What is the dosing regimen for losartan (angiotensin II receptor antagonist)?

From the Guidelines

Losartan should be dosed at 100 mg once daily for adults with hypertension, as this is the target dose recommended by the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. When initiating losartan therapy, the starting dose can be 50 mg once daily, with the option to increase to 100 mg daily if blood pressure remains uncontrolled after several weeks.

• Key considerations for dosing losartan include:
  • Starting dose: 50 mg once daily for adults with hypertension
  • Target dose: 100 mg once daily
  • Titration: gradual increase to 100 mg daily if blood pressure remains uncontrolled
  • Special populations:
    • Heart failure or diabetic nephropathy: starting dose of 25 mg once daily, with gradual titration upward
    • Elderly patients, those with hepatic impairment, or patients taking diuretics: starting dose of 25 mg daily
• It is essential to monitor blood pressure regularly when starting or adjusting losartan therapy, as the full antihypertensive effect may take 3-6 weeks to develop 1.
• Losartan works by blocking angiotensin II receptors, relaxing blood vessels, and reducing blood pressure, and should not be stopped abruptly 1.
• Patients should inform their healthcare provider about all other medications they're taking to avoid potential interactions. The most recent and highest quality study, the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure, recommends a target dose of 100 mg once daily for losartan 1.

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 dosing of losartan is as follows:

• Adult Hypertension: 50 mg once daily, increased to 100 mg once daily as needed
• 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, increased to 100 mg once daily based on blood pressure response
• Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate impairment 2

From the Research

Dosing Losartan

• The initial dose of losartan is typically 50 mg once daily, which can be titrated to 100 mg as needed to achieve the desired blood pressure goal 3.
• In patients with severe hypertension, losartan can be used as initial therapy, and the dose can be adjusted based on the patient's response to treatment 3.
• Some studies suggest that losartan 50 mg may be sufficient for patients with mild-to-moderate hypertension, while others may require titration to 100 mg to achieve optimal blood pressure control 4.
• The goal of treatment with losartan is to achieve a sitting diastolic blood pressure of less than 90 mmHg, and a systolic blood pressure of less than 135 mmHg 5.

Combination Therapy

• Losartan can be used in combination with other antihypertensive agents, such as hydrochlorothiazide, calcium channel blockers, and beta-blockers, to achieve optimal blood pressure control 3, 5.
• The addition of losartan to other antihypertensive agents can provide additional benefits in terms of reducing proteinuria and slowing the progression of renal disease 6, 7.

Special Considerations

• In patients with type 2 diabetes, the goal of treatment with losartan is to achieve a blood pressure of less than 135/80 mmHg, which can provide dramatic benefits in terms of reducing morbidity and mortality 5.
• Losartan may be a preferred first-line agent for the treatment of hypertension in patients with diabetes, due to its ability to reduce proteinuria and slow the progression of renal disease 6, 5.