Benicar (Olmesartan) vs. Cozaar (Losartan): Which Is Better?

Benicar (olmesartan) and Cozaar (losartan) are two popular medications for treating hypertension (high blood pressure). They belong to a class of drugs known as angiotensin II receptor blockers (ARBs), which are often first-choice treatments for high blood pressure. But these two medications have some key differences, including which other conditions they can treat and how they’re taken. Here’s what you need to know.

How do Benicar and Cozaar work?

Benicar and Cozaar are brand-name medications that work on the kidneys to help lower blood pressure. They’re available as the generic medications, olmesartan and losartan, respectively.

Like all ARBs, Benicar and Cozaar target angiotensin II receptors — proteins in your blood vessels, kidney, and heart. When they’re stimulated, these receptors cause your blood vessels to contract and your body to retain fluid, both of which increase your blood pressure. By blocking these receptors, ARBs lower blood pressure and make it easier for your heart to pump blood.

That’s not all though. In people with chronic kidney disease, ARBs can help the kidneys filter blood more efficiently and reduce the risk for further problems. Studies show that ARBs can be beneficial in people with heart failure or after a heart attack, especially in people who had side effects from ACE inhibitors (another medication class). 

Is Benicar or Cozaar more effective?

Cozaar and Benicar are approved to treat different sets of diseases. Cozaar was the first ARB scientists discovered. It entered the U.S. market in the mid-1990s. So it’s well studied, and the FDA approved it to treat many conditions. 

Benicar, on the other hand, is a newer ARB. Researchers have mainly studied it in the treatment of high blood pressure. Still, because the medications work similarly, they’re often considered to be equally good to treat many of the same conditions. 

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Let’s review FDA-approved uses for each medication.

Cozaar (losartan)

Cozaar is FDA approved to treat:

• Hypertension

• Kidney damage from diabetes (also known as diabetic nephropathy)

• Stroke prevention in patients with hypertension and left ventricular hypertrophy (LVH)

Benicar (olmesartan)

Benicar is FDA approved to treat:

• Hypertension

Both medications are effective for treating high blood pressure. But Benicar might have a somewhat stronger effect on blood pressure. They generally start working within 1 to 2 hours of taking them, and their blood pressure effects usually last all day with 1 dose. When taken for other reasons — or for more stable blood pressure control — your provider might prescribe the medication twice daily. 

See our article for tips on how to monitor your blood pressure at home.

How do you take Benicar and Cozaar?

Both Benicar and Cozaar are oral medications, meaning you take them by mouth — with or without food. But it’s good to be as consistent as you can with your medication timing. For example, if you start taking your medication in the morning with breakfast, keep that routine going forward.

Dosing

Because Cozaar is used for multiple conditions, dosing will depend on the individual. Dosing for hypertension usually starts at 50 mg a day. Depending on how you respond, your healthcare provider may increase this dose up to a maximum of 100 mg a day (either taken all at once or split into 2 doses of 50 mg twice a day).

With Benicar, dosing starts at 20 mg a day, which can be increased up to a maximum of 40 mg a day.

If you’re over 65 years of age or are more likely to have blood pressure that is too low, your provider may recommend starting at a lower dose than what’s listed above and then increasing the dose slowly. This is to make sure you stay safe.

Which medications interact with Benicar and Cozaar?

Benicar and Cozaar share similar drug interactions, and a few are worth highlighting below. Keep in mind that this is not an all-inclusive list. Always talk to your provider and pharmacist about which medications and supplements you’re taking before starting a new medication.

• NSAIDs (nonsteroidal anti-inflammatory drugs): These are commonly used pain medications, such as ibuprofen and naproxen. Like ARBs, these medications affect the kidneys and can cause kidney problems if regularly taken together. Talk to your provider about alternatives to NSAIDs if you’re taking an ARB.

• Other hypertension medications: Many people take multiple medications that lower blood pressure to control hypertension. But they have an additive effect and can dramatically lower your blood pressure together. Always watch out for symptoms of hypotension if your provider increases the dose of a medication or prescribes a new medication. And let them know if you notice any symptoms.

