Drug vs. Drug

Losartan vs. lisinopril: Differences, similarities, and which is better for you

Karen Berger medical writer and reviewer headshot By | February 20, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

If you are one of the 103 million Americans with high blood pressure, your doctor may have mentioned starting you on medication to lower your blood pressure. Losartan and lisinopril are both generic prescription drugs that are used to treat high blood pressure (hypertension). Losartan is an angiotensin II receptor blocker (ARB) and lisinopril is an angiotensin-converting enzyme inhibitor (ACE inhibitor).

Both drugs work on a part of the body called the renin-angiotensin system but in different ways. In the renin-angiotensin system, ACE inhibitors block a substance called angiotensin II from being made. Angiotensin II narrows the blood vessels and increases blood pressure, so by blocking the production of angiotensin II, blood pressure is lowered. ARBs block angiotensin II from binding to receptors, thereby lowering blood pressure.

What are the main differences between losartan and lisinopril?

Losartan is an ARB, available in brand name and tablet form, as Cozaar (or Hyzaar when in combination with hydrochlorothiazide, a diuretic commonly abbreviated as HCTZ). The usual dose ranges from 25 mg to 100 mg daily.

Lisinopril is an ACE inhibitor available in table form by brand names Prinivil or Zestril (or Zestoretic when in combination with HCTZ). It is also available as an oral solution called Qbrelis. The usual dose ranges from 5 mg to 40 mg daily.

Main differences between losartan and lisinopril
Losartan Lisinopril
Drug class Angiotensin receptor blocker (ARB) ACE inhibitor
Brand/generic status Brand and generic Brand and generic
What is the brand name? Cozaar
Hyzaar (losartan/HCTZ)
Prinivil
Zestril
Qbrelis (oral solution)
Zestoretic (lisinopril/HCTZ)
What form(s) does the drug come in? Tablet (alone and in combination with HCTZ) Tablet (alone and in combination with HCTZ)
What is the standard dosage? 25 to 100 mg daily 5 to 40 mg daily
How long is the typical treatment? Long-term Long-term
Who typically uses the medication? Adults, children (depending on indication) Adults, children (depending on indication)

Conditions treated by losartan vs. lisinopril

Losartan is indicated for the treatment of hypertension (HTN), or high blood pressure. It is also used to reduce stroke risk in patients with high blood pressure and left ventricular hypertrophy, and it is also used to treat diabetic nephropathy in certain patients.

Lisinopril is indicated for the treatment of HTN, as an adjunct treatment in congestive heart failure, and to improve survival after a heart attack.

Both drugs also have off-label uses, outlined below.

Condition Losartan Lisinopril
Treatment of hypertension (HTN) Yes Yes
Reduce the risk of stroke in patients with HTN and left ventricular hypertrophy (LVH) Yes Off-label
Treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria in patients with type 2 diabetes and a history of HTN Yes Off-label
Adjunctive therapy in the management of heart failure in patients who are not responding adequately to diuretics and digitalis Off-label Yes
Treatment of hemodynamically stable patients within 24 hours of acute myocardial infarction (MI) to improve survival Off-label Yes
Heart failure with reduced ejection fraction Off-label Off-label
Marfan syndrome to reduce the rate of aortic dilatation Off-label Off-label
Management of patients with non-ST-elevation acute coronary syndrome Off-label Off-label
Kidney transplant recipients Off-label Off-label (in patients with post-transplant erythrocytosis)
Patients with proteinuric chronic kidney disease Off-label (in diabetic patients) Off-label (in diabetic or nondiabetic patients)
Stable coronary artery disease Off-label Off-label

Is losartan or lisinopril more effective?

In a review of 61 studies comparing ARBs (including losartan) to ACE inhibitors (including lisinopril), both categories of drugs were found to have similar long-term effects on blood pressure. The authors also concluded that both classes of drugs have an equivalent effect on death, cardiovascular events, major adverse events, quality of life, and risk factors such as lipid levels, diabetes mellitus, and left ventricular mass and function.

In a small study of patients with kidney disease, losartan and lisinopril had similar effects on kidney function and blood pressure.

The most effective medication for you should be determined by your doctor, who can look at the full picture of your medical condition(s), history, and other medications you are taking.

Coverage and cost comparison of losartan vs. lisinopril

Both losartan and lisinopril are covered by insurance and Medicare Part D in the generic form. The brand name versions may be covered at a higher copay. The out-of-pocket cost for 30 tablets of losartan 100 mg can range from $28-$70, and the Medicare Part D copay is about $0-$13. With a SingleCare coupon, the price range is $9-$16 depending on the participating pharmacy. The out-of-pocket cost for 30 tablets of 10 mg lisinopril is about $15, and the Medicare Part D copay is about $0-$7. You can save money on lisinopril by using a SingleCare discount card or coupon.

Losartan Lisinopril
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage #90, 100 mg tablets #90, 20 mg tablets
Typical Medicare copay $0-$13 $0-$7
SingleCare cost $28-$70 $9-$26

Common side effects of losartan vs. lisinopril

The most common side effects of losartan include cough, dizziness, upper respiratory infection, fatigue, and diarrhea.

The most common side effects of lisinopril include cough, dizziness, headache, fatigue, and diarrhea.

Other side effects may occur. Consult a healthcare professional for a complete list of side effects.

