9 Side Effects of ARBs You Should Know About

Angiotensin II receptor blockers (ARBs) are first-choice medications prescribed to treat high blood pressure (hypertension). A few ARBs are also approved for other health conditions, such as heart failure and diabetic nephropathy. Currently, seven ARBs are FDA approved, including losartan (Cozaar), olmesartan (Benicar), and valsartan (Diovan). They’re also found in a number of combination blood pressure pills.

ARBs are generally well tolerated, especially after the first few weeks of treatment. But like most medications, unwanted effects are still possible. Here, we’ll cover nine important side effects of ARBs you should know about if your healthcare provider prescribes one for you.

1. Dizziness

In general, blood pressure medications may cause some people to feel lightheaded or dizzy. It’s more common early on in treatment or after a dose increase. This usually goes away after a few weeks, as your body adapts to a lower blood pressure.

Sometimes dizziness happens because your blood pressure is too low, especially when you stand up quickly from a seated position. This is called orthostatic hypotension. It’s more likely to happen if you’re taking your ARB with another blood pressure medication.

Talk with your healthcare provider if you experience dizziness that’s bothersome or doesn’t go away. You may need a lower dose. In the meantime, be careful when you stand up from a sitting or lying position. Go slowly and have something nearby that’s secure to hold onto if possible.

2. Headache

Headaches are a common side effect of ARBs. Like dizziness, this side effect typically goes away after you’ve been taking your ARB for a while.

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For mild headaches, you can try an over-the-counter (OTC) pain reliever. Acetaminophen (Tylenol) is usually a safe option for most people. Ibuprofen (Advil, Motrin) interacts with ARBs and can raise your blood pressure. But if you’re having headaches that are painful or persistent, reach out to your healthcare provider. They can help you figure out if they’re from your medication.

3. Tiredness

Blood pressure medications can make some people feel more tired. It’s most common with beta blockers, but it’s a side effect of ARBs too.

If you notice that you’re feeling more tired than usual after starting an ARB, it’s a good time to check in with your day-to-day habits. Here’s a few questions to ask yourself:

• Are you moving enough during the day and sleeping enough at night?

• Does your diet include fruits, vegetables, whole grains, and protein sources?

• Are you drinking enough fluids and staying hydrated?

Fortunately, tiredness from ARBs usually gets better as your body adjusts to a lower blood pressure. But if not, discuss it with your healthcare provider. You might need a change in your dosage or type of medication.

4. Gastrointestinal side effects

Gastrointestinal (GI) side effects, like nausea, diarrhea, or heartburn, are possible with several ARBs, including:

• Azilsartan (Edarbi)

• Irbesartan (Avapro)

• Olmesartan

• Telmisartan (Micardis)

GI side effects from ARBs are typically mild. If you’re not already, try taking your ARB with food. This might help lessen or prevent GI side effects. If you’re still having discomfort, your healthcare provider or pharmacist can help you choose an OTC stomach remedy that’s safe for you to take.

If you’re having severe diarrhea along with weight loss, tell your healthcare provider right away. Olmesartan has been linked to a rare but serious GI complication called sprue-like enteropathy. Some experts believe this serious side effect could be possible with other ARBs, too.

5. Back or joint pain

It’s unclear why, but a small percentage of people taking an ARB experience back or joint pain. These side effects were reported in clinical trials with the following ARBs:

• Candesartan (Atacand)

• Losartan

• Telmisartan

• Valsartan

Keep in mind, if you’re noticing these symptoms, they might be caused by something other than your ARB. Clinical studies also found them in people taking a placebo (a pill with no medication in it).

For mild aches and pains, try balancing rest with movement and applying heat or ice packs. Acetaminophen and OTC pain relief gels and patches may also be helpful. For pain that’s severe or persistent, contact your healthcare provider. They can rule out more serious causes and suggest a plan for your specific situation.

6. High potassium

ARBs lower the level of the hormone aldosterone, which helps remove potassium from the body. So if aldosterone levels drop, potassium levels might go up. In some cases, ARBs can cause potassium levels to be too high.

Your risk of high potassium is greater if you have kidney problems or take other medications that raise potassium levels. Ask your provider if you should avoid high potassium foods while taking an ARB.

High blood potassium can be caught early through blood tests. Stay up to date with blood tests your healthcare provider recommends. If high potassium levels go unnoticed, serious complications can happen, such as heart rhythm problems.

7. Upper respiratory infections

There’s a small chance that your risk for developing upper respiratory infections (URIs) might be a bit higher if you’re taking an ARB. A sore throat, stuffy nose, and cough are common URI symptoms.

This link was found in clinical studies for some ARBs, including:

• Candesartan

• Losartan

• Telmisartan

If you get sick while taking an ARB, follow your usual get-better routines. If you need extra symptom relief, ask your healthcare provider or pharmacist for an OTC product recommendation. They can make sure it’s safe with your other meds and help you avoid ingredients that raise blood pressure, like pseudoephedrine (Sudafed). Always seek medical care for severe symptoms, or if you’re not better in 7 to 10 days.

8. Kidney problems

ARBs are useful treatments for chronic kidney disease (CKD) and diabetic nephropathy (kidney damage caused by diabetes). That’s because they help protect kidney function. But in rare cases, ARBs might cause acute (sudden) kidney problems.

Make sure your healthcare provider knows your complete health history. While taking an ARB, your provider should monitor your kidney function from time to time. Staying current with this blood test can help providers spot kidney issues early.

Let your healthcare provider know right away if you’re suddenly urinating less often or have swelling in your arms or legs. These are possible symptoms of acute kidney problems. Getting medical help right away will lower your risk for permanent kidney damage.

9. Birth defects

ARBs can cause serious birth defects that can be fatal to a fetus if taken during pregnancy. The FDA requires a boxed warning about this risk to be included in the labeling of all ARBs. This is the most serious warning the FDA can give to a medication.

ARBs are unsafe at any time during pregnancy. If you’re taking an ARB and find out you’re pregnant, tell your healthcare provider right away. They may recommend switching to another blood pressure treatment that’s safer to take during pregnancy.

When should I contact my healthcare provider about the side effects of ARBs?

The most common side effects of ARBs usually subside after the first few weeks of treatment. Keep your healthcare provider in the loop for any side effects that are bothersome or don’t get better.

Serious side effects with ARBs are rare. Seek emergency care or call 911 for severe symptoms, including:

• Trouble breathing

• Racing heart

• Chest pain

• Facial or body swelling (angioedema)

These could be signs of a life-threatening heart problem or severe allergic reaction.

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Written by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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