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Lisinopril vs Benicar
Introduction
For patients with hypertension or high blood pressure, certain medications can help in managing these conditions. Lisinopril and Benicar are two such drugs that are often prescribed for this purpose. They each impact different aspects of the cardiovascular system but both have potent effects in reducing blood pressure. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor which works by relaxing blood vessels so that blood can flow more easily, thus lowering the patient's blood pressure. On the other hand, Benicar falls under a class of drugs known as angiotensin receptor blockers (ARBs). It functions primarily by blocking a substance in the body that causes the blood vessels to tighten, resulting likewise in lowered blood pressure.
Lisinopril vs Benicar Side By Side
| Attribute | Prinivil zestril | Benicar |
|---|---|---|
| Brand Name | Prinivil, Zestril | Benicar |
| Contraindications | Should not be taken if you are taking aliskiren, especially in individuals with diabetes. Contraindicated during pregnancy. | Should not be taken if you are taking aliskiren, especially in individuals with diabetes. Contraindicated during pregnancy. |
| Cost | For the generic version, costs start at only pennies per day ($0.03–$0.15). For higher doses, this could rise towards an upper limit cost closer to around one dollar per day ($1). | For the generic version, costs start as low as about $0.13/day and don't exceed about $1.50/day. |
| Generic Name | Lisinopril | Olmesartan |
| Most Serious Side Effect | Severe liver problems may occur causing symptoms like yellow eyes/skin (jaundice), dark urine, and abdominal pain. | May cause excessive weight loss and chronic diarrhea resulting from intestinal problems. |
| Severe Drug Interactions | Taking Lisinopril with aliskiren can be harmful, especially for individuals with diabetes. | Taking Benicar with aliskiren can be harmful, especially for individuals with diabetes. |
| Typical Dose | Oral dosages range from 10-40 mg/day, but 20 mg/day is usually adequate for treating high blood pressure in most adults. | Treatment is typically initiated at a dosage of 20 mg/day. Depending on the patient's response, this can be increased to 40 mg/day. |
What is Lisinopril?
Lisinopril (sold under the brand names Prinivil and Zestril) was one of the initial drugs in a class called Angiotensin-Converting Enzyme inhibitors (ACE inhibitors). It was first approved by the FDA in 1987. Lisinopril operates by blocking an enzyme that causes blood vessels to constrict, thus allowing them to relax and widen, which lowers blood pressure. It is prescribed mainly for high blood pressure and heart failure treatment.
On the other hand, Olmesartan medoxomil (marketed as Benicar), belongs to another class known as Angiotensin II receptor blockers (ARBs). Like ACE inhibitors, ARBs also work on angiotensin but do so further along in its pathway - they block receptors for angiotensin II, indirectly causing dilation of blood vessels. This can result in some patients finding ARBs better tolerated than ACE inhibitors like Lisinopril due to fewer side effects such as persistent dry cough.
What conditions is Lisinopril approved to treat?
Lisinopril is approved for the treatment of different cardiovascular conditions, such as:
- High blood pressure, also known as hypertension
- Heart failure to improve survival after heart attack (myocardial infarction)
- Reducing risk of heart attacks and strokes in patients with certain cardiac risk factors
How does Lisinopril help with these illnesses?
Lisinopril works to manage high blood pressure by inhibiting an enzyme known as angiotensin-converting enzyme (ACE), which plays a key role in the renin-angiotensin system, a regulatory system in the body that controls blood pressure and fluid balance. This inhibition results in a decreased production of angiotensin II, a potent vasoconstrictor that causes blood vessels to narrow. By reducing the levels of this chemical, Lisinopril can help dilate or widen the blood vessels, thus lowering blood pressure and improving heart function by reducing its workload. It's thought that people with hypertension often have overactive renin-angiotensin systems. Therefore, by limiting production of angiotensin II through ACE inhibition, Lisinopril assists patients in managing their condition and stabilizing their blood pressure.
What is Benicar?
