From the Guidelines
The maximum daily dose of losartan for a 63-year-old with normal kidney function (normal creatinine and GFR) is 100 mg per day. This is typically administered as a single daily dose or divided into two doses of 50 mg each, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Treatment usually begins at a lower dose of 25-50 mg once daily, with gradual titration to the maximum dose based on blood pressure response. For patients with hypertension, the full antihypertensive effect is generally achieved within 3-6 weeks of treatment. It's essential to monitor blood pressure regularly when starting or adjusting losartan dosage. Additionally, periodic assessment of kidney function and electrolytes (particularly potassium) is recommended, as losartan is an angiotensin II receptor blocker (ARB) that can affect kidney function and potassium levels. While the patient has normal kidney function now, age-related changes in drug metabolism should be considered, and dose adjustments may be necessary if kidney function changes over time. Side effects to watch for include dizziness, hypotension, and hyperkalemia. The most recent and highest quality study, published in 2018, supports this recommendation 1.
Some key points to consider when prescribing losartan include:
- Starting dose: 25-50 mg once daily
- Maximum dose: 100 mg per day
- Monitoring: regular blood pressure checks, periodic assessment of kidney function and electrolytes
- Potential side effects: dizziness, hypotension, hyperkalemia
- Special considerations: age-related changes in drug metabolism, potential interactions with other medications.
It is crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to adjust the treatment plan as needed to minimize adverse effects and optimize outcomes.
From the FDA Drug Label
The dosage can be increased to a maximum dose of 100 mg once daily as needed to control blood pressure Doses above 1.4 mg per kg (or in excess of 100 mg) daily have not been studied in pediatric patients There is no specific dose limitation for a 63-year-old patient with normal creatinine/GFR.
- The maximum losartan dose is 100 mg once daily. 2
From the Research
Maximum Losartan Dose
- The maximum recommended daily dose of losartan is 100mg, which can be given as a once-daily dose or by splitting the same total daily dose into two doses 3.
- This dosage recommendation does not substantially change with repetitive administration, and no dosage adjustment is necessary in patients with mild hepatic impairment or various degrees of renal insufficiency, including those with normal creatinine/GFR 3.
Considerations for 63-Year-Old Patients
- There are no clinically significant effects of age on the pharmacokinetics of losartan, suggesting that the maximum dose for a 63-year-old patient would be the same as for younger adults 3.
- Losartan has been studied in various patient populations, including those with diabetic nephropathy, heart failure, and hypertensive patients with left ventricular hypertrophy, demonstrating its efficacy and safety in these conditions 4, 5, 6, 7.
Renal Function Considerations
- Losartan is not removed during haemodialysis, and its pharmacokinetics do not substantially change in patients with various degrees of renal insufficiency 3.
- Studies have shown that losartan reduces the incidence of doubling of serum creatinine, end-stage renal disease, and death in patients with type 2 diabetes and nephropathy, suggesting its potential benefits in patients with normal creatinine/GFR 5, 6.