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Losartan vs Benicar
Introduction
For patients with hypertension or other types of heart-related conditions, certain drugs that alter the concentrations of compounds in the body associated with blood pressure can help in controlling high blood pressure and managing symptoms. Losartan and Benicar are two such drugs that are prescribed for these conditions. They each impact different components within the cardiovascular system, but both have effects on lowering blood pressure in patients with hypertension. Losartan is an angiotensin II receptor blocker (ARB), affecting levels of angiotensin II — a substance which causes veins and arteries to constrict. On the contrary, Benicar is also classified as an ARB but has been shown to be more potent at recommended doses than Losartan.
Losartan vs Benicar Side By Side
| Attribute | Cozaar | Benicar |
|---|---|---|
| Brand Name | Cozaar | Benicar |
| Contraindications | Should not be taken with aliskiren, especially in patients with diabetes or moderate to severe kidney impairment. Not recommended during pregnancy. | Should not be taken with aliskiren, especially in patients with diabetes or moderate to severe kidney impairment. Not recommended during pregnancy. |
| Cost | For brand name, approximately $4/day. Generic losartan can range from $0.10 - $0.40 per day at dosages of 50mg/day. | For brand name, averages around $230 for 30 tablets of 20 mg, about $7.60 per day. Generic olmesartan can start as low as about $.90/day. |
| Generic Name | Losartan | Olmesartan |
| Most Serious Side Effect | Kidney problems, liver problems, high potassium level. | Kidney problems, high potassium, changes in heart rhythm. |
| Severe Drug Interactions | Aliskiren, drugs that increase potassium levels. | Aliskiren, drugs that increase potassium levels. |
| Typical Dose | 25–100 mg/day, starting dose often 50 mg/day. | 20 mg per day, can be increased to 40 mg per day. |
What is Losartan?
Losartan (also known as Cozaar) was among the first drugs of the angiotensin II receptor blocker (ARB) class, which represented a significant advancement over the first class of drugs used for treating hypertension, known as angiotensin-converting enzyme (ACE) inhibitors. Losartan was first approved by the FDA in 1995. Losartan works by blocking the effects of the hormone angiotensin II, thus relaxing and widening the blood vessels to lower blood pressure. It is prescribed for the treatment of high blood pressure and to protect the kidneys from damage due to diabetes. Losartan has a selective influence on angiotensin II with only minor influence on other hormones, which results in it having fewer side effects than other hypertension drugs that have stronger effects on these other hormones.
On the other hand, olmesartan (Benicar) is a newer angiotensin II receptor blocker (ARB) that has been found to be more potent and longer-lasting than losartan. It was approved by the FDA in 2002. Similar to losartan, olmesartan works by blocking the binding of angiotensin II to its receptors, thereby reducing vasoconstriction and the secretion of aldosterone, a hormone that regulates blood pressure. This leads to blood vessel relaxation and a decrease in blood pressure. However, olmesartan has been associated with a higher risk of certain side effects compared to losartan, such as dizziness and increased blood creatinine levels, a marker of kidney function.
What conditions is Losartan approved to treat?
Losartan is approved for the treatment of various conditions, including:
- Hypertension, also known as high blood pressure
- Diabetic nephropathy in patients with type 2 diabetes and a history of hypertension
- Stroke prevention in patients with hypertension and left ventricular hypertrophy (enlargement or thickening of the wall of the heart's main pumping chamber)
How does Losartan help with these illnesses?
Losartan aids in the management of high blood pressure by blocking the action of angiotensin II, a chemical that can cause constriction or narrowing of blood vessels. By inhibiting angiotensin II receptors, Losartan allows blood vessels to relax and widen, which lowers overall blood pressure and reduces strain on the heart. Angiotensin II is a hormone that plays a crucial role in regulating kidney function, fluid balance, vasoconstriction (narrowing of blood vessels), and release of other hormones such as aldosterone. It's believed that individuals with hypertension have relatively higher levels of this hormone. Therefore, by blocking angiotensin II, Losartan can limit the negative effects associated with hypertension and help patients manage their condition more effectively.
What is Benicar?
Benicar, whose generic name is olmesartan, is a drug that works as an angiotensin II receptor antagonist and inhibits the action of angiotensin II, a hormone that constricts blood vessels. By blocking the effects of this hormone, Benicar helps to relax and widen the blood vessels, thereby lowering blood pressure and improving blood flow. It was first approved by the FDA in 2002. As Benicar is not a beta-blocker, it does not slow the heart rate or cause fatigue, common side effects of beta-blockers. Its lack of action on the heart rate and energy levels means that its side-effect profile is also different to that of beta-blockers, particularly in that it doesn't cause tiredness or reduce exercise tolerance. The effects on blood vessels can be beneficial for the treatment of hypertension, especially in patients who do not respond well to the “typical” beta-blocker drugs.
What conditions is Benicar approved to treat?
