Lisinopril vs Losartan: Differences and Similarities to Know

High blood pressure affects 116 million Americans, and only about 1 in 4 people have it well-controlled. Hypertension is defined as any systolic blood pressure (top) number over 130 mmHg and any diastolic blood pressure (bottom) number over 80 mmHg.

Lisinopril and losartan are two types of prescription medications used to lower blood pressure. While they work similarly, they are different types of drugs.

In this article, we’ll explore the differences between these two medications, dosages, cost, and side effects.

Lisinopril vs Losartan

Lisinopril is an angiotensin converting enzyme inhibitor (ACE inhibitor). Losartan is an angiotensin II receptor blocker (ARB).

Both medicines work on the renin-angiotensin system, which produces hormones that control the tightening and relaxing functions of the blood vessels. 

Angiotensin II is the hormone that leads to blood vessel constriction, which leads to higher blood pressure.

• Lisinopril and other ACE inhibitors block the body from making angiotensin II. This keeps blood vessels from constricting and lowers blood pressure.

• Losartan and other ARBs prevent angiotensin II from binding with receptors, which keeps blood pressure lower. By blocking the message that angiotensin II is trying to send, it is unable to cause blood vessels to get narrow, which makes it harder for blood to flow through them, making the heart have to pump harder to get the job done.

Because lisinopril and losartan both treat high blood pressure in a similar way, by decreasing the effects of angiotensin II, they are similar in other ways. But there are a few key differences.

Lisinopril and losartan are approved by the U.S. Food and Drug Administration (FDA) to treat the following conditions:

• Lisinopril: Hypertension, heart failure, following an acute myocardial infarction (heart attack)

• Losartan: Hypertension, diabetic nephropathy, prevention of stroke in patients with high blood pressure and left ventricular hypertrophy (LVH)

Since both medications can treat high blood pressure and work in similar ways, a healthcare provider will determine which medication is likely to work best for you based on your medical history and other prescriptions that you take.

Dosage Guide

Both medications are available as generics and brand names.

• Lisinopril: Tablets as generic or brand names Prinivil and Zestril. Oral solution as brand name Qbrelis. Normal dosage ranges from 5-40 mg per day.

• Losartan: Tablets as generic or brand name Cozaar. Normal dosage ranges from 25-100 mg per day.

Both medications should be taken by mouth. You can take them with or without food. 

It is important for losartan to be taken at the same time each day. Your doctor may tell you to do the same with lisinopril. Be sure to follow your prescriber’s instructions.

Cost of Lisinopril vs Losartan

Both lisinopril and losartan are covered by most insurances and Medicare.

• Lisinopril: Typical Medicare copay is $0-$7. Average retail price is $12 for generic. Pharmacy prices can vary widely. For those without insurance, additional savings can be found with discount cards or coupons.

• Losartan: Typical Medicare copay is $0-$13. Average retail price is $14 for generic. Pharmacy prices may be quite different. People who do not have insurance can save more with discount cards, coupons, or comparing prices at pharmacies, including online pharmacy options.

Side Effects and Precautions

Lisinopril and losartan are generally considered safe for most people. There are some cases where these drugs should be avoided for serious complications:

• Both drugs contain a black box warning for pregnancy. They can cause serious fetal harm. If you are taking either medication and find out you are pregnant, let your healthcare provider know immediately. In most cases, if you are planning to become pregnant or are not actively preventing pregnancy, a medical provider will recommend a safer medication.

• People who have kidney function problems or disorders may not be able to safely take lisinopril or losartan. Your medical provider will recommend a safe treatment based on your health conditions.

• People who already have high levels of potassium should not take lisinopril or losartan.

• People who are breastfeeding should not take lisinopril or losartan.

Lisinopril and losartan have some common drug interactions. Make sure your healthcare provider and pharmacist know everything that you take, including other medications, OTC drugs, herbal supplements, vitamins, and minerals. 

Lisinopril and losartan should not be paired with the following:

• NSAIDs: Nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen, and naproxen. These can worsen kidney problems if you take them at the same time as lisinopril or losartan. Your doctor can recommend safer pain relief alternatives.

• Potassium supplements: Even though these are over-the-counter dietary supplements, potassium is a mineral electrolyte that has important roles in kidney function and other aspects of fluid balance. Lisinopril and losartan have side effects that can lead to higher potassium levels. If you take additional potassium, it can result in levels of potassium that are too high, known as hyperkalemia. It can cause symptoms like weakness, breathing problems, and heart palpitations. In serious cases, it can be fatal.

• Other medications for high blood pressure: Taking too many medications that have a lowering effect on blood pressure can lead to serious drops in blood pressure. Dizziness, lightheaded feelings, and fainting are common signs of low blood pressure. If you notice these signs, let your healthcare provider know.

Both drugs have some common side effects.

Lisinopril Side Effects

Common side effects of lisinopril are:

• Persistent cough
• Headache
• Dizziness
• Tiredness
• Diarrhea
• Nausea
• Sneezing
• Runny nose

In some cases, lisinopril can lead to serious side effects.

• Allergic reactions like swelling of the face, lips, tongue, or throat
• Anaphylaxis
• Jaundice (yellowing of the skin or eyes)
• Infection
• Hypotension (blood pressure that is too low)
• Problems breathing or swallowing
• Dizziness or lightheadedness

Losartan Side Effects

Common side effects of losartan are:

• Cough
• Dizziness
• Diarrhea
• Fatigue
• Upper respiratory infection

More serious side effects of losartan include:

• Allergic reactions or swelling of the face, eyes, throat, lips, or tongue
• Hoarseness
• Chest pain
• Trouble breathing or swallowing

When to See a Medical Provider

Hypertension is common, but should not go untreated. If you want to explore the right medication for you, a healthcare provider can prescribe one based on your symptoms and medical history.

Blood pressure problems don’t always cause symptoms. If you are not sure what your blood pressure is, you can visit a pharmacy to have it checked.

If you have high blood pressure and want to talk to a provider about which medication is right for you, you can speak with a K Health clinician right from our app.