and diastolic blood pressures 4.
• A study published in 1997 compared the antihypertensive effects of losartan 50 mg and losartan 50 mg titrated to 100 mg in patients with essential hypertension, and found that losartan was efficacious and well tolerated, with a small additional benefit associated with increasing the dose to 100 mg in patients who did not reach the target blood pressure after the first 6 weeks on losartan 50 mg 5.
• The dosing of losartan may vary depending on the specific patient population and clinical context, and should be guided by clinical judgment and evidence-based guidelines.

Comparison with Other Medications

• Losartan has been compared to other medications, such as amlodipine, in terms of its effects on blood pressure and renal function 6.
• A study published in 1998 found that losartan decreased albumin excretion in hypertensive patients with non-diabetic nephropathy, while amlodipine did not have a significant effect on albumin excretion 6.
• Another study published in 2021 compared the effects of angiotensin-converting enzyme inhibitors and calcium channel blockers on the progression of diabetic nephropathy, and found that angiotensin-converting enzyme inhibitors were more effective in reducing the albumin excretion rate than calcium channel blockers after short-term treatments 7.