Usual Adult Dose for Hypertension

HYPERTENSION:
Hydrochlorothiazide 12.5 to 25 mg-Losartan 50 to 100 mg orally once a day

Maximum dose: Hydrochlorothiazide 25 mg-Losartan 100 mg orally once a day

Comments:

• A patient whose blood pressure is not adequately controlled with hydrochlorothiazide or losartan monotherapy may be switched to hydrochlorothiazide 12.5 mg-losartan 50 mg orally once a day.
• May increase dose if blood pressure remains uncontrolled after about 3 weeks.

Use: Treatment of hypertension. This drug is not indicated for initial therapy except when hypertension is severe enough that the benefit of achieving prompt blood pressure control exceeds the risk of initiating combination therapy.

SEVERE HYPERTENSION:
Initial treatment: Hydrochlorothiazide 12.5 mg-Losartan 50 mg orally once a day; if blood pressure remains uncontrolled after 2 to 4 weeks, may initiate maximum dose.

Maximum dose: Hydrochlorothiazide 25 mg-Losartan 100 mg orally once a day

HYPERTENSION WITH LEFT VENTRICULAR HYPERTROPHY:
Initial therapy: Losartan monotherapy; if blood pressure remains uncontrolled, may initiate this drug.

Add-on therapy: Hydrochlorothiazide 12.5 mg-Losartan 50 mg orally once a day; if blood pressure remains uncontrolled, initiate hydrochlorothiazide 12.5 mg-losartan 100 mg orally once a day, followed by hydrochlorothiazide 25 mg-losartan 100 mg orally once a day, if needed.

Use: To reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy, but there is evidence that this benefit does not apply to Black patients.

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl 30 mL/min or greater): No adjustment recommended
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended

Liver Dose Adjustments

Not recommended as initial therapy

Precautions

US BOXED WARNING:

• FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin angiotensin system (RAS) can cause injury and death to the developing fetus.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Monitoring:

• Patients with a history of angioedema (swelling of the face, lips, throat, and/or tongue) should be closely monitored.
• Monitor serum electrolytes and renal function periodically.

Patient advice:

• Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.
• Encourage patients to report any lightheadedness that may occur during treatment initiation and to stop taking this drug until consulting a physician if syncope occurs.
• Dehydration may lead to excess blood pressure reduction; inform patients to contact their healthcare provider if they experience excessive perspiration, vomiting, or diarrhea.