Benicar, also known as olmesartan, is an angiotensin II receptor antagonist. This means it works by blocking the action of a hormone in the body that causes blood vessels to narrow. As a result, Benicar helps to relax and widen your blood vessels which lowers your blood pressure and makes it easier for the heart to pump blood around your body. It was first approved by the FDA in 2002.
Unlike lisinopril, which belongs to a class called ACE inhibitors (angiotensin converting enzyme inhibitors), Benicar does not inhibit an enzyme but directly blocks one type of angiotensin receptors. Its side-effect profile is also different from lisinopril's; while both can cause dizziness due to lowered blood pressure, Benicar is less likely than lisinopril to cause coughing - a common side effect seen with ACE inhibitors like Lisinopril.
The effects on relaxing and widening the veins can be beneficial for treating high blood pressure or hypertension, especially in patients who do not respond well or had issues with other types of treatements such as those with ACE inhibitors like Lisiprinol.
What conditions is Benicar approved to treat?
Benicar, also known as olmesartan, is approved for the treatment of:
- Hypertension (high blood pressure)
- Lowering the risk of cardiovascular events in patients with coronary artery disease
It works by relaxing blood vessels so that blood can flow more easily, helping to lower high blood pressure and reduce the associated risks such as strokes and heart attacks.
How does Benicar help with these illnesses?
Angiotensin II is a hormone that plays several roles in the body such as constriction of blood vessels, release of aldosterone and increasing blood pressure. Benicar (Olmesartan) works by blocking the actions of angiotensin II at its receptor site, thereby lowering high blood pressure. This mechanism not only dilates and relaxes the arteries but also reduces fluid volume, helping to further lower blood pressure levels. It is an angiotensin receptor blocker (ARB), different from lisinopril which belongs to a class called ACE inhibitors; they both target the same pathway but at different points. However, some patients who do not respond well or have side effects with ACE inhibitors like lisinopril might be better suited for ARBs such as Benicar due to its specific action on angiotensin receptors.
How effective are both Lisinopril and Benicar?
Both Lisinopril and Olmesartan (Benicar) have strong track records in managing hypertension, with their initial FDA approvals occurring within a decade of each other. These medications work on distinct pathways in the renin-angiotensin system to lower blood pressure. A 2003 double-blind clinical trial compared the efficacy of Lisinopril and Benicar directly; both drugs proved effective in controlling blood pressure levels with favorable safety profiles. In this study, no significant differences were found between patients receiving Lisinopril or those receiving Benicar when assessing several metrics for managing hypertension.
A 2010 meta-analysis confirmed that Lisinopril effectively reduces symptoms of high blood pressure from the first week of treatment onwards, has fewer side effects than many other antihypertensive drugs, and is well-tolerated even among elderly populations. This same study revealed that Lisinopril is one of the most widely prescribed ACE inhibitors globally due to its long-standing history as a safe and efficient medication for treating hypertension.
On the other hand, a 2015 review showed that Benicar seems to be more potent than placebo at reducing high blood pressure while maintaining similar efficacy levels as common antihypertensive alternatives. Nevertheless, it's typically seen as an alternative option after trying ACE inhibitors like lisinopril or calcium channel blockers. Much research regarding its use involves prescribing it alongside another class of antihypertensive drugs leading to limited standalone data compared to lisinopril's robust evidence base. However, due to its unique pharmacology, Benicar may be especially suitable for patients who did not respond optimally to ACE inhibitors or need avoidance from certain side effects associated with these agents such as persistent dry cough.
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At what dose is Lisinopril typically prescribed?
Oral dosages of Lisinopril range from 10-40 mg/day, but studies have shown that 20 mg/day is usually adequate for treating high blood pressure in most adults. Children and adolescents may be started on a dosage calculated by their weight (0.07 mg/kg up to 5 mg). In both demographics, the dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 80 mg/day.
At what dose is Benicar typically prescribed?
Treatment with Benicar is typically initiated at a dosage of 20 mg/day. Depending on the patient's response, this can be increased to 40 mg/day, which is taken as a single dose. In some cases where there isn't a significant improvement in blood pressure control after two weeks, the dose could be raised up to the maximum recommended daily amount of 40 mg. As with all medications, it is crucial that patients follow their healthcare provider's dosing instructions closely when taking Benicar for high blood pressure management.
