Losartan vs. amlodipine: Which is better for hypertension?

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Common side effects
• Drug interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Common side effects
• Drug interactions
• Warnings
• FAQs

For those living with high blood pressure (hypertension), various medications are available to help manage the condition. Many people with high blood pressure may wonder whether losartan or amlodipine is the better choice. Doctors or healthcare providers may prescribe these drugs to treat high blood pressure, which may help prevent complications like heart attacks and strokes.

Both prescription drugs are accessible and typically covered by private insurance and Medicare plans. In some cases, they may be prescribed together. Although they serve a similar purpose, they work in different ways and may have different side effects. Therefore, it’s important to consult a healthcare provider to determine the most appropriate option. 

What are the main differences between losartan and amlodipine?

Losartan and amlodipine work differently to lower blood pressure. Losartan is an angiotensin receptor blocker (ARB). It blocks the action of a chemical in the body called angiotensin II, which narrows blood vessels. By blocking this chemical, losartan helps to widen blood vessels and lower blood pressure.

Amlodipine is a calcium channel blocker that relaxes blood vessels by preventing calcium from entering the cells of the heart and arteries. This makes it easier for the heart to pump and lowers blood pressure.

Dosing and dosage forms

Losartan typically starts at 50 mg per day and can be adjusted up to 100 mg. It is usually available as a tablet and is taken once daily. Amlodipine is often started at a low dosage of 5 mg per day, which may be increased to up to 10 mg daily. Like losartan, it is typically taken as an oral tablet once daily.

Both medications may be prescribed to children aged six and older with hypertension. However, the dosage of losartan for children is based on weight, while the dosage of amlodipine for children is 2.5 to 5 mg once daily. 

Conditions treated by losartan and amlodipine

Losartan is approved by the Food and Drug Administration (FDA) to lower high blood pressure in adults and kids over six years old. It’s also used to lower the risk of strokes in people with high blood pressure and an enlarged heart, although this benefit may not apply to African American patients. In addition, Losartan helps protect the kidneys in people with Type 2 diabetes who have high blood pressure and kidney issues.

Amlodipine is approved to treat high blood pressure and certain types of chest pain (angina), including chronic stable angina and vasospastic angina. Amlodipine relaxes blood vessels, lowering blood pressure and reducing chest pain. This action also helps lower the risk of serious problems like strokes and heart attacks.

Is losartan or amlodipine more effective?

Both losartan and amlodipine have been widely studied for managing high blood pressure. Their effectiveness may vary based on the individual and specific health conditions. In some cases, losartan and amlodipine may be used together for improved effectiveness. 

One clinical trial compared the effectiveness of amlodipine and losartan in treating mild to moderate hypertension over several weeks. Results showed that the amlodipine group achieved significantly greater reductions in blood pressure. 

The mean decrease in systolic blood pressure (SBP) was 16.1 mm Hg for the amlodipine group compared to 13.7 mm Hg for the losartan group. Similarly, the mean decrease in diastolic blood pressure (DBP) was 12.6 mmHg for the amlodipine group compared to 10.3 mmHg for the losartan group. In addition, the response rate was significantly greater with amlodipine than with losartan in African Americans and Hispanics.

The clinical significance of the improvements depends on various factors, including the initial dose, how patients respond over time, and the condition being treated. Always consult a healthcare provider for the most appropriate treatment option. 

Coverage and cost comparison of losartan vs. amlodipine

Both medications are typically covered by insurance plans, including Medicare Part D plans. However, insurance coverage, pharmacy location, and available discounts may affect the final price. In general, the costs of these medications with and without insurance are similar.

Those without insurance may have to pay the full retail cost of these medications. The retail costs can vary depending on the pharmacy. Therefore, it may be a good idea to compare prices at different pharmacies. SingleCare coupons may help reduce the retail costs of these medications, making losartan and amlodipine affordable choices for many patients.

Common side effects of losartan and amlodipine

Losartan and amlodipine may differ in their potential side effects. Both medications may cause side effects related to low blood pressure, such as dizziness, drowsiness, nausea, and an upset stomach. In addition, both drugs may cause back pain and swelling of the legs, ankles, and feet (edema). 

