Losartan vs Lisinopril: What Are The Best Alternatives To Zestril?

Last Updated: August 27, 2021

Authored by Dr. Ahmed Zayed

Reviewed by Michael Espelin APRN

Lisinopril, also known as Zestril or Prinivil, is often recommended for hypertension and may cause minor to major significant side effects such as weight gain, hyperkalemia, increased serum creatinine, and others. Consequently, some people may want to explore other alternatives even though the medication is essential as a cardiovascular risk reduction regimen. The medication is often combined with a diuretic depending on the health condition. Some side effects experienced with Zestril may be peculiar to the drug alone and vary from one person to another, causing the need for Lisinopril alternatives. The best alternative to Lisinopril would be one that has lesser adverse effects and is just as effective. People who have experienced drug interactions after taking it often ask, what should one take instead of Zestril? Here are a few alternatives to Lisinopril.

Losartan vs Lisinopril

Losartan is one of the many Lisinopril alternatives used to cure high blood pressure and to help safeguard the kidneys of diabetics. The drug can be used to reduce the risk of stroke in patients suffering from hypertension. Zestril also cures high blood pressure, heart failure and prevents future strokes. Contrasting Lisinopril vs Losartan, though both drugs are used to treat heart failures they don’t belong to the same class. 

The drug class of Lisinopril is angiotensin-converting enzyme while Losartan’s drug classification is angiotensin II receptor blocker. Angiotensin-converting enzyme drugs lower blood pressure by relaxing the veins and arteries in the body. Angiotensin II receptor treats hypertension by blocking the action of the angiotensin II widening blood vessels to enable the easy flow of blood. Thus, reducing high blood pressure.

DRUG BRAND NAME PRINIVIL/ZESTRIL COZAAR
GENERIC NAME LISINOPRIL LOSARTAN
DRUG CLASS ANGIOTENSIN-CONVERTING ENZYME ANGIOTENSIN II RECEPTOR BLOCKER
AVAILABILITY OF GENERIC VERSIONS PRESCRIPTION-ONLY PRESCRIPTION-ONLY
APPROVED AGE OF USE 6 YEARS AND OLDER 6 YEARS AND OLDER
TREATMENT LENGTH 1-6 HOURS 6-24 HOURS
PRESCRIPTION FORMS

STANDARD DOSAGE

2.5mg, 5mg, 10mg, 20mg 25mg, 50mg, 100mg
RISK OF WITHDRAWAL OR OVERDOSE Rebound hypertension Blood pressure, heart attack, or stroke
INSURANCE COVERAGE Yes Yes

Comparing the efficacy of Losartan vs Lisinopril, the consensus is that both medications have been reported to be equally effective. However, they should never be taken together. People who desire a change in medication should endeavor to consult a medical doctor for proper assessment. Weighing up the side effects of Losartan vs Lisinopril, both drugs seem to share similar aftereffects which include dizziness, fatigue, diarrhea, chest pains, cough, and low blood pressure. Prinivil has other effects like anaphylactic reactions which can be swelling of the face or other parts of the body. It is essential to adjust the dosage of transitioning from Zestril to Losartan. The Prinivil to Losartan dose conversion should be specifically recommended by a doctor.  Losartan may be preferable to Zestril because it doesn’t cause allergic reactions like facial swelling. Also, according to research Prinivil improved insulin sensitivity in non-diabetic patients suffering hypertension.

Amlodipine vs Lisinopril

There have been reports on Zestril and Amlodipine comparisons, and most results show Amlodipine to be more effective. Amlodipine vs. Lisinopril comparisons revealed a significant reduction in diastolic and systolic units that were more prominent in Amlodipine. This result is more frequent in black patients and women. Amlodipine belongs to a drug class known as calcium antagonists or calcium channel blockers. This class of drugs works by preventing calcium from entering the heart’s cells and arteries thus they lower blood pressure. Calcium is responsible for strong contractions in the heart. Amlodipine, therefore, serves as a calcium channel blocker, allowing the blood vessels to relax and enlarge. Zestril is in the angiotensin-converting enzyme drug class also known as ACE. ACE is a blocker that prevents the production of the angiotensin enzyme, an enzyme that causes the narrowing of the blood cells. Thus, both medications lower blood pressure by blocking certain substances and opening up pathways for blood to flow normally. Side effects of Amlodipine are swellings of legs and ankles, irregular heartbeats, dizziness, and nausea. In comparing both drugs, tests have revealed that Amlodipine is more efficient in treating hypertension than Zestril due to its pronounced reduction in blood pressure and better cardiovascular outcomes.