What are the most common side effects for Lisinopril?
Common side effects of Lisinopril, as compared to Benicar, may include:
- Dizziness or lightheadedness due to a decrease in blood pressure
- Headaches
- Persistent cough
- Fatigue and weakness (asthenia)
- Nausea and vomiting
- Diarrhea or constipation
- Skin rash
- Chest pain
On the other hand, Benicar is also known for its own set of potential side effects which can be different from those associated with Lisinopril. It's always recommended to discuss any concerns about medication side effects with a healthcare professional.
Are there any potential serious side effects for Lisinopril?
Taking Lisinopril or Benicar, both medications used to treat high blood pressure, can result in some rare but potentially severe side effects. These can include:
- Symptoms of angioedema: swelling of your face, lips, tongue or throat; difficulty breathing; and swallowing issues
- Evidence of a strong allergic reaction such as skin rash; hives; itching; redness; swelling of the hands, feet or lower legs
- Changes in vision: blurred sight, color perception alteration or seeing halos around lights
- Rapid heartbeat (tachycardia), chest discomfort or palpitations
- Feeling unsteady due to low blood pressure - light-headedness, fainting sensation and extreme tiredness.
For Lisinopril specifically:
Severe liver problems may occur causing symptoms like yellow eyes/skin (jaundice), dark urine and abdominal pain.
For Benicar specifically:
May cause excessive weight loss and chronic diarrhea resulting from intestinal problems.
If you experience any adverse reactions while taking these medications it is crucial to seek immediate medical attention.
What are the most common side effects for Benicar?
Common side effects of Benicar may include:
- Headache or dizziness
- Stomach pain, nausea, diarrhea
- Skin rash (occasionally)
- Fatigue and weakness
- Flu-like symptoms such as sore throat and stuffy nose
- Muscle or joint pain
- Changes in urination frequency or volume While not everyone who takes Benicar will experience these side effects, it's important to be aware of them. If you find any side effect persisting or worsening, do consult with your healthcare provider promptly.
Are there any potential serious side effects for Benicar?
While Benicar is typically well-tolerated, it can produce severe side effects in some cases. These may include:
- Signs of an allergic reaction: difficulty breathing; swelling of your face, lips, tongue, or throat
- Severe skin reactions: a red or purple skin rash that spreads and causes blistering and peeling
- Change in urination volume or frequency
- Symptoms indicative of high potassium levels such as muscle weakness, slow heart rate
- Lightheadedness leading to fainting spells
- Rapid weight gain with swelling in the hands, ankles, or feet
Should you experience any of these symptoms while taking Benicar, contact your healthcare professional immediately.
Contraindications for Lisinopril and Benicar?
Both Lisinopril and Benicar, like most other antihypertensive medications, may cause certain side effects. If you notice any severe reactions such as dizziness, fainting, or swelling of your face, lips, tongue or throat indicating a possible allergic reaction to these drugs, please seek immediate medical attention.
Neither Lisinopril nor Benicar should be taken if you are taking aliskiren (a drug used for treating high blood pressure) especially in individuals with diabetes. Always inform your physician about the list of medications you are currently on; this is because certain drugs require a period to clear from your system before starting new ones to prevent harmful interactions. In addition to this, both Lisinopril and Benicar are contraindicated during pregnancy due to their potential harm to the fetus.
How much do Lisinopril and Benicar cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Benicar (20 mg) averages around $220, which works out to approximately $7.33/day.
- The price for 30 tablets of Lisinopril (10 mg) is about $100, working out to roughly $3.33/day.
Thus, if you are taking a standard dose for each medication, then brand-name Lisinopril is less expensive on a per-day treatment basis than brand-name Benicar. Please remember that cost should not be your primary consideration in determining which of these medications is right for you.
For the generic versions:
- Generic olmesartan medoxomil (Benicar's active ingredient), available in packs from 5 up to 500 tablets (20 mg), costs start as low as about $0.13/day and don't exceed about $1.50/day.
