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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.

200mg of losartan, given orally, was used in a swine model of possible COVID-19 pathophysiology. Photo CC-BY Susanne Rysz, Johan Lundberg, et al.

Dose & medication used in animal studies

ACE2-knockout animal studies:

Other animal studies of AT1R blockade:

Losartan dosing in animal studies versus human trials. Animal dosing converted to human equivalent, and values obtained from lists on this page. Total dose over 24 hours is used. For acute injury animal models, dose is doubled to account for hypothetical, higher 24-hour protection as would be likely ideal for viral injury. Error bars represent standard deviation.

Dose & medication used in clinical trials

Would some ARBs work better than others?

Several of the animal studies use I.V. losartan. When given orally or intraperitoneally, losartan is metabolized by the liver into EXP3174, its longer-lasting, higher-affinity metabolite. When given via I.V., losartan is not metabolized into EXP3174 ("EXP3 174: The Major Active Metabolite of Losartan", Tamaki, et al).

Thrombosis and losartan versus first-pass metabolite EXP3174.

https://ascpt.onlinelibrary.wiley.com/doi/10.1111/cts.12916 - mechanical activation of AT1R versus Ang II-activation of AT1R

..however, in this trial losartan was given both intraperitoneally (first dose), and then via i.v. With i.v. administration, the first-pass effect would be skipped and losartan would not be metabolized into EXP3174, its longer-lasting, higher-affinity metabolite.

..but in a follow-up study, olmesartan, but not irbesartan, attenuated ventilator-induced diaphragm dysfunction as well.

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.

200mg of losartan, given orally, was used in a swine model of possible COVID-19 pathophysiology. Photo CC-BY Susanne Rysz, Johan Lundberg, et al.

Dose & medication used in animal studies

ACE2-knockout animal studies:

Other animal studies of AT1R blockade:

Dose & medication used in clinical trials

Losartan dosing in animal studies versus human trials. Animal dosing converted to human equivalent, and values obtained from lists on this page. Total dose over 24 hours is used. For acute injury animal models, dose is doubled to account for hypothetical, higher 24-hour protection as would be likely ideal for viral injury. Error bars represent standard deviation.

Would some ARBs work better than others?

Several of the animal studies use I.V. losartan. When given orally or intraperitoneally, losartan is metabolized by the liver into EXP3174, its longer-lasting, higher-affinity metabolite. When given via I.V., losartan is not metabolized into EXP3174 ("EXP3 174: The Major Active Metabolite of Losartan", Tamaki, et al).

Thrombosis and losartan versus first-pass metabolite EXP3174.

https://ascpt.onlinelibrary.wiley.com/doi/10.1111/cts.12916 - mechanical activation of AT1R versus Ang II-activation of AT1R

..however, in this trial losartan was given both intraperitoneally (first dose), and then via i.v. With i.v. administration, the first-pass effect would be skipped and losartan would not be metabolized into EXP3174, its longer-lasting, higher-affinity metabolite.

..but in a follow-up study, olmesartan, but not irbesartan, attenuated ventilator-induced diaphragm dysfunction as well.