High blood pressure is a silent threat. If left unchecked, it can lead to heart attacks, strokes, or kidney failure. In 2022, high blood pressure was a primary or contributing cause of 685,875 deaths in the US. Many medications claim to help, but not all work the same way.
Losartan is different. It targets the renin-angiotensin-aldosterone system (RAAS) to lower blood pressure and protect the heart and kidneys. Unlike other angiotensin receptor blockers (ARBs), it has a unique uric acid-lowering effect. But how does it compare to other ARBs?
In this article, you will learn how losartan works, its benefits, side effects, and what makes losartan different from other ARBs.
| 🔑Key Takeaways ➤ ARBs block the AT1 receptor, so you get lower blood pressure and protect your heart and kidneys. ➤ Losartan has a short half-life, but its active form lasts longer, so it is taken once daily. ➤ ARBs treat high blood pressure, heart failure, and diabetic nephropathy, and losartan also helps prevent stroke in some patients. ➤ Other ARBs have longer half-lives, and some control nighttime blood pressure better than losartan. ➤ Losartan may lower blood pressure less than some other ARBs, yet it still offers heart and kidney protection. ➤ You may face side effects like dizziness and cough with losartan, but these effects are similar to other ARBs. ➤ The cost of losartan is lower than some other ARBs, and you can find savings with discount cards or coupons. |
How losartan and other ARBs work
Losartan and other angiotensin II receptor blockers (ARBs) work by blocking the AT1 receptor, preventing angiotensin II (ATII) from raising blood pressure and increasing fluid retention. This helps relax blood vessels, reduce sodium buildup, and prevent long-term damage to the heart and arteries.
All ARBs share this exact fundamental mechanism of action, which includes the following:
- Losartan
- Candesartan
- Valsartan
- Telmisartan
- Irbesartan
- Olmesartan
- Eprosartan
- Azilsartan
Angiotensin receptor blockers lower blood pressure by stopping angiotensin II from binding to AT1 receptors. Your kidneys release renin, which triggers a chain reaction leading to the formation of angiotensin I in the liver. Then, an angiotensin-converting enzyme (ACE) converts it into angiotensin II.
Angiotensin II affects two types of receptors: AT1 and AT2. When it binds to AT1 receptors, blood vessels constrict, raising blood pressure. It also makes the body retain sodium and water, increasing fluid volume and putting extra strain on the heart. The sympathetic nervous system becomes more active, further increasing blood pressure. Over time, high levels of ATII can cause lasting damage. It thickens blood vessel walls, triggers inflammation, encourages clotting, and even leads to cell death.
The AT2 receptor works differently. When angiotensin II binds to it, blood vessels relax, improving circulation. The body also excretes more sodium, which lowers blood pressure. These effects protect the heart and blood vessels from damage. However, since ATII primarily binds to AT1 receptors, its harmful effects tend to dominate.
This is where ARBs make a difference. By blocking AT1 receptors, ARBs prevent blood vessels from tightening and reduce sodium retention. This lowers blood pressure and eases the heart’s workload. Unlike ACE inhibitors, ARBs do not stop the formation of angiotensin II. That means angiotensin II can still activate AT2 receptors, allowing its protective effects to continue.
There are multiple ways to block the renin-angiotensin-aldosterone system (RAAS). Direct renin inhibitors stop renin production, preventing the entire process from starting. ACE inhibitors block the enzyme that converts angiotensin I into angiotensin II. Aldosterone antagonists stop aldosterone from promoting sodium and water retention.
ARBs offer an effective way to lower blood pressure and protect the heart and kidneys. They are especially useful for people who cannot tolerate ACE inhibitors due to side effects like a chronic cough. By blocking the harmful effects of AT1 activation while keeping the benefits of AT2 receptors, ARBs help prevent serious complications and improve long-term health.
Losartan’s half-life compared to other arbs
ARBs differ in their half-lives, which influences their dosing schedules and duration of action. Among them, losartan has a relatively short half-life, requiring careful consideration when selecting an antihypertensive regimen.
