Losartan vs. Lisinopril: Similarities & Differences
Medically reviewed by Femi Aremu, PharmD
Hypertension (high blood pressure, or HBP) is one of the primary catalysts behind stroke and heart disease.
Losartan (brand name: Cozaar) and lisinopril (brand name: Zestril) are first-line antihypertensive drugs that control HBP. However, their class, dosage forms, dosing regimens, and uses differ.
Furthermore, they work in different ways. Losartan is an angiotensin receptor II receptor blocker (ARB) medication that works on specific receptors to provide a therapeutic effect.
Lisinopril is an angiotensin-converting enzyme inhibitor (ACE inhibitor) that inhibits enzyme conversion that raises blood pressure.
Lisinopril is available in tablet and liquid dosage forms, while losartan is available only in tablet form.
This article compares and contrasts losartan versus lisinopril.
Getty Images / Kinga Krzeminska
Understanding HBP
The risk of stroke increases with HBP (above 115/75 millimeters of mercury [mm Hg]). HBP is a significant risk factor for stroke, associated with 54% of stroke episodes worldwide.
Blood pressure is the force blood pushes against the wall of the arteries.
More specifically, HBP is when the force pushing the blood against the blood vessels' walls is consistently too high.
HBP increases the workload of the heart and blood vessels, which makes them weaker and work less efficiently. Weak blood vessels can burst or clog more easily.
Consequences
HBP can damage arteries. It can lead to other conditions, including arrhythmia (irregular heartbeat), myocardial infarction (heart attack), and stroke.
A stroke occurs when a blood vessel to the brain or heart is narrowed or blocked by a clot, and these organs are not getting enough blood and oxygen.
Associated Risk Factors
Risk factors that can increase the risk of HBP include health conditions such as diabetes, lifestyle, and family history.
Significant factors that can be controlled to reduce the risk of high blood pressure are physical inactivity, reducing sodium, obesity, too much alcohol, tobacco use, and a balanced diet.
Various medical treatment options, such as diuretics, beta-blockers, ACE inhibitors, ARBs, and others, are available on prescription to manage HBP.
Along with these, non-medical options such as lifestyle changes are also effective ways to avoid disease progression.
What Is Losartan?
Losartan is an ARB medication approved by the Food and Drug Administration (FDA) to treat HBP in adults and children 6 years and older.
In both generic and name-brand form, this product is available via prescription as an oral tablet once or twice a day as prescribed, with or without food.
Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular (CV) problems, including stroke and heart attack.
Losartan also reduces the risk of stroke in people with HBP and left ventricular hypertrophy (enlargement of the walls of the left side of the heart).
However, evidence shows it is not beneficial to decrease the risk of stroke for African-Americans.
Losartan is also approved for the treatment of diabetic nephropathy (kidney disease in people who have type 2 diabetes, which results in a lack of blood sugar control) and a history of HBP.
Losartan also reduces the rate of progression of diabetic nephropathy in these people.
Off-Label Uses
Losartan has been used off-label (a use for which the drug was not FDA-approved initially to be used) to treat heart failure (HF, a condition in which the heart cannot pump enough blood to the body).
Brand-Name Association(s)
In addition to Cozaar, other name-brand forms of losartan available include Hyzaar (containing a combination of two active ingredients, hydrochlorothiazide and losartan).
How It Works
Losartan blocks the action of certain natural substances on the receptors (angiotensin II receptors) that work to tighten the blood vessels.
The blockage of receptors reduces the action of these enzymes to improve the blood flow and helps the heart to pump blood more efficiently.
Losartan controls HBP but does not cure it.
Your blood pressure may start decreasing during the first week of the treatment. It may take three to six weeks to get the full benefit of losartan.
What Is Lisinopril?
Lisinopril is an ACE inhibitor that is FDA-approved to treat HBP in adults and children 6 years and older.
Lisinopril is also used to reduce signs and symptoms of systolic heart failure (SHF, when the heart's main chamber pumps blood ineffectively).
