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
Olmesartan
Lisinopril vs. Olmesartan Dosage
Lisinopril
Olmesartan
| 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 | 10 mg once daily | At the start |
| Maximum dose | 40 mg once daily | Week 3 onward |
| Dose changes | 2 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 |
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 |
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
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.