Lisinopril and losartan are two of the most commonly prescribed blood pressure medications in the United States, with a combined total of more than 100 million prescriptions filled annually. Both target the renin-angiotensin system but do so in different ways, leading to distinct side effect profiles and clinical considerations. A thorough lisinopril vs losartan comparison can help you understand these differences and have a productive conversation with your doctor about which medication fits your needs best.
Overview: Lisinopril and Losartan
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It works by blocking the enzyme that converts angiotensin I to angiotensin II, a powerful vasoconstrictor. By reducing angiotensin II levels, lisinopril causes blood vessels to relax and widen, lowering blood pressure. It was approved by the FDA in 1987 and is available under brand names Prinivil and Zestril.
Losartan is an angiotensin II receptor blocker (ARB). Rather than preventing the formation of angiotensin II, losartan blocks the receptors where angiotensin II binds. The end result is similar: blood vessels relax, blood pressure decreases, and the heart’s workload is reduced. Losartan was approved by the FDA in 1995 under the brand name Cozaar and was the first ARB brought to market.
While both medications effectively lower blood pressure, their different mechanisms produce different side effect profiles, which is often the deciding factor when doctors choose between them.
Lisinopril vs Losartan: Comparison Table
| Feature | Lisinopril | Losartan |
|---|---|---|
| Drug class | ACE inhibitor | ARB (angiotensin II receptor blocker) |
| Brand names | Prinivil, Zestril | Cozaar |
| FDA-approved uses | Hypertension, heart failure, post-heart attack | Hypertension, diabetic nephropathy, stroke prevention (in patients with LVH) |
| Starting dose | 10 mg once daily (5 mg in some cases) | 50 mg once daily (25 mg in some cases) |
| Typical dose range | 10-40 mg daily | 25-100 mg daily |
| Dosing frequency | Once daily | Once or twice daily |
| Half-life | 12 hours | 2 hours (active metabolite: 6-9 hours) |
| Common side effects | Dry cough, dizziness, headache, hyperkalemia | Dizziness, upper respiratory infection, back pain, hyperkalemia |
| Distinctive side effect | Persistent dry cough (up to 20% of patients) | Cough is rare (similar to placebo) |
| Generic cost (30-day supply) | $4-$10 | $4-$15 |
| Pregnancy | Contraindicated | Contraindicated |
Effectiveness for Blood Pressure
Both lisinopril and losartan are effective at lowering blood pressure, and clinical trials have shown comparable reductions in systolic and diastolic pressure at standard doses. The American Heart Association and the American College of Cardiology include both ACE inhibitors and ARBs among the four first-line classes of antihypertensive medications.
Head-to-head studies comparing lisinopril vs losartan for blood pressure control have generally found similar efficacy, with average reductions of 10 to 15 mmHg systolic and 6 to 10 mmHg diastolic at standard doses. Some studies suggest that ACE inhibitors may provide a slight edge in cardiovascular outcome protection, while ARBs tend to have better tolerability.
Both medications also offer benefits beyond blood pressure reduction. Lisinopril is commonly prescribed after heart attacks to protect heart function and for heart failure management. Losartan has proven benefits for protecting kidney function in patients with type 2 diabetes (diabetic nephropathy) and reducing stroke risk in patients with high blood pressure and left ventricular hypertrophy (LVH). Losartan is also unique among ARBs in that it has mild uric acid-lowering properties, which may benefit patients with gout.
Side Effects Compared
The most significant difference in the lisinopril vs losartan side effect comparison is the cough. ACE inhibitors like lisinopril cause a persistent, dry, ticklish cough in approximately 10% to 20% of patients. This cough is caused by the accumulation of bradykinin, a substance that ACE normally breaks down. It is the single most common reason patients switch from an ACE inhibitor to an ARB.
Losartan does not affect bradykinin metabolism and therefore rarely causes cough. If you develop a persistent cough on lisinopril, switching to losartan typically resolves the problem within one to four weeks. This is the most common clinical scenario in which a patient moves from lisinopril to losartan.
Angioedema, a rare but serious side effect involving swelling of the face, lips, tongue, or throat, occurs more frequently with ACE inhibitors than with ARBs. According to the Mayo Clinic, angioedema affects roughly 0.1% to 0.7% of patients on ACE inhibitors and is more common in Black patients. While angioedema can also occur with ARBs, the risk is substantially lower.
Both medications can cause dizziness (especially when starting or increasing the dose), elevated potassium levels (hyperkalemia), and reduced kidney function in susceptible patients. Neither should be taken during pregnancy, as both classes can cause serious harm to a developing fetus. Regular monitoring of kidney function and potassium levels is recommended for patients on either medication.
