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Drug vs. Drug

Telmisartan vs. losartan: Uses, interactions, costs, and more

Explore the uses, interactions, and costs of telmisartan and losartan
By | Dec. 30, 2024
Rx pill bottles comparing Telmisartan and losartan

Key takeaways

  • Telmisartan and losartan are two generic drugs from the angiotensin receptor blocker class, which is one of the primary options for treating hypertension.

  • Based on their beneficial effects on the cardiovascular system and kidneys, telmisartan and losartan have additional approved uses in addition to blood pressure management, but their official indications differ from one another.

  • Telmisartan has been shown to be more effective than losartan in lowering blood pressure.

  • Losartan tends to be cheaper. It potentially has a lower retail price when purchased without insurance and a lower copay when covered by an insurance plan.

  • They have similar adverse effects and drug interactions, mostly involving the potential to disturb kidney function, potassium levels, and blood pressure.

In this article:

Hailing from the same drug category, telmisartan and losartan are generic drugs that help to reduce blood pressure by the same mechanism. They are angiotensin II receptor blockers (ARBs), and by inhibiting the action of angiotensin II, ARBs lower blood pressure by reducing blood vessel constriction and renal retention of salt and water. These effects on our kidneys and cardiovascular system have led to uses besides simply treating hypertension. Regarding the additional utility, telmisartan and losartan have different approved uses from the Food and Drug Administration (FDA). This and other significant differences, including telmisartan’s superior efficacy as an antihypertensive compared to losartan, will be highlighted here.

What are the main differences between telmisartan and losartan?

Main differences of telmisartan versus losartan
Telmisartan Losartan
Drug class Angiotensin II receptor blocker Angiotensin II receptor blocker
Brand/generic status Generic Generic
What is the brand name? Micardis Cozaar
What form does the drug come in? Tablet Tablet
What is the standard dosage? 20 to 80 mg once daily 25 to 100 mg once daily
How long is the typical treatment? Indefinite Indefinite
Who typically uses the medication? Adults Adults and children 6 years and older

Conditions treated by telmisartan and losartan

Both telmisartan and losartan are indicated for the treatment of hypertension. Angiotensin receptor blockers are one of the primary drug classes recommended in national guidelines on blood pressure management. In addition, losartan has two other FDA-approved indications: stroke prevention in the setting of hypertension with left ventricular hypertrophy and diabetic nephropathy, and kidney damage related to diabetes mellitus. Conversely, telmisartan has approval for cardiovascular event risk reduction in patients who are at least 55 years old and at high risk of cardiovascular events.

Is telmisartan or losartan more effective?

More than one meta-analysis has compiled comparison data from clinical trials and concluded that telmisartan provides greater reductions in blood pressure than losartan. Researchers looked at both systolic blood pressure (SBP) and diastolic blood pressure (DBP) using different populations and methods. 

Telmisartan was found superior by an analysis of studies involving patients with mild-to-moderate hypertension, another looking at titration-to-response studies using medication titration to higher doses when necessary based on ambulatory DBP monitoring, and yet another using ambulatory monitoring of SBP and DBP. In a study involving people with diabetic nephropathy, telmisartan was more effective than losartan at reducing proteinuria, or protein spillage in the urine, from baseline even when they produced similar blood pressure reductions. Telmisartan patients may even experience less insulin resistance in the setting of metabolic syndrome than losartan patients, according to the aforementioned meta-analysis that looked at mild-to-moderate hypertensive patients.

Choosing between telmisartan and losartan is more complicated than simply looking at comparison studies. Rely on your healthcare provider to assimilate medical research findings, your specific health conditions, and your medication list to determine whether telmisartan or losartan would be best for you.

Coverage and cost comparison of telmisartan vs. losartan

Generic drugs typically cost less for those paying out-of-pocket and are more likely to be on an insurance plan’s drug formulary with a lower copay than brand-name counterparts. Telmisartan and losartan are good examples of this. For instance, Aetna’s 2024 Standard Plan and Humana’s Medicare formulary include telmisartan and losartan but not Micardis or Cozaar.