Benicar, also known as olmesartan medoxomil, is approved for the treatment of:
- Hypertension (commonly known as high blood pressure)
- Reducing the risk of cardiovascular diseases such as heart attack and stroke It's noted for its ability to effectively lower blood pressure and maintain it at a healthy level when taken regularly.
How does Benicar help with these illnesses?
Angiotensin II is a hormone that can cause blood vessels to constrict, leading to high blood pressure and potentially increasing the risk of heart disease. Benicar works as an angiotensin receptor blocker (ARB), meaning it blocks the action of angiotensin II. This results in vessel relaxation and a decrease in blood pressure, helping to protect against cardiovascular events like stroke or heart attack. While Losartan also operates on this principle, Benicar's unique structure may result in better adherence to the angiotensin receptors, potentially providing more consistent control over hypertension throughout the day. Unlike some other medications for hypertension which might affect various neurotransmitters or hormones significantly, ARBs such as Benicar primarily target only one specific hormone pathway making them less likely than certain alternatives to induce unwanted side effects.
How effective are both Losartan and Benicar?
Both Losartan and Benicar (olmesartan) have established histories of success in treating patients with hypertension, and they were initially approved by the FDA within a few years of each other. Since they act on different receptors within the renin-angiotensin system, they may be prescribed under different circumstances. The effectiveness of Losartan and Benicar in controlling blood pressure was directly studied in a double-blind clinical trial in 2005; both drugs exhibited similar efficacy in managing symptoms of hypertension as well as similar safety profiles. In this study, none of the different metrics studied to measure efficacy in controlling hypertension differed significantly between patients receiving Benicar and those receiving Losartan.
A 2010 review of meta-analysis reports on Losartan demonstrated that it is effective in reducing blood pressure and has a favorable side effect profile over many other antihypertensive drugs. The same study reports that Losartan has become one of the most widely prescribed antihypertensive drugs in the world. Further, as it was the first angiotensin II receptor blocker developed, there is a significant history and study of its effectiveness in treating hypertension. The dose showing optimal efficacy is thought to be 50-100 mg/day, and beyond controlling hypertension, it also appears to provide some degree of protection against stroke.
A 2017 review and meta-analysis indicated that Benicar seems to be more effective than placebo in controlling hypertension, and that it seems to be similar in efficacy to other common antihypertensive drugs. Nonetheless, Benicar is typically considered a second-line treatment option, meaning it is generally considered only after (or as an addition to) thiazide diuretics or other first-line treatments. Significant research on its use involves Benicar co-prescribed alongside a diuretic, so data confirming its efficacy as a stand-alone treatment is less robust than that for Losartan. Nonetheless, due to its unique pharmacology, Benicar may be an optimal treatment for patients who did not respond well to thiazides or have a particular need to avoid common side effects of thiazides, such as electrolyte imbalance.
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At what dose is Losartan typically prescribed?
Oral dosages of Losartan range from 25–100 mg/day, but studies have shown that a starting dose of 50 mg/day is often effective for treating high blood pressure in most adults. For patients with possible depletion of intravascular volume (such as those treated with diuretics), the recommended initial dose is lower: 25 mg once daily. Children and adolescents may be started on a lower dosage depending on their weight and response to therapy. If after several weeks there is no adequate drop in blood pressure, dosage can be increased or additional blood pressure medication can be added. The maximum dosage that should not be exceeded in any case is 100 mg/day.
At what dose is Benicar typically prescribed?
Benicar treatment is usually initiated at a dose of 20 mg per day. If necessary, the dosage can be increased to 40 mg per day, which should be taken as one single dose. For some patients who don't respond adequately to this regimen after two weeks, the dosage may further increase up to a maximum of 40 mg twice daily. The effects and efficacy of Benicar are continuously evaluated during treatment and doses adjusted accordingly by your healthcare provider.
What are the most common side effects for Losartan?
Common side effects of Losartan can include:
- Dizziness or lightheadedness due to a decrease in blood pressure
- Stomach pain
- Diarrhea
- Tiredness, fatigue
- Coughing
- Nasal congestion (blocked nose)
- Backache or leg/knee pain
- Decreased hemoglobin levels which might cause unusual tiredness or weakness.
On the other hand, Benicar may induce some of the following symptoms:
- Dizziness or fainting when standing up too quickly
- Changes in urination (more frequent urination than normal)
- Abdominal/stomach pain and discomfort with diarrhea as a common symptom.
If you experience any severe reactions to either drug, seek medical help immediately.
Are there any potential serious side effects for Losartan?
