Is 75 mg of Losartan Safe?
A 75 mg dose of losartan is not a standard FDA-approved dose and should be clarified with your provider, as the approved dosing is either 50 mg or 100 mg once daily for hypertension, with the maximum recommended daily dose being 100 mg. 1, 2
Standard FDA-Approved Dosing
- The FDA-approved dosing for losartan in hypertension is 50 mg once daily as the starting dose, with titration to 100 mg once daily if blood pressure remains uncontrolled after 2-4 weeks. 1, 2
- The maximum recommended daily dose is 100 mg, which can be given as a single daily dose or split into two doses (50 mg twice daily). 2
- There is no FDA-approved 75 mg dose of losartan for any indication. 1
Possible Explanations for the 75 mg Instruction
Split Dosing Scenario
- Your provider may have intended 50 mg in the morning and 25 mg in the evening (totaling 75 mg daily), though this is an unconventional regimen not supported by guidelines. 3
- Alternatively, this could be a miscommunication about 50 mg twice daily (totaling 100 mg daily), which is an acceptable guideline-supported regimen. 3
Titration Error
- The instruction may represent an intermediate titration step between 50 mg and 100 mg, though guidelines recommend moving directly from 50 mg to 100 mg rather than using intermediate doses. 3, 4
Evidence-Based Dosing Recommendations
For Hypertension
- Start at 50 mg once daily and reassess blood pressure after 2-4 weeks. 3
- Titrate to 100 mg once daily if office or home blood pressure remains ≥140/90 mmHg. 3
- If blood pressure remains uncontrolled on 100 mg daily, add hydrochlorothiazide 12.5-25 mg daily rather than exceeding the maximum losartan dose. 3
For Heart Failure or Diabetic Nephropathy
- The target dose is 100 mg once daily for diabetic nephropathy. 3
- For heart failure with reduced ejection fraction, the target dose is 100-150 mg daily, with 150 mg showing superior outcomes in the HEAAL trial. 3
Safety Monitoring Requirements
- Check serum creatinine and potassium within 1-2 weeks after starting losartan or changing doses, especially if you have diabetes or chronic kidney disease. 3
- Monitor blood pressure every 2-4 weeks during dose titration, aiming to reach target <130/80 mmHg within 3 months. 3
Critical Safety Warnings
- Never combine losartan with ACE inhibitors (like lisinopril or enalapril) or direct renin inhibitors (aliskiren), as this combination increases the risk of hyperkalemia, syncope, and acute kidney injury without added benefit. 3
- Discontinue immediately if you are pregnant or planning pregnancy, as losartan causes serious fetal toxicity including renal dysfunction, oligohydramnios, and fetal death. 3
What You Should Do
Contact your provider immediately to clarify whether they meant:
- 50 mg once daily (standard starting dose)
- 100 mg once daily (standard maximum dose)
- 50 mg twice daily (acceptable alternative to 100 mg once daily)
- Or if there was a specific reason for prescribing 75 mg
Do not attempt to create a 75 mg dose by splitting or combining tablets without explicit instructions from your provider on how to achieve this dose safely.