Losartan Daily Dosing for Hypertension
For adults with hypertension, start losartan at 50 mg once daily and increase to 100 mg once daily as needed for blood pressure control, which is the maximum recommended dose for hypertension. 1
Standard Dosing for Hypertension
- Initial dose: 50 mg once daily is the standard starting point for most adults with hypertension 2, 1
- Maximum dose: 100 mg once daily represents the ceiling for hypertension treatment 1, 3
- Losartan can be administered once or twice daily (e.g., 50 mg twice daily totaling 100 mg/day), though once-daily dosing is typical 4
- The medication can be taken without regard to food 3
Dose Titration Strategy
- Increase from 50 mg to 100 mg daily if blood pressure remains uncontrolled after initial treatment 1
- The dose adjustment should occur based on blood pressure response, typically after allowing adequate time to assess efficacy 1
- For patients with possible intravascular depletion (e.g., those on diuretic therapy), start with 25 mg once daily to avoid hypotension 1
Special Populations
Hepatic Impairment
- Start with 25 mg once daily in patients with mild-to-moderate hepatic impairment 1
- Losartan has not been studied in severe hepatic impairment and should be used with extreme caution 1
Renal Impairment
- No dose adjustment is necessary for various degrees of renal insufficiency, including patients on hemodialysis 3, 5
- Doses of 50-100 mg daily have been shown effective and well-tolerated even in patients with chronic kidney disease 5, 6
Elderly Patients
- No dose adjustment based on age alone is required, as age does not significantly affect losartan pharmacokinetics 3, 7
Combination Therapy Considerations
- Add hydrochlorothiazide 12.5-25 mg daily if blood pressure remains uncontrolled on losartan 100 mg alone, as this provides additive blood pressure-lowering effects 2, 4, 6
- The combination of losartan with a thiazide diuretic or calcium channel blocker is preferred over monotherapy for most patients with confirmed hypertension 8
- Never combine losartan with ACE inhibitors, as this increases the risk of hyperkalemia and renal dysfunction 2, 4
Target Blood Pressure Goals
- Aim for blood pressure <130/80 mm Hg in most adults with hypertension to reduce cardiovascular risk 2, 8
- For patients at increased cardiovascular risk, target systolic blood pressure of 120-129 mm Hg if well tolerated 8
Common Pitfalls to Avoid
- Do not exceed 100 mg daily for hypertension, as this is the maximum FDA-approved dose for this indication 1
- Monitor serum potassium and creatinine within 1-2 weeks after initiating therapy, especially in patients with renal impairment or those on other medications affecting potassium 4
- Avoid in pregnancy at all stages, as losartan causes serious fetal toxicity in the second and third trimesters 3
- Do not use in combination with ACE inhibitors or aldosterone antagonists due to increased risk of hyperkalemia and renal dysfunction 2, 4