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
Olmesartan
Amlodipine vs. Olmesartan Dosage
Amlodipine
Olmesartan
| 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 |
| 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
| 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
| 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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