8 Alternatives to Losartan: What to Try If Losartan Isn’t Right for You

Ever picked up your medication and wondered, “Is this really the best option?” If you’re on Losartan and not getting what you need—maybe it’s the side effects like a nagging cough or just not enough blood pressure control—you’ve got choices. The good news? Switching up your blood pressure meds isn’t rare. In fact, finding the ‘goldilocks’ drug can help you feel a whole lot better.

Doctors often start with Losartan because it’s proven and well-known. But there are plenty of other options in the same ARB family, plus a few from other classes that might suit you better. Some people switch because of side effects, costs, or even how their body handles the drug. The trick is knowing what these alternatives do differently and if any match your profile or health needs better.

• Telmisartan
• Valsartan
• Irbesartan
• Olmesartan
• Candesartan
• Eprosartan
• Azilsartan
• ACE Inhibitors
• Summary and Comparison Table

Telmisartan

If Losartan isn’t working out or your doctor wants you to try something new, Telmisartan is often next on the list. Like Losartan, it’s an ARB (angiotensin II receptor blocker)—so it lowers blood pressure by relaxing blood vessels. But here’s what makes it stand out: Telmisartan also has partial PPAR-γ agonist activity, which puts it in a unique spot compared to most other blood pressure meds. That may sound complicated, but it just means it could offer some perks beyond only controlling blood pressure.

Telmisartan’s big selling point? Some studies show it might help a bit with metabolic issues, like improving insulin resistance. People with high blood pressure who are also dealing with prediabetes or not-so-great cholesterol numbers sometimes notice a slight improvement in these areas when they switch to Telmisartan. Plus, it tends to have a pretty neutral effect on blood sugar and lipid (fat) levels, making it a solid pick if you’re worried about your numbers creeping up over time.

It's usually taken once per day, which means less hassle. Missing doses is less likely than with meds you have to juggle twice a day. Convenience counts, right?

Pros

• Once-daily dosing: Easy to stick with, less likely to forget a dose.
• Neutral on glucose and lipids: Doesn’t usually mess with your blood sugar or cholesterol.
• Potential metabolic perks: Could help a little if you have or are at risk for diabetes, thanks to the PPAR-γ activity.
• Some anti-inflammatory effects: Early research shows Telmisartan might help calm down inflammation in the body, though this isn’t the main reason to choose it.

Cons

• Less outcome data: Compared to other ARBs like Valsartan or Losartan, there aren’t as many big studies showing it helps prevent heart attacks or strokes.
• Cost: Brand-name Telmisartan can be pricier than Losartan, especially if your insurance doesn’t cover it as a generic.

And for people who like seeing straight facts, here’s a quick comparison between Losartan and Telmisartan dosing:

If you’re managing blood pressure and metabolic issues, Telmisartan is worth asking your doctor about. Just double-check that your prescription plan covers it, since pricing can sometimes be a surprise.

Valsartan

If losartan alternatives are on your radar, Valsartan is a solid contender. It falls in the same family—angiotensin receptor blockers (ARBs)—so it works in a similar way by relaxing your blood vessels and lowering that stubborn blood pressure. Doctors often switch people from Losartan to Valsartan if there are side effects, insurance hiccups, or if there’s a need for a little stronger blood pressure control.

Valsartan got a lot of attention after the generic versions hit the market. It's been around since the late 1990s, so it’s battle tested and well studied, with millions taking it worldwide. Like Losartan, it can be used to treat high blood pressure, heart failure, and help protect your kidneys if you have diabetes.

Pros

• Lots of research backing up its safety and success for hypertension—there’s a big trial called VALUE that showed it worked just as well as older drugs.
• More affordable now thanks to generic versions, which is great if cost is a worry.
• Usually just one dose a day, so it’s easy to work into your routine—no complicated schedules to memorize.
• Lower risk of cough compared to ACE inhibitors (no more annoying tickle in the throat, hopefully).
• Can also be combined with other meds, like amlodipine or hydrochlorothiazide, for people who need extra blood pressure help.

Cons

• Just like other ARBs, some people can get dizzy when they stand up too fast. Standing up slowly helps.
• If you have kidney problems already, your doctor will watch you more closely, since all ARBs need a little extra attention in that case.
• Some batches of generic Valsartan were recalled in the past due to contamination (NDMA), so it’s smart to ask your pharmacist about your current brand if you’re worried.
• It’s not the best choice during pregnancy—none of the ARBs are.

Here’s a quick comparison for context:

Valsartan isn’t wildly different from Losartan, but for some, it’s just the right fit, especially if you want something tried and true with a decent price tag.

Irbesartan

Irbesartan is another ARB that has carved out its own spot among hypertension meds. It’s often used as a backup when losartan alternatives are needed because of side effects or if you just aren’t seeing the blood pressure goals you want. What makes irbesartan interesting? It’s not only handy for high blood pressure, but it’s also commonly chosen for people with diabetic kidney problems. Docs sometimes give it to slow down the damage diabetes can do to your kidneys.