Drug Interactions
Lisinopril and losartan share several drug interactions because they both affect the renin-angiotensin system. Both should not be combined with potassium-sparing diuretics, potassium supplements, or each other without careful medical supervision due to the risk of hyperkalemia. NSAIDs (like ibuprofen and naproxen) can reduce the effectiveness of both medications and increase the risk of kidney problems.
Lisinopril has an additional interaction with sacubitril/valsartan (Entresto), a heart failure medication. A 36-hour washout period is required between discontinuing lisinopril and starting Entresto due to the risk of angioedema. Losartan is metabolized by the liver enzyme CYP2C9, and drugs that inhibit this enzyme (like fluconazole) can increase losartan levels.
Neither medication should be combined with aliskiren (a direct renin inhibitor) in patients with diabetes or moderate-to-severe kidney disease, as the combination increases the risk of hypotension, hyperkalemia, and kidney failure.
Cost Comparison
Both lisinopril and losartan are available as affordable generics. Lisinopril is one of the least expensive prescription medications available, typically costing $4 to $10 for a 30-day supply. Losartan is slightly more expensive in some markets, ranging from $4 to $15 per month, though it is still highly affordable.
Both medications are included on most pharmacy discount programs, including Walmart’s $4 generic list and similar programs at major pharmacy chains. Insurance coverage is excellent for both drugs, with most plans placing them on the lowest copay tier. Cost alone is rarely a deciding factor in the lisinopril vs losartan choice. For broader strategies on managing healthcare expenses, see our healthcare costs guide.
Which Medication Is Right for You?
Your doctor is best positioned to determine whether lisinopril or losartan is the right choice for you, but understanding the general guidance can help you participate in that decision. Lisinopril may be preferred when you need heart failure treatment, post-heart attack cardiac protection, or if cost is the primary concern (it is marginally cheaper in some markets).
Losartan may be preferred if you develop a cough on an ACE inhibitor, if you are at higher risk for angioedema, if you have diabetic nephropathy, if you have gout or elevated uric acid levels, or if stroke prevention in the setting of LVH is a priority.
Many patients try lisinopril first because it has a longer track record and slightly more cardiovascular outcome data. If they develop a cough or other intolerable side effects, switching to losartan is a straightforward and effective solution. According to clinical practice guidelines, there is no compelling reason to prefer one class over the other for straightforward hypertension without specific complicating factors.
For related medication information, see our article on how long amlodipine takes to work, which covers another commonly prescribed blood pressure medication. Our comparison of Prozac vs Zoloft follows a similar format if you are also exploring options for mood management.
Frequently Asked Questions
Can you take lisinopril and losartan together?
Taking an ACE inhibitor and an ARB together is generally not recommended. Clinical trials (including the ONTARGET study) showed that combining the two classes increased the risk of adverse effects, including hyperkalemia, hypotension, and kidney impairment, without meaningful improvements in outcomes. Most guidelines advise using one or the other, not both.
Which is better for kidney protection, lisinopril or losartan?
Both medications protect the kidneys by reducing intraglomerular pressure. Losartan has specific FDA approval for diabetic nephropathy based on the RENAAL trial, which showed it slowed the progression of kidney disease in patients with type 2 diabetes. Lisinopril and other ACE inhibitors also have strong evidence for kidney protection. Your doctor will choose based on your specific kidney health and diabetes status.
How long does it take for lisinopril and losartan to work?
Both medications begin lowering blood pressure within a few hours of the first dose. The full effect of lisinopril is typically seen within one to two weeks, while losartan may take three to six weeks to reach maximum blood pressure reduction. Your doctor will check your blood pressure after two to four weeks to assess effectiveness.
Can you drink alcohol while taking lisinopril or losartan?
Moderate alcohol consumption is generally acceptable with either medication, but alcohol can lower blood pressure and increase the risk of dizziness and lightheadedness, especially when starting the medication or after a dose increase. Heavy or binge drinking should be avoided as it can counteract the cardiovascular benefits of blood pressure treatment.
The Bottom Line
The lisinopril vs losartan comparison comes down to two closely related medications that lower blood pressure through different but complementary mechanisms. Both are effective, affordable, and well-studied. The most practical difference is the ACE inhibitor cough that affects up to 20% of lisinopril users but is essentially absent with losartan. Beyond the cough, specific clinical situations, including heart failure, diabetic kidney disease, gout, and angioedema risk, may favor one medication over the other. Your doctor can help you weigh these factors to find the best fit, and switching between the two is straightforward if the first choice does not work out.