A SingleCare discount card can lower the price of either ARB. After getting the free card, all you have to do is present it to your pharmacist along with the prescription. SingleCare coupons can help one to spend $20 on 30, 80 mg generic telmisartan tablets instead of $220 for 30, 80 mg brand-name Micardis pills. Likewise, generic losartan is $6 for 30, 100 mg tablets, compared to $160 for 30, 50 mg brand-name Cozaar pills. Losartan usually wins the price war with its lower cost for those without health insurance and possibly lesser copay for those with coverage through a private insurance plan or Medicare.

Telmisartan vs. losartan costs
Telmisartan Losartan
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Quantity 30, 80 mg tablets 30, 100 mg tablets
Typical Medicare copay $12 or less $1 or less
SingleCare cost $20 $6

Common side effects of telmisartan vs. losartan

The ARBs, including telmisartan and losartan, have similar side effects. They are generally well-tolerated meds, with the common side effects being upper respiratory infection systems, musculoskeletal or back pain, and diarrhea. Less often, serious reactions can occur, including the following:

  • Angioedema (abrupt swelling often involving the face or airway)
  • Hypotension (excessively low blood pressure)
  • Kidney function impairment or failure
  • Hyperkalemia (high blood levels of potassium)
  • Severe allergic reactions and anaphylaxis

You can talk to your doctor and pharmacist about how these risks pertain to you. They may be able to provide guidance on how best to avoid and monitor for side effects of telmisartan and losartan.

Drug interactions of telmisartan vs. losartan

The drugs that interact with telmisartan and losartan are alike. Mostly, they are drugs that compound one of the ARBs’ serious side effects. Antihypertensive and diuretic drugs could cause hypotension when used along with telmisartan or losartan. Nonsteroidal anti-inflammatory drugs (NSAIDs) may lead to kidney problems with concurrent ARB therapy. Potassium-sparing diuretics, like the aldosterone receptor antagonist spironolactone, can cause additive problems with hyperkalemia when coupled with an ARB. 

Angiotensin-converting enzyme inhibitors (ACE inhibitors) have effects on the body and blood pressure that are quite similar to ARBs. They are another primary option for hypertension treatment, but because of their similar mechanism of action and side effects, ACE inhibitors and ARBs are not usually used together due to fear of compounding adverse effects. Your healthcare team can assist you in avoiding drug interactions involving telmisartan and losartan, and while some are usually avoided like ACE inhibitors and ARBs, others may only require heightened monitoring, such as the use of potassium-sparing diuretics with ARBs.

Warnings of telmisartan and losartan

The FDA has applied black box warnings on the drug labels of telmisartan and losartan calling attention to the need to avoid them during pregnancy due to the risk of fetal harm. While they are contraindicated for use during pregnancy, the risks of using the ARBs while breastfeeding are unknown, but they are usually still avoided in favor of a different antihypertensive.

Telmisartan and losartan could be more problematic in the setting of some health conditions. Dehydration is one such state, and using an ARB while dehydrated could precipitate hypotension or kidney damage. In the setting of pre-existing kidney disease, either ARB could be beneficial but does run the risk of worsening the situation, meaning that monitoring blood tests like creatinine and potassium levels is typically necessary. The healthcare professionals caring for you can develop a plan to minimize risks.

Frequently asked questions about telmisartan vs. losartan

What is telmisartan?

Telmisartan is a generic angiotensin II receptor blocker used for hypertension management. It is also FDA approved for reducing the risk of cardiovascular events in some populations.

What is losartan?

Losartan is also an antihypertensive and a generic angiotensin II receptor blocker. Besides hypertension, FDA indications for losartan include treating nephropathy in diabetic patients and reducing stroke risk in certain types of hypertensive patients.

Are telmisartan and losartan the same?

They have many similarities, but as two distinct compounds, they are not the same.

Is telmisartan or losartan better?

In several studies, telmisartan performed better than losartan in lowering blood pressure, but this does not necessarily mean it is the better choice for an individual. Losartan is often priced lower than telmisartan.

Can I use telmisartan or losartan while pregnant?

FDA specifically warns patients to avoid telmisartan and losartan while pregnant.

Can I use telmisartan or losartan with alcohol?

Alcohol does not have a defined interaction with telmisartan or losartan, but it can be associated with high blood pressure, meaning it is likely prudent to avoid it, particularly for those with a history of hypertension.