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.
Dosing Considerations
When initiating losartan therapy, the starting dose can be 50 mg once daily, with adjustments made based on blood pressure response. The dose can be titrated up to 100 mg daily, as this is the maximum recommended dose according to the FDA-approved labeling 1.
- For patients with heart failure, the starting dose may be lower, at 25 mg once daily, which can be titrated up to 50-100 mg daily.
- Patients with hepatic impairment or volume depletion should start at 25 mg daily.
Administration and Monitoring
Losartan can be taken with or without food, and the full antihypertensive effect usually develops within 3-6 weeks of treatment. Dose adjustments should be made at 1-2 week intervals to allow for full effect assessment.
- Regular monitoring of blood pressure, renal function, and potassium levels is recommended, especially when initiating therapy or adjusting doses.
- Common side effects include dizziness, hypotension, and hyperkalemia.
- Losartan is contraindicated during pregnancy and should be used cautiously in patients with bilateral renal artery stenosis.
Mechanism of Action
As an angiotensin II receptor blocker (ARB), losartan works by blocking the binding of angiotensin II to its receptors, leading to vasodilation and decreased aldosterone secretion, which helps lower blood pressure.
- The goal dose should be at the higher end of the dose range when possible, as higher levels of blood pressure are associated with more rapid progression of kidney disease 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).
The recommended starting dose of losartan is 50 mg once daily, which can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure. A starting dose of 25 mg is recommended for patients with possible intravascular depletion. 2
- 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
- Dosage Modifications in Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate hepatic impairment
From the Research
Dosing Losartan
- The dosing of losartan can vary depending on the patient's condition and the specific formulation being used 3, 4, 5, 6, 7.
- In patients with hypertension, losartan can be used as monotherapy or in combination with other antihypertensive agents, such as hydrochlorothiazide or amlodipine 4, 5, 7.
- The typical starting dose of losartan is 50 mg once daily, which can be increased to 100 mg once daily if necessary 4.
- In patients with type 2 diabetes, losartan can be used in combination with other antihypertensive agents, such as hydrochlorothiazide or amlodipine, to control blood pressure and reduce the risk of cardiovascular complications 7.
- The choice of dosing regimen and combination therapy should be individualized based on the patient's specific needs and medical history 3, 4, 5, 6, 7.
Combination Therapy
- Losartan can be used in combination with other antihypertensive agents, such as hydrochlorothiazide or amlodipine, to achieve better blood pressure control 4, 5, 7.
- The combination of losartan and hydrochlorothiazide has been shown to be effective in reducing blood pressure and improving cardiovascular outcomes 4, 5.
- The combination of losartan and amlodipine has also been shown to be effective in reducing blood pressure, although the metabolic effects of this combination may be less favorable than those of losartan and hydrochlorothiazide 7.
Special Considerations
- In patients with non-diabetic nephropathy, losartan has been shown to reduce albumin excretion and improve renal function 3.
- In patients with left ventricular hypertrophy, losartan has been shown to reduce the risk of stroke and cardiovascular morbidity 4.
- In patients with type 2 diabetes, losartan can be used to control blood pressure and reduce the risk of cardiovascular complications, although the choice of dosing regimen and combination therapy should be individualized based on the patient's specific needs and medical history 7.