• Potassium supplements: Potassium supplements are not technically drugs, but they can interact dangerously with ARBs. ARBs can raise your potassium levels as a side effect. Taking extra potassium will increase your risk for symptoms of potassium levels that are too high, such as weakness, trouble breathing, and heart palpitations. At very high levels, high potassium can be life-threatening. Avoid extra potassium unless your provider recommends. This also goes for other sources of extra potassium, like salt substitutes and potassium-containing medications (like Klor-Con and K-Tab).

• ACE inhibitors: ARBs work similarly to this class of blood pressure medications. So it’s best to not take them together. Make sure your provider knows if you’re already taking an ACE inhibitor. 

What are the most common side effects of Benicar and Cozaar?

Benicar and Cozaar share similar side effects to other ARBs. Here are some of the most common:

• High potassium: ARBs can cause your potassium blood levels to increase, especially in people with chronic kidney disease. This can lead to symptoms like weakness, trouble breathing, and heart palpitations. If you take an ARB, monitor your consumption of high-potassium foods, dietary supplements, or salt replacement additives that use potassium instead of sodium (like this one).

• Facial swelling: All ARBs come with the rare but dangerous risk of swelling of the tongue, lips, mouth, and throat (angioedema). This swelling can be so serious that it can block your airways and stop you from breathing. If you notice any such swelling, let your provider know right away.

• Kidney problems: While these medications can protect the kidneys in patients with kidney disease and diabetes, they can also make kidney problems worse in some people. Your healthcare provider will closely monitor your kidney function because of this.

ACE inhibitors — another popular type of blood pressure medication — can also cause angioedema. ACE inhibitors and ARBs are very similar medications, but ARBs are thought to be safe even in people who have had this side effect from ACE inhibitors. ACE inhibitors can also cause a persistent cough, while ARBs do not.

Can Benicar and Cozaar cause cancer?

Starting in 2018, certain blood pressure medications — including some lots of losartan (generic Cozaar) — were found to contain small amounts of potentially cancer-causing chemicals. The FDA began immediately recalling these products, though the issue is still ongoing.  

Because of this, many healthcare providers recommended their patients to switch from losartan to another ARB like olmesartan (Benicar), at least until the contamination issue was resolved. While most of these issues have been resolved, talk to your pharmacist if you’re taking losartan to see if your specific losartan product has been affected.

Do not suddenly stop taking your medication unless your provider advises you to do so. Abruptly stopping losartan is dangerous and can cause your blood pressure to increase rapidly.

Do Benicar and Cozaar need any special monitoring?

Benicar and Cozaar lower your blood pressure, so while you’re taking them, your provider may ask you to monitor your blood pressure at home and to let them know if you experience dizziness, lightheadedness, and fainting. These all can be symptoms of blood pressure that’s too low. So your provider may adjust the dose of your medication.

Also, you may need to have a blood test every few months to monitor how your kidneys are functioning and to check if your potassium levels have changed. If you have abnormal results, your provider may lower the dose of your medication or recommend a different one.

Who shouldn’t take Benicar and Cozaar?

These medications are safe and effective for most people. But avoid them if you’re pregnant or planning to become pregnant, as they can be harmful to a growing fetus.

How to save on Benicar and Cozaar

Benicar and Cozaar are available as brand-name medications. But you can also find them as lower-cost generics. GoodRx can help you navigate the many ways to save on your prescription:

• Save with GoodRx. GoodRx can help you save over 90% off the average retail price of the generic versions of Benicar and Cozaar. Generic Benicar’s price at certain pharmacies is less than $1 with a free GoodRx discount. Generic Cozaar’s price at certain pharmacies is less than $4 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for the Benicar and Cozaar patient assistance programs, which offer the medication at no charge.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, brand-name Benicar’s price is as little as $5 if you use the manufacturer’s savings card.

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Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for the past decade with different roles and responsibilities. He has served as an associate professor of pharmacy practice for almost a decade, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Sarah Studyvin, DO, MPH

Sarah Studyvin, DO, MPH, is training to be an adult congenital heart disease cardiologist. She is a board-certified doctor in internal medicine and pediatrics.

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