Irbesartan works by blocking angiotensin II—just like losartan—so it stops your blood vessels from tightening up. This helps lower your blood pressure. It’s generally taken once a day and you’ll find it in a variety of doses, especially the common 150 mg and 300 mg tablets. People tend to tolerate it well. Dose flexibility means it’s easy to step up if you need more pressure control.

Pros

• Solid track record for reducing high blood pressure (especially for people with diabetes or kidney issues).
• Usually just a single pill a day. No popping meds multiple times daily.
• Lower risk of a dry cough compared to ACE inhibitors.
• Can be paired with diuretics for even better results.
• Rarely causes serious side effects; most people just get mild ones, like dizziness at the start.

Cons

• Can sometimes lead to high potassium levels, so labs need to be watched—especially if you have kidney disease.
• A few people notice fatigue or mild headaches, but usually nothing major.
• Costs more than older standby drugs (like some ACE inhibitors), depending on your insurance.

Fun fact: In a big study, irbesartan dropped the risk of worsening kidney disease in people with type 2 diabetes by about 20%. That’s some real-world benefit beyond just lowering your blood pressure.

If you care most about kidney support (especially with diabetes), irbesartan deserves a close look when you and your doc are weighing losartan alternatives.

Olmesartan

When your doctor talks about ARBs (that’s angiotensin receptor blockers, by the way), Olmesartan often pops up as a strong alternative to losartan alternatives. It works by blocking a chemical in your body that tightens blood vessels—so your blood pressure drops and your heart doesn’t have to work as hard. People reach for Olmesartan if they're not seeing results on other meds or if they want something that offers pretty steady, round-the-clock control.

One cool fact: Olmesartan is known for keeping blood pressure consistent over a full 24 hours. Some studies have even found it may lower blood pressure a little more than a few other ARBs, especially overnight. This makes it a solid option if you’ve got higher numbers in the mornings or if your readings bounce around a lot.

Pros

• Once-daily dosing, so no need to split pills or set extra alarms
• Strong all-day and overnight blood pressure control
• Well-tolerated for most people (very low chance of cough or swelling)
• Works well for people with both high blood pressure and kidney problems

Cons

• Some folks get GI side effects, like diarrhea or, in rare cases, a condition called "sprue-like enteropathy" (mainly happens after long use)
• Usually costs more out-of-pocket than generic losartan or ACE inhibitors
• Not recommended during pregnancy (like other ARBs)

If you’ve tried other blood pressure medication in the past and haven’t found your match, Olmesartan could be worth discussing with your doctor. Don’t forget to keep track of any side effects, just in case, because catching them early helps avoid bigger problems later.

Candesartan

If you’re searching for something beyond Losartan, candesartan might pop up as a top contender. It’s another ARB (angiotensin II receptor blocker), and it’s pretty popular for both high blood pressure and heart failure. What makes candesartan stand out? For starters, it’s known for rock-solid blood pressure control—often holding steady for a full 24 hours with just one daily dose. That’s a big win if you dread keeping track of complicated dosing schedules.

Doctors like candesartan because it’s predictable and generally well-tolerated. Headaches and dizziness are the most common side effects, but fewer people deal with cough or swelling compared to some other blood pressure meds. Plus, candesartan is less likely to mess with your blood sugar or potassium than some other options, which matters if you’ve got other health issues tossed in the mix, like diabetes or chronic kidney disease.

Wondering how it stacks up to losartan alternatives? In a bunch of studies—it even matched up or outperformed some other ARBs in keeping blood pressure down, especially over the long haul. And people with heart failure sometimes experience fewer hospital trips when switched to candesartan. The numbers? Check this out:

Pros

• Works all day with once-daily dosing—less hassle, fewer missed doses.
• Great safety profile, even for folks with diabetes or chronic kidney problems.
• Lower risk of a persistent cough or major side effects compared to ACE inhibitors.
• Strong evidence in both high blood pressure and heart failure.

Cons

• Not always generic, so copays or pharmacy costs might run higher.
• Some people still get headaches or dizziness, especially at first.
• Can raise potassium levels—your doctor will probably want to check labs now and then.
• May not be suitable if you’ve got severe liver disease.

Candesartan won’t be everyone’s first try, but if Losartan lets you down or you’re fighting both blood pressure and heart issues, this one’s worth discussing with your provider.

Eprosartan

Looking for something in the ARB family that works a bit differently? Eprosartan might catch your eye. While it doesn’t get as much attention as Losartan or Valsartan, it’s still a solid option, especially for those dealing with hypertension. One thing that makes Eprosartan unique is its dual action—blocking certain receptors involved in blood pressure and also helping to relax blood vessels by influencing your nervous system.

Eprosartan’s standard dose is usually 600 mg taken once or twice daily. Studies have shown it’s effective at lowering blood pressure in both younger adults and older folks. Plus, it’s not metabolized by the liver the same way many other ARBs are, so it can be a safer pick if you have liver issues.

