Blood Pressure Medication Comparison Tool
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TL;DR
- Losartan (Cozaar) is an ARB that works well for many with hypertension, especially if you can’t tolerate ACE inhibitors.
- Common alternatives include lisinopril, valsartan, irbesartan, amlodipine, hydrochlorothiazide, enalapril, and atenolol.
- Key factors when choosing: mechanism of action, side‑effect profile, cost, and any accompanying conditions (e.g., diabetes, kidney disease).
- Losartan is generally cheap and once‑daily, but may cause high potassium; ACE inhibitors often cause cough.
- Talk to your GP about blood tests and possible drug interactions before switching.
When you’ve been told you need a blood‑pressure pill, the brand name Cozaar can sound mysterious. It’s actually Losartan, an angiotensinII receptor blocker (ARB) that relaxes blood vessels and lowers blood pressure. But the market is crowded with other options, and many patients wonder whether a different drug might fit their lifestyle or health profile better. Below we break down Losartan side by side with the most common alternatives, looking at how they work, typical doses, side effects, cost in the UK, and who benefits most.
How Losartan Works and Who It Helps Most
Losartan blocks the AT‑1 receptor, preventing angiotensinII - a hormone that narrows blood vessels - from tightening them. The result is smoother blood flow and lower pressure. It’s especially useful for people who develop a persistent dry cough on ACE inhibitors, and for those with diabetic kidney disease because it slows protein loss in the urine.
Typical start‑dose is 25mg once daily, often increased to 50mg or 100mg depending on response. Generics cost around £0.30-£0.40 per tablet, making it one of the most affordable ARBs on the market.
Major Alternatives: Mechanisms at a Glance
Below is a quick snapshot of seven other drugs you might encounter when managing hypertension.
| Drug | Class | Typical dose | Common side‑effects | Average UK cost per month |
|---|---|---|---|---|
| Losartan | ARB | 25‑100mg once daily | Dizziness, high potassium, rarely angioedema | £9‑£12 |
| Lisinopril | ACE inhibitor | 5‑40mg once daily | Dry cough, elevated creatinine, rare angioedema | £8‑£11 |
| Valsartan | ARB | 80‑320mg once daily | Dizziness, headache, high potassium | £12‑£15 |
| Irbesartan | ARB | 150‑300mg once daily | Dizziness, fatigue, hyperkalemia | £13‑£16 |
| Amlodipine | Calcium‑channel blocker | 2.5‑10mg once daily | Swelling (edema), flushing, gum hyperplasia | £7‑£10 |
| Hydrochlorothiazide | Thiazide diuretic | 12.5‑25mg once daily | Low potassium, increased urination, gout flare | £5‑£8 |
| Enalapril | ACE inhibitor | 5‑20mg once daily | Cough, dizziness, rare angioedema | £9‑£12 |
| Atenolol | Beta‑blocker | 25‑100mg once daily | Fatigue, cold extremities, bradycardia | £6‑£9 |
When to Pick Losartan Over Others
If you’ve tried an ACE inhibitor and were plagued by a stubborn cough, Losartan is often the go‑to swap. Its ARB class doesn’t affect bradykinin, the substance blamed for that dry cough. Additionally, for patients with chronic kidney disease linked to diabetes, guidelines from NICE recommend an ARB - Losartan or Valsartan - as first‑line therapy because of their kidney‑protective effects.
People on potassium‑sparing diets or taking potassium supplements should have their blood tested regularly, as Losartan can raise potassium more than ACE inhibitors.
When an Alternative Might Be Better
Lisinopril or Enalapril are often cheaper than ARBs and work well for patients without cough issues. They have a long safety record and are the most prescribed ACE inhibitors in the UK.
If you have significant peripheral edema, a calcium‑channel blocker like Amlodipine can be a better choice; it actually reduces vascular resistance without affecting kidney function.
For those who need a drug that tackles both blood pressure and fluid retention (e.g., in heart failure), a combination of an ARB with a diuretic like Hydrochlorothiazide is common. The diuretic lowers volume, while the ARB prevents vasoconstriction.
