Lisinopril vs. Olmesartan

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

Key Takeaways

  • Lisinopril and olmesartan both lower blood pressure but come from different drug classes, which changes their side effects and price.

  • Lisinopril is a low-cost, once-daily ACE inhibitor known for causing a dry cough in some patients; olmesartan is a once-daily ARB that skips that cough but costs much more.

  • Both drugs carry a boxed warning against use during pregnancy and require periodic monitoring of potassium levels and kidney function.

Lisinopril vs. Olmesartan Drug Summary

Lisinopril

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

Olmesartan

Olmesartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure in adults and children 6 and older. It works by blocking the receptor that causes blood vessels to tighten, and it's taken as a single tablet once a day.

Lisinopril vs. Olmesartan Side Effects

Lisinopril

Most common
headache (3.8%)
dizziness (3.5%)
cough (2.5%)
fatigue (1%)

Olmesartan

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

Lisinopril vs. Olmesartan 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

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

Lisinopril vs. Olmesartan Indications

Lisinopril

Lisinopril is an ACE inhibitor approved to treat high blood pressure in adults and children age 6 and up. It's also FDA-approved for heart failure and to improve survival after a heart attack, often used alongside other heart medicines.

  • Treats high blood pressure in adults and children 6 and older

  • Also approved for heart failure

  • Approved to improve survival after a heart attack

  • Often combined with a diuretic or other blood pressure medicine

Olmesartan

Olmesartan is an ARB approved to treat high blood pressure in adults and children age 6 and up, either alone or combined with other blood pressure medicines. It isn't recommended as the first medicine started in patients 75 and older or those with liver problems.

  • Treats high blood pressure in adults and children 6 and older

  • Can be used alone or with other blood pressure medicines

  • Not recommended as initial therapy in patients 75 and older

  • Not recommended as initial therapy with liver impairment

Lisinopril vs. Olmesartan Pros and Cons

Lisinopril

Lisinopril is a generic ACE inhibitor with decades of use and strong outcomes data beyond just blood pressure, including heart failure and post-heart-attack care. It's inexpensive and widely stocked, though the dry cough linked to ACE inhibitors is a common reason patients switch drug classes.

Pros

  • Generic price is typically $4 to $15 per month without insurance

  • Long track record with outcomes data in heart failure and after a heart attack

  • Also FDA-approved for conditions beyond hypertension, so one prescription can cover more

Cons

  • Dry, persistent cough is a well-known reason patients discontinue ACE inhibitors

  • Carries a higher relative risk of angioedema than ARBs

  • Dose must be reduced and monitored more closely in kidney impairment

Olmesartan

Olmesartan is a generic ARB that treats hypertension without the ACE-inhibitor cough, using a simple three-step dosing schedule. It carries a much higher list price than generic lisinopril, and its label includes specific cautions around starting treatment in older adults and a rare but serious bowel condition.

Pros

  • Doesn't cause the dry cough associated with ACE inhibitors

  • Simple three-step once-daily titration from 10 mg to 40 mg

  • Doses above 40 mg show no added blood pressure benefit, keeping the regimen simple

Cons

  • Typical monthly list price runs $115 to $205, well above generic lisinopril

  • Not recommended as initial therapy in patients 75 and older

  • Linked to rare sprue-like enteropathy causing severe diarrhea and weight loss

Common Symptoms and Related Diseases You Can Explore

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