Cozaar (losartan) alternatives: What can I take instead of losartan?

Compare losartan alternatives | Valsartan | Lisinopril | Losartan/hydrochlorothiazide | Amlodipine | Chlorthalidone | Natural alternatives | How to switch meds

Losartan potassium tablet (generic name for brand Cozaar) is a commonly used medication to help lower blood pressure in people with hypertension. Additionally, losartan can be used to manage congestive heart failure, control chronic kidney disease (including diabetic nephropathy), and reduce the risk of stroke in people with both hypertension and left ventricular hypertrophy. Losartan belongs to a group of high blood pressure medications called angiotensin II receptor blockers (ARBs). This medication works to open up blood vessels to lower blood pressure and helps to prevent damage to the heart and kidneys. 

Who shouldn’t take losartan?

Losartan can be used in people 6 years of age and older. While an effective treatment for some people, losartan may not be the best or safest option for all people managing hypertension, congestive heart failure, or kidney disease. Along with other ARB medications, losartan has a black box warning for fetal toxicity. Losartan should not be used in women who are pregnant or plan to become pregnant. Additionally, losartan should not be combined with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.  

Some losartan alternatives have approved indications for other conditions aside from hypertension and could be used to help manage more than one condition. Additionally, people will often require more than one medication to help manage their blood pressure. There are several combination tablets that contain more than one hypertension medication that makes dosing more convenient. Losartan and other ARBs are available in combination tablets with other medications that work in unique ways to help lower blood pressure.

RELATED: Blood pressure treatments and medications

What can I take in place of losartan?

There are several other options available to treat high blood pressure if not improved with losartan. These alternative prescription medications include other types of ARBs, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), diuretics, beta blockers, central alpha agonists, alpha-blockers, and aldosterone receptor antagonists. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Other alternatives to losartan

Angiotensin II receptor blockers (ARBs)

• Edarbi (azilsartan)
• Atacand (candesartan)
• Teveten (eprosartan)
• Avapro (irbesartan)
• Benicar (olmesartan)
• Micardis (telmisartan)

Angiotensin-converting enzyme (ACE) inhibitors

• Lotensin (benazepril) 
• Capoten (captopril) 
• Monopril (fosinopril) 
• Univasc (moexipril) 
• Aceon (perindopril) 
• Accupril (quinapril)
• Altace (ramipril)
• Mavik (trandolapril)

Calcium channel blockers (CCBs)

• Cardene (nicardipine)
• Procardia (nifedipine)
• Sular (nisoldipine)
• Verelan (verapamil)

Diuretics

• Bumex (bumetanide)
• Diuril (chlorothiazide)
• Lasix (furosemide)
• Lozol (indapamide)
• Zaroxolyn (metolazone)
• Demadex (torsemide)

Beta blockers

• Sectral (acebutolol)
• Tenormin (atenolol)
• Kerlone (betaxolol)
• Zebeta (bisoprolol fumarate)
• Coreg (carvedilol)
• Trandate, Normodyne (labetalol)
• Lopressor (metoprolol tartrate)
• Corgard (nadolol)
• Bystolic (nebivolol)
• Visken (pindolol)
• Inderal (propranolol)
• Betapace (sotalol)

Alpha-blockers

• Cardura (doxazosin mesylate)
• Minipress (prazosin)
• Hytrin (terazosin)

Central alpha agonists

• Catapres (clonidine)
• Tenex (guanfacine)
• Aldomet (methyldopa)

Aldosterone receptor antagonists

• Inspra (eplerenone)
• Aldactone (spironolactone)

ARB combinations

• Avalide (irbesartan and hydrochlorothiazide)            
• Azor (olmesartan and amlodipine)
• Benicar HCT (olmesartan and hydrochlorothiazide)
• Diovan HCT (valsartan and hydrochlorothiazide)
• Micardis HCT (telmisartan and hydrochlorothiazide)
• Twynsta (telmisartan and amlodipine)

Top 5 losartan alternatives

1. Diovan (valsartan)

Valsartan is in the same medication class as losartan and works as an angiotensin II receptor blocker (ARB). According to the American Heart Association (AHA) hypertension guidelines, ARBs like losartan and valsartan are first-line treatment options. Furthermore, one study has shown that valsartan and losartan are equally effective in lowering diastolic blood pressure. 

Aside from the treatment of hypertension, valsartan has other FDA indications including heart failure and post-myocardial infarction (after a heart attack). Valsartan may be considered as an alternative for people managing hypertension and heart failure. In The Valsartan Heart Failure Trial (Val-HeFT), valsartan significantly reduced hospitalizations for heart failure. 

Valsartan is either dosed as an 80 to 320 mg tablet by mouth once daily for hypertension or as a 160 mg tablet by mouth twice daily for heart failure or post-myocardial infarction (heart attack).

RELATED: Valsartan side effects 

2. Prinivil, Zestril (lisinopril)

Lisinopril works as an angiotensin-converting enzyme (ACE) inhibitor. Like losartan, lisinopril is recommended as a first-line medication for treating hypertension, according to the AHA guidelines. 

Aside from the treatment of hypertension, lisinopril has other FDA indications including heart failure and reduction of mortality in acute myocardial infarction (heart attack). 

Like losartan, lisinopril and other ACE inhibitors should not be used in pregnant women due to fetal toxicity risk. 

Along with similar side effects to losartan, such as dizziness and low blood pressure (hypotension), ACE inhibitors are more likely than ARBs to cause a unique adverse effect of persistent cough. The cough can be bothersome to some people and require a change in medication. 

