Losartan Daily Dosing for Hypertension
Standard Dosing Recommendation
For adults with hypertension, start losartan at 50 mg once daily and increase to 100 mg once daily as needed for blood pressure control, with 100 mg once daily being the maximum recommended dose for hypertension. 1
Initial Dosing Strategy
- Standard starting dose: 50 mg once daily for most adults with hypertension 1
- Low starting dose: 25 mg once daily is recommended for patients with possible intravascular depletion (e.g., those on diuretic therapy) or mild-to-moderate hepatic impairment 1
- The medication can be taken without regard to food 2
Dose Titration and Targets
- Maximum monotherapy dose: 100 mg once daily for hypertension 1
- The dosage can be increased from 50 mg to 100 mg once daily as needed to control blood pressure 1
- For optimal blood pressure control, aim for treated systolic blood pressure values of 120-129 mmHg in most adults, as long as treatment is well tolerated 3
Combination Therapy Considerations
- If blood pressure remains uncontrolled on losartan 100 mg alone, add hydrochlorothiazide 12.5-25 mg daily 4
- The preferred combinations for hypertension are a renin-angiotensin system blocker (such as losartan) with a dihydropyridine calcium channel blocker or a diuretic 3
- The addition of 12.5 mg hydrochlorothiazide to 50 mg losartan produces significant additional antihypertensive response 5
Special Populations and Conditions
Hypertensive Patients with Left Ventricular Hypertrophy
- Start with 50 mg once daily 1
- Add hydrochlorothiazide 12.5 mg daily and/or increase losartan to 100 mg once daily, followed by increasing hydrochlorothiazide to 25 mg once daily based on blood pressure response 1
Nephropathy in Type 2 Diabetic Patients
- Start with 50 mg once daily 1
- Increase to 100 mg once daily based on blood pressure response 1
- Research supports that 100 mg daily is the optimal dose for renoprotection and blood pressure reduction in diabetic nephropathy, being significantly more effective than 50 mg daily in reducing albuminuria 6
Renal Impairment
- Losartan is recommended for chronic kidney disease with eGFR >30 mL/min per 1.73 m² 4
- No dosage adjustment is necessary in patients with various degrees of renal insufficiency 2
- Losartan 50-100 mg once daily is effective and well-tolerated in hypertensive patients with chronic renal disease, including those on hemodialysis 7
Pediatric Patients (6 years and older)
- Usual starting dose: 0.7 mg/kg once daily (up to 50 mg total) 1
- Doses above 1.4 mg/kg (or in excess of 100 mg) daily have not been studied 1
- Not recommended in pediatric patients less than 6 years of age or with eGFR <30 mL/min/1.73 m² 1
Dosing Frequency Options
- Losartan can be administered once or twice daily, but the total daily dose should not exceed 100 mg for hypertension 4
- If twice-daily dosing is desired for more consistent coverage, split the 100 mg total daily dose into 50 mg twice daily 4
- The active metabolite E3174 has an estimated terminal half-life of 6-9 hours, supporting once-daily dosing 2
Critical Safety Monitoring
- Monitor blood pressure regularly during dose titration 8
- Monitor for hyperkalemia, especially when using higher doses 4
- Regular monitoring of electrolyte balance and serum creatinine is recommended 4
- Avoid combining losartan with ACE inhibitors, as this combination increases the risk of hyperkalemia and renal dysfunction without additional benefit 4, 8
Common Pitfalls to Avoid
- Underdosing is widespread in clinical practice, with less than 25% of patients ever titrated to target doses 4
- Higher doses provide greater benefits than lower doses, with little evidence that medium-range doses approximate the benefits of target doses 4
- Dizziness is the only drug-related adverse event reported more frequently with losartan than placebo (2.4% versus 1.3%) 5
- First-dose hypotension is uncommon 9
- Losartan has a similar incidence of cough to placebo, making it advantageous for patients with ACE inhibitor-related cough 9