Is it appropriate to take 50 mg of losartan instead of 75 mg?

Losartan Dosing: 50 mg vs 75 mg

You should not take 50 mg of losartan instead of 75 mg without medical guidance, because 75 mg is not a standard FDA-approved dose and your prescriber likely intended a specific titration strategy that requires clarification. 1

Why 75 mg Is Not Standard

• The FDA-approved dosing for losartan in hypertension is 50 mg or 100 mg once daily—there is no 75 mg tablet formulation or recommended intermediate dose. 1
• If you were prescribed "75 mg," your provider may have intended one of the following:
  • Losartan 50 mg plus hydrochlorothiazide 12.5 mg (a common fixed-dose combination)
  • A titration step between 50 mg and 100 mg (though not evidence-based)
  • A compounding error or miscommunication

Evidence-Based Target Dosing

• For hypertension, the ACC/AHA guidelines recommend starting at 50 mg once daily and increasing to 100 mg once daily if blood pressure remains ≥140/90 mmHg after 2–4 weeks. 2
• For heart failure with reduced ejection fraction, the target dose is 100–150 mg daily; the HEAAL trial showed that 150 mg daily was superior to 50 mg daily with a 10% relative risk reduction in death or heart failure hospitalization. 2
• For diabetic nephropathy, the target dose is 100 mg once daily to achieve maximal renal protection. 2

Why Higher Doses Matter

• Clinical trials consistently demonstrate that higher doses of losartan provide greater cardiovascular and renal benefits than lower doses, with little evidence that medium-range doses approximate the benefits of target doses. 2
• Underdosing is widespread in clinical practice, with less than 25% of patients ever titrated to target doses, leading to suboptimal outcomes. 2
• Pharmacokinetic studies confirm that the maximum recommended daily dose is 100 mg, which can be given once daily or split into two doses, but 75 mg has no established role. 3, 4

What You Should Do

• Contact your prescriber immediately to clarify whether you should be taking:
  • Losartan 50 mg alone
  • Losartan 100 mg (the evidence-based target dose)
  • Losartan 50 mg plus hydrochlorothiazide 12.5 mg (if blood pressure is not controlled on losartan alone) 2, 1
• Do not self-adjust from a presumed 75 mg to 50 mg without medical guidance, as this may worsen blood pressure control or disease progression.

Critical Safety Monitoring

• After any dose change, serum creatinine and potassium should be rechecked within 1–2 weeks, especially if you have diabetes or chronic kidney disease. 2
• Never combine losartan with an ACE inhibitor or direct renin inhibitor (e.g., aliskiren), as this raises the risk of hyperkalemia, syncope, and acute kidney injury without added benefit. 2

Common Pitfall to Avoid

• Do not assume that staying on a lower dose is "safer"—the evidence shows that target doses (100 mg for hypertension, 100–150 mg for heart failure) provide the best outcomes for morbidity and mortality, and losartan is well-tolerated at these doses. 2, 5, 4