Losartan
Losartan has a relatively short half-life among ARBs. After oral administration, losartan is rapidly absorbed, reaching peak concentrations within 1 to 2 hours. Its terminal half-life is approximately 2 hours. However, losartan is metabolized into an active metabolite, EXP3174, which is 10 to 40 times more potent than losartan itself. The terminal half-life of EXP3174 ranges from 6 to 9 hours.
Due to this pharmacokinetic profile, losartan is typically administered once daily. Clinical studies have demonstrated that a 50 mg once-daily dose of losartan effectively reduces blood pressure over a 24-hour period, with efficacy comparable to enalapril 20 mg daily. This once-daily dosing regimen is generally sufficient to maintain blood pressure control in most patients.
Other ARBs
In comparison, other ARBs have longer half-lives:
- Valsartan – around 6 hours
- Olmesartan – 12 to 14 hours
- Irbesartan – 11 to 15 hours
- Telmisartan – 24 hours (longest-acting ARB)
- Eprosartan – 5 to 9 hours
- Candesartan cilexetil – 9 hours
- Olmesartan medoxomil – 12 to 14 hours
Indications for losartan vs other ARBs
Losartan vs other ARBs medication shows that losartan uniquely carries an indication for stroke prevention in hypertensive patients with left ventricular hypertrophy. In contrast, other ARBs are more focused on reducing cardiovascular mortality or managing overall risk in high-risk populations.
Indications for losartan
Losartan is widely prescribed for:
- High blood pressure
- Heart failure
- Diabetic nephropathy
However, it has specific uses that set it apart from other ARBs. Losartan is indicated for stroke prevention in hypertensive patients with a history of left ventricular hypertrophy. This indication is unique to losartan, though it does not apply to African American patients. Additionally, losartan is effective in reducing proteinuria in patients with diabetic nephropathy, making it a preferred option for kidney protection.
Losartan is typically prescribed at an initial dose of 50 mg once daily, with a maximum recommended dose of 100 mg per day. Due to its shorter half-life, some patients may require dosing adjustments to maintain blood pressure control throughout the day.
Another advantage of losartan is its availability in combination with hydrochlorothiazide, a diuretic that enhances its blood pressure-lowering effects. This combination therapy is beneficial for patients needing additional blood pressure control beyond what losartan alone can provide.
Indications for other ARBs
Like losartan, other ARBs are primarily used to treat high blood pressure, heart failure, and diabetic nephropathy. However, each ARB has distinct indications and advantages. For example, irbesartan is also approved for diabetic nephropathy, but unlike losartan, it does not have an indication for stroke prevention.
Valsartan and telmisartan are notable for their cardiovascular benefits. Valsartan is approved for reducing cardiovascular mortality in patients with left ventricular dysfunction following a myocardial infarction. Telmisartan, on the other hand, is indicated for reducing cardiovascular risk in adults aged 55 and older who cannot tolerate ACE inhibitors. It is also approved for stroke and myocardial infarction prophylaxis.
Efficacy in blood pressure control
Losartan vs other ARBs medication reveals that losartan is generally less effective at lowering blood pressure compared to ARBs like olmesartan, telmisartan, and valsartan. These alternatives not only offer stronger overall control but also provide better reductions in nighttime blood pressure, which is critical for cardiovascular risk.
Losartan
Losartan is a common treatment for high blood pressure, but studies show it may not be as effective as other ARBs. A meta-analysis of 62 clinical trials with 15,289 patients found that losartan had a weaker blood pressure-lowering effect. At 50 mg, it lowered systolic pressure by 2.5 mmHg less and diastolic pressure by 1.8 mmHg less than other ARBs at the same dose. Even at 100 mg, it still fell short, reducing systolic pressure by 3.9 mmHg less and diastolic pressure by 2.2 mmHg less than other ARBs at their highest doses.
Furthermore, losartan lowers blood pressure in children, but increasing the dose doesn’t always mean better results. A study on kids aged 6 months to 6 years tested three different doses—low, medium, and high. After three weeks, systolic blood pressure dropped by 7.3 mmHg, 7.6 mmHg, and 6.7 mmHg, depending on the dose. Diastolic pressure showed similar results, with drops of 8.2 mmHg, 5.1 mmHg, and 6.7 mmHg. Surprisingly, there was no clear pattern—higher doses didn’t guarantee greater reductions. The effect lasted over two years, and losartan was well tolerated, even at 1.4 mg/kg per day. More medicine didn’t always mean better control, making dosage adjustments less straightforward.