Pros

• Usually well-tolerated, with a low risk of a dry cough (unlike some ACE inhibitors).
• Can be prescribed to people with mild to moderate liver issues.
• Might have a gentler effect on heart rate versus other ARBs, which can be good for certain patients.
• No need to take it with food—you get flexibility with your dosing.

Cons

• Less research backing its effectiveness in lowering risk of heart attack and stroke, compared to Losartan or Valsartan.
• Might need to be taken twice a day for best results, which not everyone likes.
• Some folks may notice dizziness or headache, especially at the start.
• Being less popular, it can be pricier or harder to find at some pharmacies.

One study from Europe tracked patients taking Eprosartan for high blood pressure over 12 months. Results? Nearly 65% saw their systolic pressure drop below 140 mmHg. That’s not too shabby, especially if you’re looking for a Losartan alternative that plays well with other meds like diuretics or calcium channel blockers. Some doctors will mix and match to get your numbers into that sweet spot.

If you’re still hunting for the right fit, don’t write off Eprosartan just because your pharmacist raises an eyebrow. It’s always worth asking your doctor about it—especially if the usual suspects aren’t working out.

Azilsartan

Azilsartan is one of the newer players in the blood pressure medication world. It’s an ARB, just like Losartan, but some studies suggest that Azilsartan might lower blood pressure a bit more than other ARBs out there. If your numbers are stubborn and won’t budge, this med could be worth looking into with your doctor. It’s usually offered as once-daily dosing, which means you don’t have to worry about missing midday pills.

One thing that stands out is how Azilsartan may be more effective at getting both the top (systolic) and bottom (diastolic) numbers where you want them. In head-to-head studies, more people hit their target blood pressure with Azilsartan than with Losartan or even Valsartan. Plus, just like other ARBs, it usually doesn’t cause a cough—something that can drive people nuts with ACE inhibitors.

But there are a few things to consider. Azilsartan tends to cost a bit more and might not be covered by all insurance plans yet, since it’s relatively new. Also, it’s not recommended for folks with severe kidney problems or people who are pregnant. As with most ARBs, you’ll want to make sure your potassium levels don’t creep up too high.

Pros

• Studies show stronger blood pressure lowering effects compared to Losartan.
• Usually taken once a day—easy to keep up with.
• Rarely causes cough or angioedema.
• No significant impact on blood sugar or cholesterol.

Cons

• Higher cost and limited insurance coverage compared to older ARBs.
• Not recommended for people with severe kidney disease or pregnancy.
• Possible increased potassium; blood work is needed to stay safe.
• Less long-term safety data since it’s newer to the market.

So, if you haven’t seen results from Losartan, or you just want something that packs a bigger punch for hypertension, Azilsartan might be a good conversation starter at your next doctor’s visit.

ACE Inhibitors

When people talk about blood pressure medication, ACE inhibitors almost always come up. They’re another big group of drugs, and doctors prescribe them a ton for hypertension, heart failure, and even for protecting your kidneys if you have diabetes. If Losartan (an ARB) isn’t working for you, an ACE inhibitor might be your doctor’s next pick.

Some of the common names you'll see are lisinopril, enalapril, and ramipril. They work by blocking an enzyme that helps make a hormone called angiotensin II (which tightens your blood vessels). Without it, your blood vessels relax, and blood pressure goes down.

Pros

• ACE inhibitors lower the risk of heart attack, stroke, and kidney problems, especially in people with diabetes.
• Usually taken just once a day, which makes it easy to stick to your routine.
• There’s a lot of research backing up their safety and effectiveness over decades, so doctors are very comfortable using them.
• Usually pretty affordable, even without insurance.

Cons

• The biggest drawback: up to 20% of people get a dry, persistent cough—sometimes annoying enough to need a switch.
• Rarely, they can cause swelling in your lips, tongue, or face (angioedema), which can be dangerous if it blocks your airway.
• Not a good fit for pregnant women or people with certain kidney issues.
• Some folks can see changes in potassium or kidney function, so you’ll probably get blood work now and then.

If you're eyeing the numbers, ACE inhibitors are super popular. Here’s a quick look at how they stack up in the U.S. compared to other blood pressure medications:

So if Losartan isn't working, ACE inhibitors are definitely a tried-and-true next step. Always talk things over with your doctor, but at least now the options feel a little less mysterious.

Summary and Comparison Table

With so many losartan alternatives out there, it honestly comes down to your needs, side effects, and how your body reacts. Some people respond better to certain ARBs like telmisartan or valsartan, while others find switching to an ACE inhibitor makes all the difference. Your doc will always weigh the pros and cons, but a little prep work on your part helps you ask smarter questions at your next appointment.

Here’s a quick side-by-side to help you sort out the main differences between the most commonly used meds when it comes to blood pressure medication:

Still on the fence? You’re not alone—about one in three people with hypertension end up trying more than one med before things click. If you’re dealing with annoying side effects or your readings won’t budge, bring this summary to your next doctor’s visit and talk it through. There’s almost always another option to try if your current blood pressure medication isn’t cutting it. Just don’t adjust your meds on your own—team up with your doctor and take it one step at a time.