Amlodipine vs Lisinopril.

Lisinopril vs Metoprolol

Many hypertension medications work to improve arterial distensibility as well as reduce blood pressure in hypertensive patients. A Metoprolol vs. Lisinopril contrast assessment showed that Zestril functioned better in the improvement of arterial distensibility (vessel wall expansion). Metoprolol is in a drug class called beta blockers. These drugs work by blocking epinephrine(adrenaline), thus lowering the heart rate and enlarging the veins and arteries to increase blood flow. Prinivil, on the other hand, blocks ACE to lower blood pressure. Zestril and Metoprolol share the same side effects including diarrhea, dizziness, and cough. However, some side effects of Metoprolol like shortness of breath and bradycardia can be fatal. Though both drugs are efficient at fighting high blood pressure, research revealed that Prinivil has an advantage over Zestril in some aspects of emotional, cognitive, and social functioning.

Ramipril vs Lisinopril

Is Ramipril a better-tolerated Zestril substitute? According to findings, Ramipril is one of the most preferred angiotensin-converting enzyme (ACE) inhibitors with a high rate of improving cardiovascular health. Ramipril vs. Lisinopril comparison shows a more consistent patient response for Ramipril with minimum side effects. As for the propensity to treat chronic heart failure, both medications are equally effective. Ramipril has a half-life of 50 hours, while Prinivil has 16.4 hours. Ramipril and Prinivil belong to the same drug class, ACE, therefore, patients often ask if ACE inhibitors are interchangeable. So far, there isn’t enough evidence to show if one ACE inhibitor is completely superior to the other. However, in a special test to compare the efficacy of both drugs, it was concluded that 2.5mg per day of Ramipril was a better tolerated antihypertensive medication than the 10mg daily dose of Zestril. The assumption with each emerging analysis is that all ACE inhibitors may play the same role in hypertension cases. Both drugs have similar side effects including dizziness, tiredness, cough, diarrhea, and vomiting.

Ramipril vs Lisinopril.

Lisinopril vs Enalapril

Just like Zestril, Enalapril is an ACE inhibitor. Thus it serves as a blocker to certain chemicals that tighten blood vessels. Enalapril works by suppressing the rennin-angiotensin-aldosterone system, blocks the angiotensin-converting enzyme, and stops the conversion of angiotensin I to angiotensin II. This helps to widen blood vessels and allows blood to flow smoothly and the heart to pump blood more efficiently. Both medications share similar side effects such as dizziness, nausea, vomiting, headache, and in some cases, blurred vision. A comparative study on Enalapril vs. Lisinopril for efficacy showed that Zestril recorded a more significant result in 24 hours. However, some people will need to administer the drug for weeks until the effects are fully felt. It is also considered a more effective antihypertensive therapy and slightly superior due to its longer pharmacokinetic difference, persistence, and half-life.

Switching From Prinivil Safely

It is not advised to stop taking Zestril abruptly. It might be dangerous to suddenly stop taking the medication without first consulting a doctor. The individual stands a high risk of rebound hypertension. The condition known as rebound hypertension is a spontaneous rise in blood pressure, which occurs when a highly potent hypertensive medication is stopped. To stop the medication, one should contact a doctor for instructions on how to wean it off.

Also, it can be quite difficult for some patients to wean off Zestril because of substance abuse disorder. If any signs of abuse are noticed in patients, they should schedule an appointment with a healthcare specialist in the addiction treatment field. They can correctly diagnose abuse issues that occurred and find the right substance rehab facility to recover.

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Page Sources

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Published on: March 11th, 2020

Updated on: August 27th, 2021

About Author

Dr. Ahmed Zayed

Dr. Ahmed Zayed is a Bachelor of Medicine and Surgery. He is graduated from the University of Alexandria, Egypt. Dr. Ahmed Zayed has a passion for writing medical and health care articles and focuses on providing engaging and trustworthy information to readers.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.