Moreover, this drug reduces mortality in people at risk for a heart attack.
Off-Label Uses
Off-label uses for lisinopril include migraine prevention. myocardial fibrosis (MF), and infertility treatment.
Brand-Name Association(s)
Lisinopril is marketed under various brand names.
In addition to Zestril, there exists Qbrelis (lisinopril), and as a combination medicine, Zestoretic (lisinopril and hydrochlorothiazide).
How It Works
Lisinopril works by inhibiting the enzymes (angiotensin-converting enzymes) in the body from making angiotensin II, which works to tighten the blood vessels and increase blood pressure.
The inhibition of these enzymes eases the blood flow and makes the heart pump blood more efficiently.
Dosing Guidelines
The following briefly overviews some standard dosing practices for losartan vs. lisinopril.
Note that neither drug is approved for use in children under 6 years old.
Losrtan
Losartan is available as 25, 50, and 100 milligrams (mg) film-coated tablets.
The dosing regimen for losartan is as follows:
HBP:
An adult dose is 50 mg once daily.
The usual dose in children 6 years and older is 0.7 milligrams per kilogram (mg/kg) once daily.
Hypertensive people with LVH:
The standard starting dose is 50 mg/day.
Nephropathy in type 2 diabetic people:
The standard dose is 50 mg once daily. However, dosing for this condition may be increased to 100 mg once daily.
Lisinopril
Lisinopril is available as 2.5, 5, 10, 20,30 and 40 mg tablets. It is also available in a 150-milliliter (mL) bottle as an oral solution.
The general dosing regimen for lisinopril is as follows:
HBP:
The standard dose in adults is 10 mg (as a monotherapy treatment) or 5 mg (on a diuretic) once daily.
The standard dose in children 6 years and older is 0.07 mg/kg (up to 5 mg total) once daily.
HF:
The standard dose is 5 mg once daily. Sometimes, healthcare providers may increase the dose (as tolerated) to 40 mg once daily.
Post-heart attack:
The standard dose is 5 mg taken within 24 hours of a heart attack, 5 mg after 24 hours, and 10 mg once daily.
Safe Consumption Guidelines
Take losartan tablet orally once a day with or without food as prescribed. Start taking at a lower dose and gradually increase as required.
Conversely, take a lisinopril tablet or solution (liquid) orally once a day as prescribed. Start taking at a lower dose and gradually increase as required.
When taking liquid dosage form, only use the measuring device (cup or syringe) provided to measure the dose.
Take these medicines as prescribed, and do not increase or change the dose.
Don't stop taking these drugs without asking your healthcare provider, even if your symptoms improve.
Talk to your healthcare provider before using salt substitutes containing potassium. Take a low-salt or low-sodium diet when taking these medicines.
Which Works Better?
Losartan and lisinopril have been deemed safe and effective options for treating various HBP-related conditions. Furthermore, both drugs have similar levels of efficacy.
To support this, one study compared the effectiveness and safety of lisinopril versus losartan for the treatment of cardiomyopathy (heart disease that harms heart muscle).
The study found no therapeutic difference between lisinopril and losartan over a one-year duration of treatment.
Moreover, the study showed that each drug significantly improved systolic function (cardiac output, which is a product of stroke volume and heart rate) following one year of analysis.
Alternative Treatment Options
HBP is the leading cause of many other vascular disorders.
Antihypertensive medications are an effective way to treat high blood pressure and other associated complications.
However, many non-medical remedies are also proven effective in controlling blood pressure.
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure also recommends lifestyle changes for people with HBP.
It recommends reducing sodium intake, increasing exercise, moderating alcohol consumption, losing weight, and following a balanced diet.
Also, as a holistic approach to well-being includes dietary, exercise, and mental health-related pursuits, behavioral therapies such as meditation or deep breathing can also help treat HBP.
Finally, noninvasive procedures, such as acupuncture, have been documented as beneficial in lowering blood pressure to treat HBP and other vascular disorders.
