Losartan vs. Olmesartan

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

Key Takeaways

  • Losartan and olmesartan are both angiotensin II receptor blockers (ARBs) used to treat high blood pressure, and both are taken once daily by mouth.

  • Losartan carries extra FDA approvals for reducing stroke risk in people with left ventricular hypertrophy and for slowing kidney damage from type 2 diabetes, which olmesartan does not have.

  • Generic losartan typically costs far less per month than olmesartan, which can matter for people without strong insurance coverage.

Losartan vs. Olmesartan Drug Summary

Losartan

Losartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure in adults and children 6 and older. It is also FDA-approved to lower stroke risk in people with high blood pressure and left ventricular hypertrophy, and to slow kidney damage in type 2 diabetes with protein in the urine. It comes as a tablet taken once a day, usually starting at 50 mg.

Olmesartan

Olmesartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure in adults and children 6 and older, alone or with other blood pressure medicines. It comes as a tablet taken once a day, typically starting at 20 mg and adjusted after a few weeks. Unlike losartan, it does not carry FDA approval for reducing stroke risk or treating diabetic kidney disease.

Losartan vs. Olmesartan Side Effects

Losartan

Most common
Dizziness (up to 3%)
Back pain (up to 2%)
Upper respiratory infection (up to 8%)
Nasal congestion (up to 2%)

Olmesartan

Most common
Dizziness (3%)
Back pain (>1%)
Headache (>1%)
Diarrhea (>1%)

Losartan vs. Olmesartan Dosage

Losartan

Dosage
Dosage Table
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

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

Losartan vs. Olmesartan Indications

Losartan

Losartan is FDA-approved to treat high blood pressure in adults and children 6 and older. It also lowers the risk of stroke in people who have high blood pressure with left ventricular hypertrophy, though this benefit has not been shown in Black patients. It is approved to slow kidney damage in adults with type 2 diabetes, high blood pressure, and protein in the urine.

  • Treats high blood pressure in adults and children 6+

  • Reduces stroke risk with high blood pressure and LVH

  • Slows diabetic kidney disease with proteinuria

  • Can be combined with other blood pressure medicines

Olmesartan

Olmesartan is FDA-approved to treat high blood pressure in adults and children 6 and older, either alone or combined with other antihypertensive medicines. It is not approved as initial therapy for people 75 and older or for those with liver problems. It does not carry the added stroke-risk or kidney-protection approvals that losartan has.

  • Treats high blood pressure in adults and children 6+

  • Can be combined with other blood pressure medicines

  • Not approved as first therapy in people 75 or older

  • Not approved as first therapy with liver impairment

Losartan vs. Olmesartan Pros and Cons

Losartan

Losartan has decades of use, broad insurance coverage, and low-cost generics at nearly every pharmacy. It also carries added FDA approvals for stroke-risk reduction and diabetic kidney protection that not every ARB has. Its main tradeoff is a somewhat shorter duration of action than some newer ARBs.

Pros

  • FDA-approved for stroke-risk reduction with LVH

  • FDA-approved to slow diabetic kidney disease

  • Generic tablets often cost $10 to $90 a month without insurance, before savings programs

Cons

  • Shorter duration of action than some newer ARBs

  • May need a second daily dose for full 24-hour control in some people

  • Stroke-risk benefit not shown in Black patients

Olmesartan

Olmesartan lowers blood pressure with once-daily dosing and a long half-life that gives steady 24-hour control. It lacks the added stroke-risk and kidney-protection indications that losartan carries. Its generic list price also tends to run higher than losartan's before any discounts or coupons.

Pros

  • Long half-life gives steady 24-hour blood pressure control

  • Doses above 40 mg add no extra benefit, simplifying titration

  • Effective as monotherapy or combined with other medicines

Cons

  • No FDA approval for stroke-risk reduction

  • No FDA approval for diabetic kidney protection

  • Rare risk of severe chronic diarrhea with weight loss

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