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
Losartan
Lisinopril vs. Losartan Dosage
Lisinopril
Losartan
| 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 |
| 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
| 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
| 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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