Losartan vs. Carvedilol
See how Losartan and Carvedilol compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Losartan is an ARB taken once daily for blood pressure and kidney protection, while carvedilol is a beta-blocker used for blood pressure, heart failure, and recovery after a heart attack.
Carvedilol needs a slow twice-daily titration and causes more dizziness and fatigue, while losartan starts at an effective dose with once-daily dosing.
Only carvedilol has FDA approval for heart failure and reducing death after a heart attack; only losartan is approved to slow diabetic kidney disease.
Losartan vs. Carvedilol Drug Summary
Losartan
Losartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure, lower stroke risk in people with hypertension and thickened heart muscle, and slow kidney damage from type 2 diabetes. It comes as a tablet taken once a day, usually starting at 50 mg.
Carvedilol
Carvedilol is a combined alpha- and beta-blocker used to treat high blood pressure, chronic heart failure, and heart damage after a heart attack. It is taken twice a day with food, starting at a low dose that is slowly increased over several weeks.
Losartan vs. Carvedilol Side Effects
Losartan
Carvedilol
Losartan vs. Carvedilol Dosage
Losartan
Carvedilol
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 3.125 mg twice daily | At the start |
| Maximum dose | 25 mg twice daily | If needed |
| Dose changes | 3 increases | As tolerated |
Losartan
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Carvedilol
| STAGE | DOSE | WHEN |
| Starting dose | 3.125 mg twice daily | At the start |
| Maximum dose | 25 mg twice daily | If needed |
| Dose changes | 3 increases | As tolerated |
Losartan vs. Carvedilol Indications
Losartan
Losartan is FDA-approved to treat high blood pressure in adults and children over age 6. It also reduces stroke risk in people with hypertension and left ventricular hypertrophy, and slows kidney disease in people with type 2 diabetes and proteinuria.
Treats high blood pressure in adults and children over 6
Lowers stroke risk with hypertension and thickened heart muscle
Slows kidney damage in type 2 diabetes with proteinuria
Stroke-risk benefit not established in Black patients
Carvedilol
Carvedilol is FDA-approved to treat chronic heart failure, from mild to severe, and to lower the chance of death after a heart attack in people with reduced heart pumping function. It is also approved to treat high blood pressure, alone or combined with other medications.
Treats mild to severe chronic heart failure
Lowers death risk after a heart attack with weak heart function
Treats high blood pressure, alone or with other drugs
Sometimes used off-label for atrial fibrillation rate control
Losartan vs. Carvedilol Pros and Cons
Losartan
Losartan offers simple once-daily dosing without a lengthy titration schedule, and it doesn't cause the dry cough sometimes seen with ACE inhibitors. As a generic ARB, it's inexpensive and widely stocked at pharmacies, though it isn't approved for heart failure.
Pros
Once-daily dosing with no lengthy titration needed
Does not cause the dry cough linked to ACE inhibitors
Also slows kidney damage in diabetic nephropathy
Inexpensive, widely available generic
Cons
Not FDA-approved for heart failure
Carries a pregnancy boxed warning for fetal harm
Needs periodic blood tests for potassium and kidney function
Stroke-prevention benefit not established in Black patients
Carvedilol
Carvedilol has proven mortality benefits in heart failure and after a heart attack, benefits losartan does not offer. It requires a gradual twice-daily titration over weeks and carries higher rates of dizziness, fatigue, and low blood pressure during that adjustment period.
Pros
Proven to reduce deaths in heart failure and post-heart attack
Also effective for high blood pressure
Can be combined with diuretics or other antihypertensives
Also available as once-daily extended-release capsule (Coreg CR)
Cons
Requires slow twice-daily titration over several weeks
Higher rates of dizziness, fatigue, and low blood pressure
Should not be stopped abruptly due to rebound risk
Not recommended for patients with asthma or bronchospasm
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