Amlodipine vs. Olmesartan

See how Amlodipine and Olmesartan compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Amlodipine and olmesartan both lower blood pressure but work differently: amlodipine relaxes blood vessels by blocking calcium channels, while olmesartan blocks angiotensin II receptors.

  • Amlodipine is also FDA-approved for angina, giving it a broader use case than olmesartan, which is approved only for high blood pressure.

  • Amlodipine typically costs far less than olmesartan, while olmesartan is approved for children as young as 6 and carries a pregnancy boxed warning.

Amlodipine vs. Olmesartan Drug Summary

Amlodipine

Amlodipine is a dihydropyridine calcium channel blocker used to treat high blood pressure and certain types of angina. It relaxes blood vessels by blocking calcium channels in vascular smooth muscle, and it's taken as a single tablet once a day, with no need for renal dose adjustments.

Olmesartan

Olmesartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure in adults and children age 6 and older. It works by blocking angiotensin II from narrowing blood vessels, and it's taken as a single tablet once a day, alone or combined with other blood pressure medicines.

Amlodipine vs. Olmesartan Side Effects

Amlodipine

Most common
edema (up to 10.8%)
palpitations (up to 4.5%)
dizziness (up to 3.4%)
flushing (up to 2.6%)

Olmesartan

Most common
dizziness (3%)
headache (>1%)
back pain (>1%)
diarrhea (>1%)

Amlodipine vs. Olmesartan Dosage

Amlodipine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose 10 mg once daily If needed
Dose changes 2 increases As tolerated

Olmesartan

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose 40 mg once daily Week 3 onward
Dose changes 2 increases As tolerated

Amlodipine vs. Olmesartan Indications

Amlodipine

Amlodipine is FDA-approved for high blood pressure and several types of angina, including chronic stable angina and vasospastic (Prinzmetal's) angina. It's also used in coronary artery disease. This broader angina indication sets it apart from ARBs like olmesartan.

  • Hypertension

  • Chronic stable angina

  • Vasospastic (Prinzmetal's) angina

  • Coronary artery disease

Olmesartan

Olmesartan is FDA-approved specifically for high blood pressure in adults and children age 6 and older. It can be used alone or added to other blood pressure medications for extra control. Unlike amlodipine, it does not carry an angina indication.

  • Hypertension in adults

  • Hypertension in children 6 and older

  • Can be combined with other antihypertensives

  • Not approved as initial therapy in patients 75+

Amlodipine vs. Olmesartan Pros and Cons

Amlodipine

Amlodipine has decades of clinical use, a low cost, and no need for kidney-based dose adjustments. It's a versatile option for patients who have angina in addition to high blood pressure. Its main downside is dose-related swelling in the legs, which can lead some patients to switch medications.

Pros

  • Roughly $5 to $30 per month, far less than olmesartan

  • Also approved for chronic stable and vasospastic angina

  • No renal dose adjustment needed

Cons

  • Dose-related leg and ankle swelling (up to 10.8%)

  • Can worsen angina if started or increased in severe CAD

  • Not a RAAS blocker, so no kidney-protective benefit

Olmesartan

Olmesartan is a well-tolerated ARB approved for use in children as young as 6, offering a pediatric option that amlodipine's angina-focused label doesn't cover. It carries a boxed warning against use in pregnancy and costs significantly more than amlodipine. Its side effect profile is generally mild but includes rare risks like sprue-like enteropathy.

Pros

  • Approved for children as young as 6

  • Lower reported rate of dizziness than many antihypertensives

  • Can be combined with other blood pressure drugs for added control

Cons

  • Roughly $115 to $205 per month, much pricier than amlodipine

  • Boxed warning against use during pregnancy

  • Not recommended as initial therapy in patients 75+ or with liver impairment

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