Joe asked
I’m stuck in Mexico because of US flight cancellations. I take Benicar 40mg and HCTZ 12.5 mg every day for hypertension. They carry HCTZ here, but not Benicar. They do have Losartan however. Can I safely substitute 40mg of that for the next 5 days until I get home?
At a glance
- Cozaar and Benicar are in the same class of drugs (angiotension II receptor blockers).
- Although they are in the same class, they do have subtle differences between them. However, if one is unavailable, it may be an option to switch temporarily to the other.
Answer
The substitution of losartan (generic for Cozaar) for Benicar (olmesartan) is most likely okay, but it would be prudent to discuss this with your doctor to appropriately work out the correct dosing of losartan.
Benicar (olmesartan) is known as an ARB (Angiotensin Receptor Blocker), and is in the same class of medication as Cozaar (losartan).
Most studies and experts agree that there generally is not a significant difference in efficacy between drugs in this class. Having said that, certain studies have shown potential differences that should be considered.
Differences Between Cozaar (Losartan) And Benicar (Olmesartan)
Even though Cozaar and Benicar are in the same class of drugs, that doesn't necessarily mean they are interchangable. I describe some differences between them below.
Blood Pressure Lowering
Several large meta-analysis studies show that, on average, Benicar is slightly more effective in lowering overall blood pressure when compared to Cozaar.
Below is a chart that offers a summary of the blood pressure lowering effectiveness of each drug.
Blood Pressure Lowering Comparison Chart
Drug | Dose (mg) | Systolic BP Decrease | Diastolic BP Decrease |
Benicar | 5 10 20 40 | 11-13 10-17 11-21 5-22 | 8-12 13-18 4-17 5-17 |
Cozaar | 25 50 100 | 8-12 8-19 9-12 | 7-10 5-15 9-10 |
Adapted From ClinicalKey ARB Class Overview
Safety
Most studies show no differences in safety profiles between drugs in the ARB class.
Indications
While Benicar (olmesartan) and Cozaar (losartan) are similar, they do have different FDA approved indications.
Cozaar Indications
- Hypertension
- Diabetic Nephropathy
- Proteinuria
- Stroke Prophylaxis
Benicar Indications
- Hypertension
While Benicar (olmesartan) only has the one FDA approved indication, it doesn't necessarily mean it's not effective for the indications that Cozaar (losartan) has.
Final Words
As Cozaar (losartan) and Benicar (olmesartan) are so similar and Benicar is currently unavailable to you, your doctor may agree temporarily switching to Cozaar. The main consideration will be the dose.
When switching blood pressure drugs, it is often recommended to try and find a dose that is comparable in terms of average reduction of blood pressure and stay on the conservative side to avoid potential side effects such as dizziness and hypotension (low blood pressure). Be sure to discuss the situation with your doctor.
References
- Cozaar Prescribing Information. Merck
- Benicar Prescribing Information. FDA
- Valsartan vs. other angiotensin II receptor blockers in the treatment of hypertension: a meta-analytical approach. PubMed
- ClinicalKey ARB Oveview. ClinicalKey