While Losartan is generally well-tolerated, there are potential serious side effects that can occur. These include:
- Allergic reactions such as difficulty breathing; swelling of your face, lips, tongue or throat
- Change in urination (either more or less than usual), bloody or cloudy urine
- Chest pain and rapid heart rate
- High potassium level - signs may include a slow heart rate, weak pulse, muscle weakness
- Kidney problems - symptoms could be little to no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired
- Liver problems – characterized by nausea, upper stomach pain, itching sensation on the skin surface, fatigue feeling , loss of appetite , dark urine , clay-colored stools and jaundice (yellowing of the skin or eyes)
If you experience any of these symptoms while taking Losartan do not hesitate to seek immediate medical attention.
What are the most common side effects for Benicar?
When comparing Benicar to Losartan, you'll find that while both are used for treating high blood pressure, the side effects can differ slightly. Side effects of Benicar may include:
- Dizziness or lightheadedness as your body adjusts to the medication
- Stomach pain and nausea
- Diarrhea or other changes in bowel habits
- Mild itching or skin rash
- Weakness with a sudden urge to urinate more often than usual
- Weight loss due to decreased appetite
- Back pain or joint pain While these side effects might not occur in all patients, it's important to consult your healthcare provider if any persist or become bothersome.
Are there any potential serious side effects for Benicar?
With Benicar, although it is generally well-tolerated, in some cases it can cause serious side effects. Such symptoms may include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Symptoms related to a change in heart rhythm like chest pain, fast or slow heart rate
- Unusual changes in mood or behavior and confusion
- Decreased urination or inability to urinate at all
- High potassium - nausea, weakness, tingly feeling, chest pain, irregular heartbeats
- Kidney problems - little or no urinating; painful or difficult urination; swelling in your feet or ankles
If you experience any of these symptoms while on Benicar treatment stop taking the medication immediately and seek medical help.
Contraindications for Losartan and Benicar?
Both Losartan and Benicar, along with most other antihypertensive medications, may cause certain side effects. If you notice any severe or unusual symptoms such as rapid weight gain, difficulty breathing, or severe abdominal pain, please seek immediate medical attention.
Neither Losartan nor Benicar should be taken if you are currently taking, or have been taking, aliskiren, a medication for people with diabetes or moderate to severe kidney impairment. Always inform your physician about all the medications you are taking; aliskiren requires a period of about 2 weeks to clear from the system to prevent dangerous interactions with Losartan and Benicar. Moreover, if you're pregnant or planning to become pregnant, both Losartan and Benicar should be avoided as they can cause harm or death to the developing fetus.
How much do Losartan and Benicar cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Benicar (20 mg) averages around $230, which works out to about $7.60 per day.
- The price for 30 tablets of Losartan (50 mg) is roughly $120, working out to approximately $4/day.
Hence, if you are in the higher dosage range for Losartan (i.e., 100 mg/day), then brand-name Benicar could be less expensive on a per-day treatment basis. It's important to note that cost should not be your primary consideration when deciding which drug is right for you.
When it comes to generic versions:
- Generic losartan (50mg tablets) can be bought in packs of 30 and above, with approximate costs ranging from $0.10 - $0.40 per day at dosages of 50mg/day or between $0.20 - $0.80 per day if taking typical dosages up to 100mg/day.
- Olmesartan medoxomil – the generic version of Benicar – can also come in packs ranging from 15 up to hundreds with daily costs starting as low as about $.90/day depending on where and how many are purchased upfront and could go up based on dosage requirements.
Popularity of Losartan and Benicar
Losartan, available as a generic and under the brand name Cozaar, was estimated to have been prescribed to about 37 million people in the US in 2020. Losartan accounted for just over 22% of angiotensin receptor blocker (ARB) prescriptions in the US. It has been consistently popular since its introduction due to its effectiveness and lower cost.
Olmesartan, marketed under brand names such as Benicar, was prescribed to approximately 2.8 million individuals in the USA during the same period. In terms of ARB prescriptions in America, olmesartan represents about 5%. Despite being less commonly used than losartan, it has remained relatively stable over recent years without any significant decline or increase.
Conclusion
Both Losartan and Benicar (olmesartan) have long-standing records of usage in patients with hypertension, backed by numerous clinical studies indicating that they are more effective than placebo treatments in reducing blood pressure. They belong to the class of drugs known as angiotensin II receptor blockers (ARBs), which work by blocking a substance in the body that causes blood vessels to tighten. As a result, both drugs help your blood vessels relax and lower your blood pressure.
Losartan is often considered as a first-line treatment option for hypertension, while Benicar may be prescribed when patients do not respond well to other ARBs or need additional control over their high blood pressure.
Both medications are available in generic form, representing significant cost savings especially for those who must pay out-of-pocket. The onset of action for both these drugs can take some time; therefore an adjustment period may be necessary where effects may not be noticeable right away.
The side effect profile is similar between the two drugs, being generally well-tolerated but there can be instances where one drug might cause certain side effects such as dizziness or muscle cramps more than the other. For both medications, it's crucial that patients closely monitor their health condition and should seek medical help immediately if they notice any severe side-effects like sudden weight gain or swelling in hands/legs.
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Refrences
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