Losartan is given by mouth as the potassium salt. The maximum hypotensive effect is achieved in about 3 to 6 weeks after initiating treatment. In hypertension the usual dose is 50 mg once daily. The dose may be increased, if necessary, to 100 mg daily as a single dose or in two divided doses. An initial dose of 25 mg once daily should be given to patients with intravascular fluid depletion, and is recommended in the elderly over 75 years of age. Similar reductions may be appropriate in patients with hepatic or renal impairment. Children aged 6 years or over with hypertension may be given an initial dose of 700 micrograms/kg once daily, with a maximum of 50 mg, adjusted according to response. In diabetic nephropathy Losartan is given in an initial dose of 50mg once daily, increased to 100 mg once daily depending on the blood pressure.

Precautions: Losartan is contraindicated in pregnancy. It should be used with caution in patients with renal artery stenosis. Losartan is excreted in urine and in bile and reduced doses may therefore be required in patients with renal impairment and should be considered in patients with hepatic impairment. Patients with volume depletion (for example those who have received high-dose diuretic therapy) may experience hypotension; volume depletion should be corrected before starting therapy, or a low initial dose should be used. Since hyperkalaemia may occur, serum-potassium concentrations should be monitored, especially in the elderly and patients with renal impairment, and the concomitant use of potassium-sparing diuretics should generally be avoided.

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