From the Guidelines
Olmesartan 20 mg daily is approximately equivalent to lisinopril 20 mg daily. When switching between these medications, patients should start with olmesartan 20 mg once daily and then adjust the dose based on blood pressure response. The maximum recommended dose of olmesartan is 40 mg daily, as indicated in the 2018 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. These medications work similarly as they both affect the renin-angiotensin-aldosterone system, though through different mechanisms - olmesartan is an angiotensin II receptor blocker (ARB) while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor.
When transitioning between these medications, blood pressure should be monitored closely for 1-2 weeks to ensure adequate control. Olmesartan may be preferred in patients who experience ACE inhibitor-induced cough, as ARBs typically don't cause this side effect. Patients should take olmesartan at the same time each day, with or without food, and continue other prescribed antihypertensive medications unless directed otherwise by their healthcare provider. It's also important to note that the dose of olmesartan can be adjusted based on the patient's response to the medication, and the goal dose should be at the higher end of the dose range when possible, as suggested in the KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease 1.
Some key points to consider when using olmesartan include:
- The usual dose range for olmesartan is 20-40 mg daily, with a maximum recommended dose of 40 mg daily 1.
- Olmesartan should not be used in combination with ACE inhibitors or direct renin inhibitors 1.
- Patients with a history of angioedema with ACE inhibitors can receive an ARB, such as olmesartan, beginning 6 weeks after the ACE inhibitor is discontinued 1.
- Olmesartan may be associated with an increased risk of hyperkalemia, especially in patients with chronic kidney disease (CKD) or those on potassium supplements or potassium-sparing drugs 1.
Overall, the choice of olmesartan or lisinopril should be based on the individual patient's needs and medical history, and the decision to switch between these medications should be made in consultation with a healthcare provider.
From the Research
Equivalent Dose of Olmesartan to Lisinopril 20mg
There are no direct comparisons between olmesartan and lisinopril in the provided studies to determine an equivalent dose.
- The studies provided focus on the effectiveness of olmesartan in combination with other antihypertensive drugs, such as amlodipine and hydrochlorothiazide, for the treatment of hypertension 2, 3, 4, 5.
- One study compares the efficacy of olmesartan with other angiotensin II receptor blockers (ARBs), including losartan, valsartan, and irbesartan, but does not include a comparison with lisinopril, an angiotensin-converting enzyme inhibitor (ACEI) 6.
- Therefore, there is no evidence to support a specific equivalent dose of olmesartan to lisinopril 20mg based on the provided studies.