Losartan dosage twice daily
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Twice-Daily Losartan Dosage for Hypertension Management
Introduction to Losartan and Hypertension
Losartan is a widely used angiotensin II receptor blocker (ARB) prescribed for managing hypertension. While typically administered once daily, some clinical scenarios necessitate a twice-daily (BID) regimen to achieve optimal blood pressure (BP) control. This article synthesizes research findings on the efficacy and safety of twice-daily losartan dosing compared to once-daily administration.
Efficacy of Twice-Daily Losartan
Blood Pressure Control
Several studies have evaluated the efficacy of losartan in different dosing regimens. A study comparing once-daily and twice-daily losartan found that both 50 mg twice daily and 100 mg once daily significantly reduced systolic and diastolic BP compared to placebo, with no significant difference between the two dosing schedules 23. Another study confirmed that twice-daily administration of losartan (50 mg BID) provided a smooth and sustained antihypertensive effect over 24 hours, similar to 100 mg once daily .
Diurnal/Nocturnal Blood Pressure Ratio
Research has also explored the impact of dosing schedules on the diurnal/nocturnal BP ratio. A study comparing evening-only versus morning and evening dosing of losartan (100 mg once daily vs. 50 mg BID) found that twice-daily administration was more effective in normalizing the diurnal index, which is crucial for patients with a non-dipper BP pattern . This pattern is associated with higher cardiovascular risks, suggesting that BID dosing may offer additional protective benefits.
Safety and Tolerability
Adverse Events
The safety profile of losartan in different dosing regimens has been extensively studied. A large cohort study found no significant differences in adverse events, such as angioedema, acute kidney injury, or hyperkalemia, between once-daily and twice-daily dosing . Additionally, losartan was generally well tolerated across various studies, with adverse events comparable to placebo 26.
Long-Term Safety
Long-term studies have shown that losartan, whether administered once or twice daily, maintains a favorable safety profile. Common adverse events include headache, dizziness, and fatigue, but these were not significantly more frequent in the BID group compared to the once-daily group . This consistency in safety data supports the flexibility in dosing schedules based on patient needs.
Conclusion
Twice-daily dosing of losartan is an effective and safe alternative to once-daily administration for managing hypertension. It provides sustained BP control and may offer additional benefits for patients with specific BP patterns, such as non-dippers. The choice between once-daily and twice-daily dosing should be tailored to individual patient profiles, considering both efficacy and tolerability.
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