Other ARBs
Some ARBs work better than losartan for lowering blood pressure. A study found that olmesartan, telmisartan, and valsartan controlled blood pressure more effectively at the same doses. If you need stronger blood pressure control, these may be better options.
Nighttime blood pressure matters too. A study found that allisartan, olmesartan, and telmisartan worked best for lowering it. Allisartan dropped systolic nighttime blood pressure by 13.04 mmHg. Olmesartan lowered it by 11.67 mmHg, and telmisartan by 11.11 mmHg. Since high nighttime blood pressure increases the risk of heart disease, these ARBs might be a smarter choice for people with nocturnal high blood pressure.
Side effects
While all ARBs work the same way, their side effects can differ. Here’s how losartan compares to other ARBs.
Losartan-specific side effects
Losartan shares many side effects with other ARBs but also has some unique risks.
Serious side effects
These require immediate medical attention. They may signal dangerous health complications.
- Blurred vision
- Tingling or “pins and needles” sensations
- Confusion
- Trouble breathing
- Dizziness, fainting, or feeling lightheaded when standing
- Fast or irregular heartbeat
- Nausea or vomiting
- Stomach pain
- Sweating
- Unusual fatigue or weakness
Clinical trials show that dizziness occurs in at least 1% more patients on losartan than on a placebo. Cough happens too, with 3.1% of losartan users. This trial had about 2,900 patients who are on losartan, and fatigue (asthenia) was one of the most reported side effects. Yet, overall adverse events were similar between the losartan and placebo groups. Even among patients with diabetes, renal impairment, or heart failure, losartan’s safety profile stayed consistent. This data suggests that while losartan can cause serious side effects, its overall risk is comparable to other high blood pressure medications.
Rare side effects
These are uncommon but can have serious health consequences. Seek medical help if they occur:
- Kidney impairment or failure
- Fainting spells (syncope)
- Atrial fibrillation
- Heart attack
- Low platelet count (thrombocytopenia)
- Blood vessel inflammation (vasculitis)
- Liver problems, including hepatitis and abnormal liver enzyme levels
A study found that losartan can reduce proteinuria and slow the progression of diabetic nephropathy. However, ARBs like losartan can sometimes lower glomerular filtration too much, which may worsen kidney function when blood pressure drops too low.
Thrombocytopenia is another risk. A case study described a 61-year-old man whose platelet count dropped dramatically after his losartan dose was increased. When he switched to another ARB, his count did not improve much. After he stopped taking ARBs, his platelet count recovered.
ARBs’ common side effects
ARBs are usually well-tolerated, but they can still cause side effects. Some may be mild, while others require medical attention.
- Dizziness, lightheadedness, or fainting when standing up (especially after the first dose or when combined with diuretics)
- Diarrhea
- Muscle cramps or weakness
- Back or leg pain
- Insomnia (trouble sleeping)
- Fast, slow, or irregular heartbeat
- Sinusitis or upper respiratory infections
- Confusion
- Severe vomiting
- Abnormal blood test results
A study found that a data from VigiBase, the WHO pharmacovigilance database, indicate that ARBs have a higher risk of diarrhea than ACE inhibitors. Among ARBs, eprosartan and telmisartan show a significant link to diarrhea. Other ARBs do not show this pattern. This means the risk of diarrhea is specific to certain drugs, not the entire class. If you experience severe vomiting or diarrhea, you may face dehydration and low blood pressure, and you should get medical help.
Specific ARB side effects
Not all ARBs cause the same problems. Some have side effects that others don’t:
- High potassium levels
- Fluid retention, leading to swelling
- Olmesartan (Benicar): Can cause severe digestive issues, including chronic diarrhea and significant weight loss
In a case report, a 59-year-old male experienced intractable diarrhea, vomiting, and a 25-pound weight loss after being treated with olmesartan due to high blood pressure. He underwent extensive testing, including a colonoscopy and upper endoscopy, which showed lymphocytic colitis and total villous blunting of the duodenum. His symptoms completely resolved after he stopped using the drug.
