What is the recommended dosing for Losartan (Angiotensin II receptor antagonist)?

From the Guidelines

Losartan should be started at 25-50 mg once daily for adults with hypertension, with the dose adjustable to 25-100 mg daily based on blood pressure response, as recommended by the most recent guidelines 1. The dosing of losartan can vary depending on the patient's condition, such as heart failure or reduced kidney function.

• For patients with heart failure, the starting dose is lower at 25 mg once daily, which can be gradually increased to 50-150 mg daily.
• For those with reduced kidney function or volume depletion, a starting dose of 25 mg is recommended. Losartan works by blocking angiotensin II receptors, relaxing blood vessels and lowering blood pressure.
• It can be taken with or without food, and the full effect may take 3-6 weeks to develop.
• Common side effects include dizziness, hypotension, and elevated potassium levels. Patients should have their blood pressure, kidney function, and potassium levels monitored regularly.
• Losartan is contraindicated during pregnancy and should be used cautiously in patients with severe liver disease.
• If a dose is missed, it should be taken as soon as remembered unless it's almost time for the next dose. The American Journal of Kidney Diseases recommends goal doses of losartan to be at the higher end of the dose range when possible, which is 25-100 mg daily in 1-2 divided doses 1. Higher doses of losartan, such as 150 mg daily, have been shown to be superior to lower doses, such as 50 mg daily, in reducing the risk of death or heart failure hospitalization 1. The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends losartan as an angiotensin receptor blocker (ARB) for the treatment of heart failure with reduced ejection fraction (HFrEF), with a target dose of 50-150 mg once daily 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 recommended dosage of losartan is as follows:

• Adult Hypertension: 50 mg once daily, with a maximum dose of 100 mg once daily
• 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, with a possible increase to 100 mg once daily
• Patients with Hepatic Impairment: 25 mg once daily for mild-to-moderate impairment 2

From the Research

Losartan Dosing Information

• The maximum losartan dose used in the RENAAL and LIFE studies was 100 mg daily 3.
• In the RENAAL study, losartan was administered at a dose of 50 to 100 mg once daily 4.
• The dosing of losartan in the treatment of hypertension in patients with type 2 diabetes mellitus is not strictly defined, but it is recommended to use it as part of a regimen to achieve blood pressure goals of less than 135/80 mm Hg 5.

Blood Pressure Goals

• International guidelines recommend lowering blood pressure to 140/90 mm Hg or less in patients with uncomplicated hypertension, and to 130/80 mm Hg or less for patients with diabetic or chronic renal disease 6.
• Target diastolic blood pressures of less than 80 mm Hg appear optimal, while systolic targets have not been as rigorously evaluated, but targets of 135 mm Hg or less are reasonable 5.

Losartan Efficacy

• Losartan has been shown to reduce the primary composite end-point of doubling of serum creatinine, end-stage renal disease, or death by 16% in patients with type 2 diabetes and nephropathy 3, 4.
• Losartan also reduced the incidence of end-stage renal disease by 28% and the rate of first hospitalization for heart failure by 32% in these patients 3, 4.
• The benefit of losartan exceeded that attributable to changes in blood pressure, suggesting that it has direct effects on intrarenal mechanisms of damage 3, 4.