Side Effects & Safety
Like all drugs, losartan and lisinopril carry the potential for side effects upon consumption.
However, these medications come with an FDA warning that neither drug should be used in pregnant people due to potential damage to a developing fetus.
Side effects associated with the use of losartan and lisinopril are listed below.
Common Side Effects
Some common side effects of losartan and lisinopril include:
Pain in different body parts
Muscle cramps, tiredness or weakness
Drug-Specific Side Effects
In the case of losartan, it may also cause heartburn and decreased sensitivity to touch.
Some other side effects of lisinopril include:
Call your healthcare provider if the symptoms do not go away.
Severe Side Effects
On rare occasions, losartan and lisinopril carry the potential for more severe side effects.
Call your healthcare provider if you have any of the following symptoms:
Angioedema (swelling of the eyes, face, lips, throat, tongue, hands, feet, ankles, or lower legs)
Difficulty breathing or swallowing
Warnings and Precautions
The use of losartan and lisinopril should be avoided in people with the following:
Hypersensitivity or history of angioedema to any component of losartan or lisinopril.
Pregnant people
Breastfeeding people
Use losartan and lisinopril with caution and monitor carefully for:
Potential for Interaction
Before being prescribed losartan or lisinopril, your healthcare provider will work with you to determine whether you are taking any medications that pose a risk of negative interaction as a byproduct of your current drug regime(s).
Examples of drugs that may negatively interact with losartan or lisinopril include:
ACE inhibitors, such as Lotensin (benazepril) and Vasotec (enalapril)
Nonsteroidal anti-inflammatory medications (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen)
Selective COX-2 inhibitors (a type of NSAID), such as Celebrex (celecoxib)
Diuretics, such as Midamor (amiloride) and Aldactone (spironolactone)
Medications used for the treatment of bipolar disorder, such as Lithobid (lithium)
Losartan-Specific Interactions
Specific to losartan, the following drugs should not be taken while using losartan:
Drugs used to treat or prevent yeast infections, such as Diflucan (fluconazole)
Drugs used for the treatment of epilepsy, such as Luminal (phenobarbital)
Drugs used to treat tuberculosis (TB), such as Rifadin (rifampin).
Lisinopril-Specific Interactions
Specific to lisinopril, the following drugs should not be taken while using lisinopril:
Mammalian target of rapamycin (mTOR) inhibitors, such as Rapamune (sirolimus) and Torisel (temsirolimus)
Furthermore, do not take lisinopril if you take other antihypertensive medications, such as Diovan (valsartan) or Entresto (sacubitril), or have stopped taking this type of medication within 36 hours.
Always tell your healthcare provider about all prescription, non-prescription, vitamins, and herbal drugs you take before starting the therapy with these drugs.
Summary
HBP increases the risk of heart disease and stroke. Tens of millions of adults in the United States have uncontrolled HBP, which is Americans' leading cause of death.
Regular exercise, a balanced diet, a low intake of alcohol and tobacco, and a healthy weight can reduce the tension and stress of vessels to lower blood pressure.
Losartan and lisinopril are first-line, effective therapies for controlling and managing HBP and associated conditions.
Losartan and lisinopril belong to different classes of drugs and are available in different dosage forms and strengths.
However, know that losartan and lisinopril come with an FDA warning regarding its use in pregnant people. Pregnant people must not use these drugs to avoid harm to the fetus.
Do not take these drugs more than prescribed. Continue taking even if you feel better, and don't discontinue without asking your healthcare provider.
Frequently Asked Questions
How do I store losartan vs. lisinopril?
Store all forms of losartan and lisinopril in a dry, secure place (away from children and pets) and at room temperature (68-77 F).
Furthermore, keep either product away from areas susceptible to high moisture levels or harsh lightning.
Can I stop taking losartan or lisinopril now that my blood pressure is lower?
Regardless of your feelings or current blood pressure levels, do not stop taking losartan or lisinopril without first asking your healthcare provider.
Read the original article on Verywell Health.