Lisinopril is dosed as a 10 to 40 mg tablet by mouth once daily.

RELATED: Losartan vs. lisinopril

3. Hyzaar (losartan and hydrochlorothiazide)

Hyzaar (losartan-HCTZ) is a brand-name combination tablet that contains losartan and a diuretic, hydrochlorothiazide. Along with losartan, thiazide diuretics like hydrochlorothiazide are recommended as first-line medications for hypertension treatment, according to the AHA guidelines. Hyzaar is also approved for use in stroke prevention in hypertension and left ventricular hypertrophy.

Since people managing hypertension will often need more than one medication, Hyzaar is a more convenient option as only one tablet is needed each day.  

Hyzaar should not be used in pregnant women due to fetal toxicity risk.

4. Norvasc (amlodipine)

Amlodipine works as a calcium channel blocker (CCB). Like losartan, amlodipine is recommended as a first-line medication for treating hypertension, according to the AHA guidelines. Aside from hypertension treatment, amlodipine is approved for use in coronary artery disease. In the PREVENT study for coronary artery disease, amlodipine demonstrated favorable outcomes with fewer hospitalizations for angina (chest pain) and revascularization procedures. Amlodipine may be considered as an alternative for people managing hypertension and heart disease. 

Common side effects include headache and edema (swelling caused by excess fluid). 

Amlodipine is dosed as a 5 to 10 mg tablet by mouth once daily.

RELATED: Amlodipine alternatives

5. Thalitone, Hygroton (chlorthalidone)

Chlorthalidone works as a thiazide diuretic and is sometimes referred to as a “water pill”. Like losartan, chlorthalidone is recommended as a first-line medication for treating hypertension, according to the AHA guidelines. Aside from hypertension treatment, chlorthalidone can be used to treat edema and decrease swelling of fluid trapped in the body’s tissues. Chlorthalidone may be considered as an alternative for people managing hypertension and edema associated with congestive heart failure, hepatic cirrhosis, corticosteroid therapy, estrogen therapy, or kidney problems. 

It’s important for those taking diuretics to have their fluid status and electrolytes monitored by their doctor as this type of medication can cause imbalances. 

Chlorthalidone is dosed as a 12.5 to 25 mg tablet by mouth once daily for hypertension and a 50 to 100 mg tablet by mouth once daily for edema.

Natural alternatives to losartan

Alternative remedies for losartan include certain supplements, lifestyle changes, and diet modifications to help keep blood pressure in a healthy range. According to the AHA hypertension guidelines, alternative remedies are effective at lowering blood pressure and benefiting cardiovascular health.

Lifestyle modifications include regular physical exercise, weight loss, and diet changes. Being overweight, especially weight in the belly, is linked to increased blood pressure, according to the American College of Cardiology. 

Diet changes

A heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, is recommended for people with hypertension. The DASH diet focuses on eating fruits, vegetables, low-fat milk, whole grains, fish, poultry, beans, and nuts. This diet also aims to decrease sodium, foods and beverages with added sugars, and red meat. 

Limiting alcohol consumption

Additionally, the AHA recommends adults with elevated blood pressure or hypertension who currently consume alcohol should limit their intake to no more than two standard drinks for men and one standard drink for women per day.

Potassium supplements

Supplementation of potassium is recommended by the AHA guidelines for adults with hypertension unless contraindicated by the presence of reduced kidney function related to chronic kidney disease (CKD) or the use of medications that make it harder for the body to get rid of potassium, which may result in hyperkalemia. Potassium is found in foods such as raisins, apricots, potatoes, beans, spinach, broccoli, avocado, bananas, and oranges. 

However, it may be hard to get enough potassium through foods alone, especially if also taking a thiazide diuretic such as hydrochlorothiazide or chlorthalidone. Thiazide diuretics can cause potassium loss through increased urine production. A healthcare provider can prescribe a potassium supplement for those unable to get an adequate amount of potassium after ensuring potassium levels allow for therapy.

RELATED: How to lower blood pressure quickly and naturally

How to switch to a losartan alternative

1. Discuss all health conditions with a healthcare provider

Before switching from losartan to an alternative, it’s important that the prescribing doctor is aware of all medical conditions. Some alternatives should be used with caution or avoided with certain medical conditions. For example, all medications that contain ACE inhibitors (such as lisinopril and enalapril) and ARBs (such as valsartan and losartan-HCTZ) must not be used in pregnant women or women planning on becoming pregnant. Alternatives in the beta blocker antihypertensive class (such as atenolol and metoprolol succinate) must be avoided in certain heart conditions such as bradycardia (slow heart rate).

2. Do not suddenly stop taking losartan without medical advice

Only stop taking losartan if the prescribing doctor has been consulted and decided stopping the medication is safe. If losartan is stopped suddenly, there may be a sudden spike in blood pressure. It’s important for a therapy plan to be established prior to stopping losartan suddenly. Once losartan is safely stopped and a new medication has been prescribed, review the prescribing information for the new medication.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from losartan to an alternative, it’s important that the prescribing doctor has reviewed a patient’s medication list including prescription drugs and over-the-counter meds. Some alternatives have dangerous drug interactions that must be avoided.

4. Continue to monitor blood pressure readings

For those managing hypertension, it’s important to check blood pressure with an at-home monitor. Keeping a blood pressure journal can help healthcare providers determine if the medication plan is working or needs adjustments.

Lea este artículo en español aquí.