Maximum Recommended Dose of Losartan for Hypertension
The maximum recommended dose of losartan for hypertension is 100 mg once daily, as established by the FDA and supported by major clinical guidelines. 1
Standard Dosing for Hypertension
- The FDA-approved maximum dose for hypertension is 100 mg once daily, with a typical starting dose of 50 mg once daily 1
- Doses above 100 mg daily have been studied primarily in heart failure populations, not for hypertension management 2
- The 50 mg dose produces near-maximum antihypertensive effects, with 100 mg providing only modest additional blood pressure reduction 3
Clinical Context: When Higher Doses Are Used
While 100 mg is the maximum for hypertension, 150 mg daily has been studied specifically in heart failure with reduced ejection fraction, where the HEAAL trial demonstrated a 10% relative risk reduction in death or heart failure hospitalization compared to 50 mg daily 2
However, for hypertension specifically:
- The American College of Cardiology guidelines confirm 100 mg once daily as the maximum dose for blood pressure control 2, 4
- If blood pressure remains uncontrolled on losartan 100 mg daily, add hydrochlorothiazide 12.5-25 mg daily rather than exceeding the 100 mg losartan dose 4, 1
Special Populations
Pediatric patients (age 6 and older):
- Maximum dose is 100 mg daily (same as adults) 4, 1
- Starting dose is 0.7 mg/kg once daily (up to 50 mg total) 1
- Doses above 1.4 mg/kg or exceeding 100 mg daily have not been studied in children 1
Hepatic impairment:
- Start with 25 mg once daily in mild-to-moderate hepatic impairment 1
- Losartan has not been studied in severe hepatic impairment 1
Renal impairment:
- No dosage adjustment needed for various degrees of renal insufficiency, including dialysis patients 5
- Both 50 mg and 100 mg doses were effective and well-tolerated in patients with chronic kidney disease 5
Critical Safety Considerations
- Monitor potassium and renal function within 1-2 weeks after starting losartan, especially in patients with baseline renal impairment or systolic BP <80 mm Hg 4
- Never combine losartan with ACE inhibitors, as this increases risk of hyperkalemia and renal dysfunction without additional benefit 2, 4
- Losartan can be administered once or twice daily (e.g., 50 mg twice daily for total of 100 mg), though once-daily dosing is standard 2
When Maximum Dose Fails
If blood pressure remains uncontrolled on losartan 100 mg daily:
- Add hydrochlorothiazide 12.5-25 mg daily as first-line combination therapy 4, 1
- Target blood pressure is <130/80 mm Hg for most adults with hypertension 4
- Consider alternative antihypertensive agents from different classes if combination therapy is insufficient 2
Common Pitfall to Avoid
Do not exceed 100 mg daily for hypertension management. The 150 mg dose studied in heart failure trials is not FDA-approved for hypertension and provides minimal additional blood pressure reduction beyond 100 mg 2, 1, 3. Instead, optimize therapy by adding a thiazide diuretic or switching to combination therapy 4.