   Losartan     Lisinopril
Side Effect Applicable? Frequency Applicable? Frequency
Cough Yes 17-29% Yes 3.5-69%
Dizziness Yes 3% Yes 5.4%
Upper respiratory
infection
Yes 8% Yes 2.1%
Nasal congestion Yes 2% Yes 0.4%
Back pain Yes 2% No
Fatigue Yes >4% Yes 2.5%
Diarrhea Yes >4% Yes 2.7%
Nausea Yes Not reported Yes 2%
Headache Yes Not reported Yes 5.7%

Source: DailyMed (losartan), DailyMed (lisinopril)

Drug interactions of losartan vs. lisinopril

Losartan or lisinopril should not be used with potassium or other medications that increase potassium (such as potassium-sparing diuretics), because of the risk of hyperkalemia. Additionally, ask your doctor about potassium in your diet and if you should avoid potassium-rich foods and salt substitutes that contain potassium.

NSAIDs (nonsteroidal anti-inflammatory drugs) should not be used in combination with losartan or lisinopril, because the combination could cause kidney injury or kidney failure.

Losartan or lisinopril should not be used in combination with another ACE inhibitor, ARB, or Tekturna (aliskiren) because the combination increases the risk of low blood pressure, high potassium, fainting, kidney damage, or kidney failure.

Consult your healthcare provider for a full list of drug interactions.

Drug Drug Class Losartan Lisinopril
Potassium Electrolyte Yes Yes
Midamor (amiloride)
Aldactone (spironolactone)
Dyrenium (triamterene)
Inspra (eplerenone)
Potassium-sparing diuretics Yes Yes
Aspirin
Motrin, Advil (ibuprofen)
Aleve (naproxen)
Mobic (meloxicam)
Celebrex (celecoxib)
Relafen (nabumetone)
NSAIDs Yes Yes
Vasotec (enalapril)
Lotensin (benazepril)
Accupril (quinapril)
Altace (ramipril)
ACE inhibitors Yes Yes
Diovan (valsartan)
Edarbi
Atacand (candesartan)
Avapro (irbesartan)
Micardis (telmisartan)
Benicar (olmesartan)
ARBs Yes Yes
Tekturna (aliskiren) Renin inhibitor Yes Yes
Lithium Antimanic agent Yes Yes

Warnings of losartan and lisinopril

Losartan and lisinopril both come with a boxed warning, which is the strongest warning as required by the FDA. Drugs (such as losartan and lisinopril) that act on the renin-angiotensin system can cause serious fetal injury/birth defects or death and should be discontinued once pregnancy is established.

Other warnings that apply to losartan and lisinopril:

  • Patients who are dehydrated or take diuretics may develop low blood pressure (hypotension).
  • Changes in renal function, including acute renal failure, may occur. The risk is higher in patients with kidney problems or severe heart failure. These patients may not be a candidate for an ACE inhibitor or ARB. If one of these drugs is started, kidney function should be monitored.
  • Potassium levels should be monitored.

Lisinopril has additional warnings:

  • There is a possibility of an anaphylactic reaction (severe allergic reaction), including angioedema (swelling) of the face, extremities, lips, tongue, glottis, and/or larynx. This reaction can occur anytime during treatment. Angioedema associated with laryngeal edema may be fatal. Where there is involvement of the tongue, glottis or larynx, likely to cause airway obstruction, emergency treatment is necessary. Lisinopril should be discontinued if these reactions occur.
  • There is a small risk of liver problems; liver enzymes should be monitored.
  • Due to the breakdown of a substance called bradykinin, a dry cough may occur. Once the medication is stopped, the cough should go away.

Frequently asked questions about losartan and lisinopril

What is losartan?

Losartan is an angiotensin receptor blocker that helps lower blood pressure. It can also be used for various other conditions, outlined above.

What is lisinopril?

Lisinopril is an ACE inhibitor that helps lower blood pressure. It is also used for other medical conditions, outlined above.

Are losartan vs. lisinopril the same?

Although both medications work on the renin-angiotensin system, they work on different areas of the system, but both medications lower blood pressure and are used for other heart or kidney conditions. They also have other differences in dosing, warnings, and price.

Other common ACE inhibitors (like lisinopril) you may have heard of include Lotensin (benazepril), Vasotec (enalapril), Accupril (quinapril), and Altace (ramipril).

Other ARBs (like losartan) you may have heard of include Edarbi (azilsartan – no generic available), Atacand (candesartan), Avapro (irbesartan), Micardis (telmisartan), Diovan (valsartan), and Benicar (olmesartan).

Is losartan or lisinopril better?

Studies have shown ARBs like losartan and ACE inhibitors like lisinopril to have similar effects. Consult your healthcare provider to see if one of these medications is right for you.

Can I use losartan or lisinopril while pregnant?

Losartan or lisinopril should NEVER be taken while pregnant. Both drugs are very dangerous to a developing fetus and could cause serious birth defects or even death to the fetus. If you are already taking losartan or lisinopril and find out that you are pregnant, consult your doctor immediately.

Can I use losartan or lisinopril with alcohol?

Drinking alcohol while taking losartan or lisinopril can increase dizziness, or affect your blood pressure or other medical condition(s). Consult your doctor about the use of alcohol with losartan or lisinopril.

Should I take lisinopril and losartan together?

No. Although some blood pressure medications are used in combination (such as losartan or lisinopril in combination with a diuretic), lisinopril and losartan should not be taken together. Doing so increases the risk of low blood pressure, high potassium, and injury to the kidneys, which could be very serious or even potentially fatal.

Is losartan an ACE inhibitor or a beta blocker?

Losartan is an angiotensin receptor blocker. It is not an ACE inhibitor or a beta blocker.

Does losartan cause fewer side effects than lisinopril?

Both drugs have similar side effects, although lisinopril is more likely to cause a dry cough and has a risk of angioedema (severe allergic reaction). Consult your healthcare professional for a full list of side effects.