Losartan Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Diabetic Nephropathy

Initial dose: 50 mg orally once a day.
Maintenance dose: 25 to 100 mg orally in 1 to 2 divided doses.

Usual Adult Dose for Hypertension

Initial dose: 50 mg orally once a day.
Maintenance dose: 25 to 100 mg orally in 1 to 2 divided doses.

Usual Pediatric Dose for Hypertension

Greater than or equal to 6 years: 0.7 mg/kg orally once daily (up to a maximum of 50 mg)

Renal Dose Adjustments

Not recommended for use in pediatric patients with GFR less than 30 mL/min/1.73 m2.

Liver Dose Adjustments

Initial dose: 25 mg orally once a day.
Maintenance dose: 25 to 100 mg orally in 1 to 2 divided doses.

Dose Adjustments

Doses may be increased as needed and tolerated every 3 to 6 weeks in increments of 25 to 50 mg in volume-replete patients. Doses should be halved in the presence of intravascular volume depletion.

If there is an inadequate response in the "trough" period just prior to dosing, twice a day dosing may be helpful.

Precautions

There are numerous warnings and contraindications to the use of this drug during pregnancy. Drugs, like losartan, that act directly on the renin-angiotensin-aldosterone (RAA) system can cause fetal and neonatal morbidity and death when administered during pregnancy. Several dozen cases have been reported in the world literature in patients who were taking angiotensin converting enzyme (ACE) inhibitors. When pregnancy is detected or expected, losartan should be discontinued as soon as possible.

Excessive hypotension has been rarely observed in patients with uncomplicated hypertension treated with losartan. Symptomatic hypotension can occur in volume- or salt-depleted patients with an activated renin-angiotensin system; therefore, such conditions should be corrected prior to administration or therapy should be initiated under close medical supervision.

In some patients whose renal function is dependent upon the RAA system, such as patients with severe congestive heart failure, use of ACE inhibitors or angiotensin II receptor inhibitors, has been associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death. In addition, as with ACE inhibitors, use of angiotensin II receptor inhibitors can lead to increases in BUN and serum creatinine in patients with unilateral or bilateral renal artery stenosis.

Electrolyte imbalances are common in patients with renal impairment, with or without diabetes, and should be assessed. Hyperkalemia has been reported in a clinical study conducted in type 2 diabetic patients with proteinuria.

Hypersensitivity reactions including angioedema have been reported.

Elderly patients appear to exhibit the same level of risks (i.e., development of hyperkalemia) and benefits (e.g., renoprotection) as younger patients from losartan therapy.

There are no data on the effect of losartan on blood pressure in pediatric patients under the age of 6 or in pediatric patients with glomerular filtration rate less than 30 mL/min/1.73 m2.

Dialysis

Losartan is not removed by hemodialysis.

Other Comments

Daily doses greater than 100 mg have not been shown to add significant benefit.
The maximal antihypertensive effect may not be realized for 3 to 6 weeks after initiation of therapy or dose changes.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

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