Losartan’s common side effects include upper respiratory infections and a stuffy nose (nasal congestion). Amlodipine’s other common side effects include fatigue and flushing or sudden reddening of the skin, typically on the face and neck.

Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Losartan), DailyMed (Amlodipine)

Drug interactions of losartan vs. amlodipine

Losartan and amlodipine share several interactions with other medications. However, amlodipine generally interacts with more medications than losartan. Individuals who take other medications may need to use more caution with amlodipine than with losartan. 

Losartan can increase potassium levels in the blood. When taken with other medications that also raise potassium, such as certain diuretics or potassium supplements, there is a risk of hyperkalemia (high potassium levels). While amlodipine does not directly affect potassium levels, any significant changes in blood pressure or kidney function may affect how the body handles potassium.

Using losartan with other medications that affect the same blood pressure-regulating system, like ACE inhibitors or a drug called aliskiren, can increase the risk of low blood pressure, high potassium, and kidney problems. Taking amlodipine with other blood pressure-lowering medications may also increase the risk of low blood pressure. 

Some medications may increase the amount of amlodipine in the body, potentially increasing adverse events. Examples include certain antifungals and antibiotics like ketoconazole and clarithromycin. Amlodipine can also increase the levels of certain other drugs in the body, like simvastatin (used to lower cholesterol) and immunosuppressants such as cyclosporine and tacrolimus. Therefore, the dosage of amlodipine or other medications may need to be adjusted. 

Consult a healthcare professional for other possible drug interactions

Warnings of losartan and amlodipine

Both losartan and amlodipine can cause low blood pressure. Patients should be aware of symptoms like dizziness or fainting and consult their doctor if they occur. Both medications also require careful monitoring in patients with liver or kidney problems, as they can affect how the body processes the drug.

Losartan can cause serious harm to an unborn baby if taken during pregnancy, particularly in the later stages. Pregnant women should stop taking losartan immediately if they discover they are pregnant. In addition, losartan can raise potassium levels in the blood, which may be dangerous, especially in individuals at risk of high potassium levels. 

Starting or increasing the dose of amlodipine can sometimes lead to worsening chest pain or even a heart attack, especially in patients with severe coronary artery disease. Patients should seek immediate medical attention if they experience new or worsening chest pain after starting this medication.

Frequently asked questions about losartan vs. amlodipine

What is losartan?

Losartan belongs to a class of drugs called angiotensin receptor blockers. It is commonly prescribed to treat high blood pressure and to help protect the kidneys from damage due to diabetes. Losartan is also used to lower the risk of strokes in patients with high blood pressure and left ventricular hypertrophy.

What is amlodipine?

Amlodipine is a calcium channel blocker often used to treat high blood pressure and chest pain. By lowering blood pressure, amlodipine helps prevent strokes, heart attacks, and kidney problems. It can be taken alone or with other medications to achieve better blood pressure control.

Are losartan and amlodipine the same?

Losartan and amlodipine are not the same. Losartan is an ARB, while amlodipine is a calcium channel blocker. Each medication works differently to lower blood pressure. They also have different dosages and side effects. 

Is losartan or amlodipine better?

The effectiveness of losartan versus amlodipine depends on the individual. Losartan may be preferred in people with diabetic kidney disease, while amlodipine may be preferred in people with chronic chest pain. For blood pressure, some studies suggest amlodipine provides a greater decrease in blood pressure than losartan. However, they may sometimes be used together for more effective control. 

Can I use losartan or amlodipine while pregnant?

Patients are generally advised not to use losartan while pregnant due to harmful risks to the unborn baby. On the other hand, amlodipine may be a safer alternative for pregnancy. However, it’s important to consult a healthcare provider for guidance. 

Can I use losartan or amlodipine with alcohol?

It is generally recommended to limit or avoid alcohol consumption while taking either losartan or amlodipine. Drinking alcohol can lower blood pressure and may increase the risk of side effects like dizziness and lightheadedness.

Can losartan and amlodipine be taken together?

Yes, losartan and amlodipine can be taken together if prescribed by a healthcare provider. Combination therapy may be effective for people whose blood pressure is not adequately controlled by either drug alone. Studies have shown that using a fixed-dose combination of losartan and amlodipine may improve blood pressure control and reduce the risk of cardiovascular events.