philipn / Dosing ARBs for COVID-19 c3fa853dfa71f27979252020033a740af07890f1

If ARBs (or other drugs modulating the renin-angiotensin system) help in COVID-19, what would be the ideal dosing and medication to use?  This page explores this question.

Dose & medication used in clinical trials

• Losartan:
  • 12.5mg bid. 200 participants total.
  • 25mg od for 14 days. Multi-arm trial, estimate ~1000 participants total.
  • 25mg od for 10 days. 580 participants total.
  • 25mg bid. 20 participants total.
  • 25mg bid for 14 days. 100 participants total.
  • 25 od, escaled to 50mg. 34 participants total.
  • 50mg od. 200 participants total.
  • 50mg od for 15 days. 176 participants total.
  • 100mg od. Multi-arm trial, estimate ~5000 participants.
  • Titration up to 100mg od over 3 days. 1372 participants total.
• Valsartan:
  • Titrated based on BP, max 160mg bid. 651 participants total.
• Telmisartan:
  • 20mg od. 338 participants total.
  • 40mg od for 21 days. 40 participants total.
  • 40mg od for 14 days. 60 participants total.
  • 80mg bid. 400 participants total.
• Candesartan:
  • 4mg od, "titrated to normotension". Multi-arm trial, estimated ~50 participants total.
• Unspecified ARB/dose:
  • CLARITY trial. 605 participants total.

If ARBs (or other drugs modulating the renin-angiotensin system) help in COVID-19, what would be the ideal dosing and medication to use?  This page explores this question.

Dose & medication used in animal studies

ACE2-knockout animal studies:

• 15 mg/kg losartan in mice. Result: attenuation of lung injury from SARS spike protein + acid combination. Note that this was an acute injury: the mice were challenged with acid once after losartan was given.
  • Human equivalent dose (80kg human): 97 mg losartan.
• 50 mg/kg/day irbesartan in mice. Result: "rescued the systolic dysfunction, normalized altered signaling pathways, flow-mediated dilation, and the increased oxidative stress in the cardiovascular system."
  • Human equivalent dose (80kg human): 324 mg irbesartan.

Other animal studies of AT1R blockade:

• 30 mg/kg losartan. Ang II and thrombosis. Result: "losartan abolished prothrombotic effect of Ang II"
  • Human equivalent dose (80kg human): 195 mg losartan

Dose & medication used in clinical trials

• Losartan:
  • 12.5mg bid. 200 participants total.
  • 25mg od for 14 days. Multi-arm trial, estimate ~1000 participants total.
  • 25mg od for 10 days. 580 participants total.
  • 25mg bid. 20 participants total.
  • 25mg bid for 14 days. 100 participants total.
  • 25 od, escaled to 50mg. 34 participants total.
  • 50mg od. 200 participants total.
  • 50mg od for 15 days. 176 participants total.
  • 100mg od. Multi-arm trial, estimate ~5000 participants.
  • Titration up to 100mg od over 3 days. 1372 participants total.
• Valsartan:
  • Titrated based on BP, max 160mg bid. 651 participants total.
• Telmisartan:
  • 20mg od. 338 participants total.
  • 40mg od for 21 days. 40 participants total.
  • 40mg od for 14 days. 60 participants total.
  • 80mg bid. 400 participants total.
• Candesartan:
  • 4mg od, "titrated to normotension". Multi-arm trial, estimated ~50 participants total.
• Unspecified ARB/dose:
  • CLARITY trial. 605 participants total.