Losartan Dosing for Hypertension

For adult hypertension, start losartan at 50 mg once daily and titrate to a maximum of 100 mg once daily as needed for blood pressure control. 1

Standard Adult Dosing

Initial dose: 50 mg once daily is the FDA-approved starting dose for most patients with hypertension 1
Maximum dose: 100 mg once daily represents the ceiling for blood pressure reduction in hypertension 1
Titration timing: Adjust dosage based on blood pressure response, typically after allowing adequate time for therapeutic effect 1
Administration: Can be taken without regard to food, and timing (morning vs. evening) can be based on patient convenience to improve adherence 2

Start at 25 mg once daily in patients with possible intravascular depletion (e.g., those on diuretic therapy) to avoid excessive hypotension 1

Start at 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

No dose adjustment needed for various degrees of renal insufficiency, including patients on hemodialysis 3
Losartan was effective and well-tolerated at standard doses (50-100 mg daily) in patients with creatinine clearance as low as 10-29 mL/min per 1.73 m² 3

Starting dose: 0.7 mg/kg once daily (up to 50 mg total) 1
Maximum dose: 1.4 mg/kg once daily (not to exceed 100 mg daily) 1, 4
Not recommended in children under 6 years or with estimated GFR <30 mL/min/1.73 m² 1
Can be administered as tablet or suspension 1

Add hydrochlorothiazide 12.5-25 mg daily if blood pressure remains uncontrolled on losartan 100 mg alone 1, 4
The combination provides additive blood pressure-lowering effects superior to either agent alone 5, 6
Target blood pressure: <130/80 mm Hg for most adults with hypertension to reduce cardiovascular risk 2

Start at 50 mg once daily, add hydrochlorothiazide 12.5 mg daily, then increase losartan to 100 mg daily followed by hydrochlorothiazide to 25 mg daily based on blood pressure response 1

Start at 50 mg once daily and increase to 100 mg once daily based on blood pressure response 1

While the FDA-approved maximum for hypertension is 100 mg daily 1, target doses of 150 mg daily have been studied in heart failure with reduced ejection fraction, showing superior outcomes compared to 50 mg daily 7, 2
This higher dosing is specific to heart failure management, not routine hypertension 7

Monitor potassium and renal function within 1-2 weeks after initiation, especially in patients with baseline renal impairment or very low systolic BP (<80 mm Hg) 7
Never combine with ACE inhibitors due to increased risk of hyperkalemia and renal dysfunction 7, 2
Contraindicated in pregnancy (second and third trimester) due to serious fetal toxicity 8
Avoid abrupt withdrawal to prevent rebound hypertension 2

Underdosing is widespread: Many patients remain on suboptimal doses when 100 mg daily may be needed for adequate blood pressure control 7, 5
Inadequate titration: Allow sufficient time (at least 2 weeks) between dose adjustments to assess full therapeutic effect 7
Premature addition of second agent: Ensure losartan is titrated to 100 mg daily before adding combination therapy unless blood pressure is severely elevated 5

Excellent tolerability: Adverse event rates similar to placebo, with dizziness being the only side effect reported more frequently than placebo (2.4% vs 1.3%) 6, 9
No ACE inhibitor-related cough: Particularly advantageous for patients with history of ACE inhibitor intolerance 6
Withdrawal rates lower than placebo (2.3% vs 3.7%) in clinical trials 9