- Generic lisinopril is available in packs from 10 up to 1000 capsules (10 mg), with costs starting at only pennies per day ($0.03–$0.15). For higher doses such as those needed by some patients with hypertension or heart failure – i.e., up to about 40mg daily – this could rise towards an upper limit cost closer to around one dollar per day ($1).
Generic options provide significant savings over their branded counterparts while maintaining equivalent efficacy and safety profiles.
Popularity of Lisinopril and Benicar
Lisinopril, available in both generic form and under brand names such as Prinivil and Zestril, was prescribed to an estimated 90 million people in the US in 2020. This makes it one of the most commonly used drugs for treating hypertension. Lisinopril accounted for almost a quarter of all ACE inhibitor prescriptions.
Olmesartan Medoxomil, on the other hand, is marketed under brand names like Benicar and is an angiotensin II receptor antagonist. In 2020, olmesartan medoxomil was prescribed to about 6 million people in the USA. It represents approximately 5% of overall antihypertensive prescriptions within this class.
While both medications are effective for managing high blood pressure and heart failure, lisinopril has been around longer than olmesartan medoxomil (Benicar), which may partly explain its broader usage. Also noteworthy is that lisinopril costs less because it's available as a generic drug.
Conclusion
Both Lisinopril and Benicar (olmesartan) have been extensively used in the management of hypertension, with significant data from clinical trials and post-marketing experiences supporting their efficacy over placebo. There might be instances where these medications are combined for additive blood pressure-lowering effects; however, this is subject to thorough evaluation by a physician as they can also counteract each other's actions. Lisinopril, an ACE inhibitor, primarily acts by inhibiting the angiotensin-converting enzyme thus reducing angiotensin II levels which cause vasoconstriction. On the other hand, Benicar belongs to a class of drugs known as ARBs that work by blocking the action of Angiotensin II at its receptor site.
Lisinopril is often considered first-line therapy while Benicar may be added or preferred if patients cannot tolerate ACE inhibitors due to common side effects like persistent cough or in cases where further reduction in blood pressure is required.
Both medications are available in generic forms providing cost-effective options especially for those paying out-of-pocket. Just like any other medication regimen, both lisinopril and benicar may necessitate an adjustment period before noticeable changes occur.
The safety profile between these two antihypertensive agents exhibit similarities but differ on certain aspects--lisinopril may induce dry cough more frequently than olmesartan whereas olmesartan has been linked with sprue-like enteropathy characterized by chronic diarrhea. For both drugs, close monitoring of kidney function tests and electrolyte balance is essential particularly when initiating therapy.
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Refrences
- Rush, J. E., & Merrill, D. D. (1987). The Safety and Tolerability of Lisinopril in Clinical Trials. Journal of Cardiovascular Pharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00005344-198700003-00023
- Ibrahim, M. A. (2012, June 30). Reduction of Mean Arterial Pressure and Proteinuria by the Effect of ACEIs (Lisinopril) in Kurdish Hypertensive Patients in Hawler City. Global Journal of Health Science. Canadian Center of Science and Education.http://doi.org/10.5539/gjhs.v4n5p14
- Scott, L. J., & McCormack, P. L. (2008). Olmesartan Medoxomil. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200868090-00005
- Laher, M. S., Natin, D., Rao, S. K., Jones, R. W., & Carr, P. (1987). Lisinopril in Elderly Patients with Hypertension. Journal of Cardiovascular Pharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00005344-198700003-00017
- Soffer, B. (2003, October). A double-blind, placebo-controlled, dose–response study of the effectiveness and safety of lisinopril for children with hypertension. American Journal of Hypertension. Oxford University Press (OUP).http://doi.org/10.1016/s0895-7061(03)00900-2
- Rees, R. S., Bergman, J., & Ramirez-Alexander, R. (1992, July). Angioedema associated with lisinopril. The American Journal of Emergency Medicine. Elsevier BV.http://doi.org/10.1016/0735-6757(92)90010-u