Olmesartan vs. Benazepril
See how Olmesartan and Benazepril compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Olmesartan (an ARB) and benazepril (an ACE inhibitor) both lower blood pressure through the same hormone pathway, so doctors often switch patients between the two if one causes side effects.
Benazepril typically costs far less than olmesartan, but olmesartan avoids the dry, persistent cough that leads some people to stop taking ACE inhibitors.
Both drugs carry a boxed warning against use during pregnancy and require monitoring for high potassium and kidney function.
Olmesartan vs. Benazepril Drug Summary
Olmesartan
Olmesartan is an angiotensin II receptor blocker (ARB) used to treat high blood pressure in adults and children 6 years and older. It works by blocking a hormone that narrows blood vessels and is taken as one tablet by mouth once a day.
Benazepril
Benazepril is an ACE inhibitor used to treat high blood pressure in adults. It works by blocking the enzyme that produces a blood-vessel-narrowing hormone and is usually started at a low dose that is increased over time.
Olmesartan vs. Benazepril Side Effects
Olmesartan
Benazepril
Olmesartan vs. Benazepril Dosage
Olmesartan
Benazepril
| STAGE | DOSE | WHEN |
| Starting dose | 40 mg once daily | Week 3 onward |
| Maximum dose | 40 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 5 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Olmesartan
| STAGE | DOSE | WHEN |
| Starting dose | 40 mg once daily | Week 3 onward |
| Maximum dose | 40 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Benazepril
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 5 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Olmesartan vs. Benazepril Indications
Olmesartan
Olmesartan is FDA-approved to treat high blood pressure in adults and children as young as 6, either alone or combined with other blood pressure medications. It isn't recommended as the first medicine tried in people 75 or older or in those with liver problems, since these groups weren't well studied for starting therapy with this drug alone.
Approved for adults and children 6 years and older
Can be used alone or added to other blood pressure medicines
Not recommended as first-line therapy in patients 75 or older
Not recommended as first-line therapy with liver impairment
Benazepril
Benazepril is FDA-approved to lower blood pressure in adults, often as part of a broader treatment plan. It isn't approved for children under 6, and the label notes it works less well as a single drug in Black patients, so it's frequently paired with other antihypertensives in that group.
Approved to lower blood pressure in adults
Not approved for children under 6 years old
Not recommended for pediatric patients with reduced kidney function
Label notes reduced monotherapy effect in Black patients
Olmesartan vs. Benazepril Pros and Cons
Olmesartan
Olmesartan is an ARB, so it avoids the dry cough that sometimes causes people to stop ACE inhibitors like benazepril, but it costs more out of pocket. It carries its own rare risks, including a slow-onset severe diarrhea syndrome, and isn't recommended as a first choice for older or liver-impaired patients starting treatment for the first time.
Pros
Doesn't cause the dry, persistent cough common with ACE inhibitors like benazepril
Simple three-step dosing (10 mg, 20 mg, 40 mg) with no added benefit above 40 mg
FDA-approved down to age 6 with an established pediatric dosing option
Cons
Not recommended as initial therapy in patients 75 or older or with liver impairment
Carries a rare risk of sprue-like enteropathy (severe diarrhea with weight loss)
Costs more than benazepril, roughly $115 to $205 per month before insurance
Benazepril
Benazepril is an inexpensive, long-established ACE inhibitor with a wide dosing range for fine-tuning blood pressure control. Its main drawbacks are a higher chance of cough and the ACE-inhibitor class risk of angioedema, a rare but potentially life-threatening swelling reaction.
Pros
Much lower typical cost, roughly $9 to $30 per month before insurance
Long track record, FDA-approved since 1991
Wider dosing range (up to 80 mg) allows more fine-tuning
Cons
Carries an ACE-inhibitor risk of angioedema, including rare fatal swelling reactions
Cough is a known side effect that leads some patients to stop the drug
Less effective as monotherapy in Black patients, per FDA label
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