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 (route of administration unspecified) 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 (route of administration unspecified) 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, intravenous, in mice. Ang II and thrombosis. Result: "losartan abolished prothrombotic effect of Ang II"
- Human equivalent dose (80kg human): 195 mg losartan. But the mouse study used I.V. dosing, not oral.
- 30mg/kg losartan, p.o., in mice. Induced arterial thrombosis. Result: significantly attenuated thrombosis (42% versus control)
- 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:
- Telmisartan:
- Candesartan:
- Unspecified ARB/dose: