Lisinopril vs. Losartan

See how Lisinopril and Losartan compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Lisinopril is an ACE inhibitor and losartan is an ARB, but both are first-line, once-daily generics for high blood pressure.

  • Lisinopril is more likely to cause a dry, persistent cough, and losartan is a common alternative for people who can't tolerate that side effect.

  • Lisinopril also has FDA approval for heart failure and post-heart-attack care, while losartan is separately approved for diabetic kidney disease and stroke-risk reduction.

Lisinopril vs. Losartan Drug Summary

Lisinopril

Lisinopril is an ACE inhibitor used to treat high blood pressure, heart failure, and to improve survival in the days after a heart attack. It works by blocking an enzyme that narrows blood vessels, and it's usually taken as one tablet, once a day.

Losartan

Losartan is an angiotensin receptor blocker, or ARB, used to treat high blood pressure, protect the kidneys in type 2 diabetes, and lower stroke risk in certain heart patients. It blocks the same hormone system as lisinopril at a later step, and it's usually taken once a day.

Lisinopril vs. Losartan Side Effects

Lisinopril

Most common
headache (up to 6%)
dizziness (up to 5%)
hypotension (up to 4%)
cough (up to 4%)

Losartan

Most common
respiratory infection (up to 8%)
dizziness (up to 3%)
nasal congestion (up to 2%)
back pain (up to 2%)

Lisinopril vs. Losartan Dosage

Lisinopril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose Up to 80 mg once daily If needed
Dose changes 3 increases As tolerated

Losartan

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg once daily At the start
Maximum dose Up to 100 mg/day If needed
Dose changes 3 increases As tolerated

Lisinopril vs. Losartan Indications

Lisinopril

Lisinopril is FDA-approved for high blood pressure in adults and children 6 and older, as an add-on treatment for heart failure, and to improve survival in the days after a heart attack. It's often prescribed alone or with other blood pressure medications.

  • High blood pressure (adults and children 6+)

  • Heart failure (used alongside other therapies)

  • Acute heart attack (started within 24 hours)

  • Diabetic kidney protection (off-label use)

Losartan

Losartan is FDA-approved for high blood pressure in adults and children 6 and older, to slow diabetic kidney disease in adults with type 2 diabetes, and to reduce stroke risk in patients with hypertension and an enlarged heart muscle (left ventricular hypertrophy).

  • High blood pressure (adults and children 6+)

  • Diabetic kidney disease (type 2 diabetes)

  • Stroke risk reduction (with enlarged heart muscle)

  • Heart failure (off-label use in some patients)

Lisinopril vs. Losartan Pros and Cons

Lisinopril

Lisinopril has one of the longest track records of any blood pressure drug, with outcomes data in heart failure and after heart attacks in addition to hypertension. As a generic ACE inhibitor it is widely stocked, though it commonly causes a distinctive dry cough.

Pros

  • Also FDA-approved for heart failure and to improve survival after a heart attack

  • Decades of long-term outcomes data since its 1980s approval

  • No dosage adjustment typically needed for elderly patients

  • Once-daily dosing works for most patients with hypertension

Cons

  • Causes a dry, persistent cough in a meaningful share of patients

  • Carries a higher relative risk of angioedema (swelling) than ARBs

  • Requires kidney function and potassium monitoring, especially at the start

Losartan

Losartan works through the same hormone pathway as lisinopril but blocks it one step later, which usually avoids the ACE-inhibitor cough. It is also a widely available generic ARB with its own specific approvals for diabetic kidney disease and stroke-risk reduction.

Pros

  • Specifically FDA-approved to slow diabetic kidney disease in type 2 diabetes

  • Also approved to reduce stroke risk in patients with an enlarged heart muscle

  • Rarely causes the dry cough associated with ACE inhibitors like lisinopril

  • Lower relative risk of angioedema than ACE inhibitors

Cons

  • Not FDA-approved for heart failure or post-heart-attack care like lisinopril

  • May need twice-daily dosing in some patients for full 24-hour control

  • Fewer years on the market than lisinopril, with somewhat less long-term data

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