Beta‑blockers such as Atenolol are preferred when you have an accompanying heart rhythm problem or a history of heart attack.
Side‑Effect Profiles: What to Watch For
All antihypertensives come with trade‑offs. Below is a quick cheat‑sheet:
- Losartan: Check potassium levels; watch for dizziness when standing up quickly.
- Lisinopril/Enalapril: If a cough develops, ask your doctor about switching to an ARB.
- Valsartan/Irbesartan: Similar to Losartan, but some patients find Valsartan slightly more potent at higher doses.
- Amlodipine: May cause swelling of ankles; keep an eye on weight gain.
- Hydrochlorothiazide: Can deplete potassium; supplement if you have muscle cramps.
- Atenolol: May cause fatigue or low heart rate; not ideal for active athletes.
Cost Considerations in 2025
Prescription charges in England are currently £9.35 per item, but many patients qualify for free prescriptions via pre‑payment certificates or medical exemptions. When budgeting, look at the generic price per tablet rather than the brand name. Losartan’s generic cost has stayed under £0.40 per tablet for the past three years, making it a solid low‑cost option.
Some newer ARBs, like olmesartan, are still under patent and can cost twice as much. If cost is a major factor, stick with the well‑established generics listed in the table above.
Practical Tips for Switching or Starting a New Drug
- Get baseline labs: electrolytes, kidney function (eGFR), and fasting glucose.
- Discuss any existing meds: NSAIDs, potassium supplements, or lithium can interact with ARBs.
- Start low, go slow: most doctors begin at the lowest effective dose and titrate every 2‑4 weeks.
- Monitor blood pressure at home twice daily for the first two weeks after a change.
- Schedule a follow‑up appointment after one month to review labs and blood pressure logs.
Following this routine reduces the risk of sudden drops in pressure and helps you stay on track with your target (<140/90mmHg for most adults, lower for those with diabetes or kidney disease).
Frequently Asked Questions
Can I take Losartan and a diuretic together?
Yes, combining an ARB like Losartan with a thiazide diuretic such as Hydrochlorothiazide is a common strategy. The diuretic reduces fluid volume while Losartan relaxes vessels, giving a stronger combined effect. Your doctor will watch your potassium and kidney function closely.
Why does my doctor recommend an ACE inhibitor before an ARB?
ACE inhibitors have been on the market longer and are usually cheaper. Guidelines suggest trying an ACE first unless you have a history of cough or angioedema, in which case an ARB like Losartan is the better first choice.
Is the cough from lisinopril permanent?
For most people the cough disappears within a few weeks of stopping the drug. If it persists, discuss switching to an ARB; the cough is linked to the drug’s effect on bradykinin and doesn’t occur with Losartan.
Can I use Losartan if I’m pregnant?
No. ARBs, including Losartan, are contraindicated in pregnancy because they can affect fetal kidney development. Switch to a methyldopa or labetalol under medical supervision if you become pregnant.
How quickly does Losartan lower blood pressure?
Most patients see a modest reduction within 2‑4 weeks, with the full effect appearing after 6‑8 weeks of consistent dosing.
What should I do if I miss a dose?
Take the missed tablet as soon as you remember, unless it’s almost time for the next dose. In that case, skip the missed one and continue with your regular schedule. Never double‑dose.
Choosing the right hypertension pill isn’t a one‑size‑fits‑all decision. By weighing mechanism, side‑effects, cost, and any extra health conditions, you can land on a drug that keeps your pressure in check without unwanted surprises. If you’re unsure which Losartan alternatives suit you best, book a review with your GP and bring this comparison along - it makes the conversation much clearer.
Elaine Curry on 29 September 2025, AT 17:00 PM
Wow you just laid out the whole drug table like a cheat sheet for my own BP nightmare I totally feel you because I’ve been juggling losartan and lisinopril for years and still can’t remember which one makes my ankles swell
Maybe you should add a personal anecdote about the taste of cheap pills it really helps people relate