LORANTA may be used alone or in combination with other antihypertensive agents.
Hypertension: Monotherapy: The usual starting dose in adult is 50 mg of Losartan potassium once daily and the maintenance dose can be administered once or twice daily with total daily doses ranging from 25 mg to 100 mg. The maximal antihypertensive effect is attained in 3-6 weeks after initiation of therapy.
In patients with possible depletion of intravascular volume (e.g. patients treated with high-dose diuretics), an initial dose of 25 mg once daily is recommended. In patients with a history of hepatic impairment, the lower dose should be considered.
No initial dosage adjustment is necessary for elderly patients, patients with renal impairment and patients on dialysis. However, the use of Losartan potassium is not recommended in patient with renal impairment who has serum creatinine > 3.0 - 4.0 mg/dL.
Combination therapy: In patients with an inadequate blood pressure control by Losartan potassium monotherapy or hydrochlorothiazide (HCTZ) 25 mg/day monotherapy or in patients with HCTZ induced hypokalemia, the combination therapy of Losartan potassium and HCTZ can be used. Dosage of the combination can be initiated with 50 mg of Losartan potassium and 12.5 mg of HCTZ daily as the fixed combination. In patients with an inadequate blood pressure control by Losartan potassium 100 mg monotherapy, dosage of the fixed combination may be increased to 100 mg of Losartan potassium and 12.5 mg of HCTZ once daily. If blood pressure is not desirely controlled after 3 weeks (or after 2-4 weeks of therapy in those with severe hypertension), dosage may be increased to 100 mg of Losartan potassium and 25 mg of HCTZ once daily. Additional increases using the fixed combination are not recommended.
The combination of Losartan potassium and HCTZ is not recommended for use in patients with creatinine clearances of 30 mL/minute or less nor in those with hepatic impairment or intravascular volume depletion (e.g. patients receiving high dose diuretic).
Renal protection in Type 2 diabetes patients with proteinuria: The usual initial dose is 50 mg of losartan potassium once daily. The dosage may be increased to 100 mg once daily based on blood pressure response. Losartan potassium may be administered with other antihypertensive agents (e.g. diuretics, calcium channel blockers, alpha-blockers, beta-blockers and centrally acting agents) as well as with insulin and other hypoglycemic drugs (e.g. sulfonylureas, glitazones and glucosidase inhibitors).
Reduction in the risk of cardiovascular morbidity and mortality rate in hypertensive patients with left ventricular hypertrophy: The usual initial dose is 50 mg of losartan potassium once daily. A low dose of HCTZ can be added. The introduced dose of losartan potassium may be increased to 100 mg once daily based on blood pressure response.
Hepatic impairment: In patients with a history of hepatic impairment, the lower dose should be considered.
Renal impairment: In patients with a history of renal impairment, the lower dose should be considered.
Pediatric use: Losartan potassium is not recommended in pediatric patients younger than 6 years of age, in pediatric patients with glomerular filtration rate below 30 mL/min/1.73 m2, in pediatric patients with hepatic impairment, or in neonates because of inadequate established safety and effectiveness data.
For pediatric patients 6 years of age and older who can swallow tablets, the recommended dose is 25 mg once daily in patients weighed ≥ 20 to < 50 kg. The dosage may be increased to maximum of 50 mg once daily. The initial dose for patients > 50 kg is 50 mg of Losartan potassium once daily. The dosage may be increased to a maximum of 100 mg once daily.
For pediatric patients with intravascular volume depletion, these conditions should be corrected prior to administration of Losartan potassium.