Olmesartan has been linked to sprue-like enteropathy, a severe condition that mimics celiac disease, so the FDA issued a safety warning in 2013. The symptoms include more than 10 loose bowel movements daily, severe dehydration, and electrolyte imbalances like hypokalemia. Despite these risks, olmesartan is still widely used because it effectively lowers blood pressure.
Cost comparison
The cost of ARBs, including losartan, can vary based on dosage, pharmacy, and insurance. Knowing these differences can help you find the best price.
When comparing losartan vs other ARBs meds, factors like availability of generics, manufacturer discounts, and patient assistance programs can significantly impact affordability.
Losartan
The price of losartan varies depending on the dosage, pharmacy location, and whether it is purchased with or without insurance. The cost for a 50 mg oral tablet is approximately $11 for a 15-tablet supply when paying in cash.
The price of losartan 25 mg oral tablets starts at $10.89 for 15 tablets, while the 100 mg version costs around $13.02 for 30 tablets. These prices reflect cash payments and may not be valid with insurance plans. Additionally, costs can fluctuate due to factors such as pharmacy choice, manufacturer pricing, and geographic location.
To help reduce the cost of losartan, patients can use the Drugs.com discount card, which offers savings of up to 80% or more at participating pharmacies, including Walgreens, CVS Pharmacy, Target, Walmart Pharmacy, and Duane Reade. However, it is important to note that this is a discount program and not an insurance plan.
Losartan may also have potential savings options through coupons, copay cards, or rebates, but no active manufacturer promotions were found at the time. These offers, when available, can be obtained through printable coupons, trial samples, or rebates requiring registration or a medical provider’s approval.
For patients with financial difficulties, patient assistance programs (PAPs) typically offer free or low-cost medications. However, no specific PAPs were found for losartan. Patients who need financial help should check with their healthcare provider for possible local or state-sponsored programs.
Other ARBs
When comparing the cost of ARBs, significant price differences emerge based on the medication, dosage, and availability of generic versions.
Some ARBs, like valsartan and candesartan, are more affordable, while others, such as olmesartan and telmisartan, fall into a mid-range pricing category. Edarbi, the only brand-name-only ARB listed, is the most expensive, with costs exceeding $279 for a 30-day supply. While discount programs help reduce prices, manufacturer-sponsored patient assistance programs are generally unavailable, except for Edarbi.
The table below provides a detailed cost comparison of these medications:
| ARB Medication | Lowest Price (30 Tablets) | Highest Price (30 Tablets) | Availability of Patient Assistance Program | Generic Available |
| Olmesartan (Benicar) | 62.67 | 97.15 | No | Yes |
| Candesartan (Atacand) | 37.91 | 47.37 | No | Yes |
| Valsartan (Diovan) | 21.42 | 32.78 | No | Yes |
| Irbesartan (Avapro) | 29.24 | 39.42 | No | Yes |
| Telmisartan (Micardis) | 33.23 | 61.36 | No | Yes |
| Edarbi (Azilsartan Medoxomil) | 279.74 | 303.26 | Yes | No |
Wrap up
Losartan and other ARBs effectively lower blood pressure by blocking AT1 receptors, preventing the harmful effects of angiotensin II. This action relaxes blood vessels, reduces fluid retention, and protects the heart and kidneys from long-term damage. While all ARBs share the same basic mechanism, they differ in half-life, efficacy, and specific indications.
Losartan, despite its widespread use, has a shorter half-life and may be less effective at lowering blood pressure than some other ARBs. However, it has unique benefits, such as stroke prevention and kidney protection.
When comparing losartan vs other ARBs drugs, differences in side effects and cost also matter. Some ARBs cause more gastrointestinal issues or electrolyte imbalances, while affordability plays a key role in long-term treatment choices.
FAQs on losartan vs other ARBs
Can Losartan cause weight gain?
No, losartan isn’t known to cause weight gain. Weight changes, including weight gain and weight loss, weren’t reported as side effects.
Which ARB lasts the longest?
Telmisartan lasts longer in the body compared to losartan, providing better 24-hour coverage.
Is Losartan safe during pregnancy?
No, Losartan is not safe during pregnancy. It can reduce the level of fluid around the baby, especially in the second and third trimesters, leading to long-term kidney and lung damage, along with other complications.
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