What is the equivalent transition dose from olmesartan (Benicar) 5 milligrams twice daily to losartan (Cozaar)?

From the Guidelines

When transitioning from olmesartan 5mg twice daily to losartan, the recommended equivalent dose would be losartan 50mg once daily. This recommendation is based on the dose comparison of angiotensin II receptor blockers (ARBs) provided in the study 1, which lists the starting and goal doses for various ARBs, including olmesartan and losartan. Although the study does not provide a direct comparison of the potency of olmesartan and losartan, it does list the goal dose for losartan as 25-100 mg daily in 1-2 divided doses, and for olmesartan as 20-40 mg daily. Considering the total daily dose of olmesartan is 10mg, the equivalent losartan dose is higher due to its lower potency.

• Key points to consider when making this transition include:
  • Monitoring blood pressure for 1-2 weeks after making this change to ensure adequate blood pressure control is maintained, as higher levels of blood pressure are associated with more rapid progression of kidney disease, as noted in the study 1.
  • If blood pressure control is inadequate on losartan 50mg daily, the dose can be increased to losartan 100mg daily, which is the maximum recommended dose, according to the study 1.
  • Both medications are ARBs that work by blocking the action of angiotensin II, a hormone that causes blood vessels to narrow, but they have different potencies and pharmacokinetic properties, which explains the dosing difference in the transition.
  • The transition should be done without a tapering period, simply switching from the last dose of olmesartan to the first dose of losartan the next day, as both medications have a similar mechanism of action and switching between them does not require a gradual dose adjustment.

From the Research

Transitioning from Olmesartan to Losartan

When transitioning from olmesartan 5mg twice daily to losartan, it's essential to consider the equivalent dosages and efficacy of both medications.

• The studies 2, 3, 4, 5, 6 compared the efficacy of olmesartan and losartan in patients with hypertension.
• According to the study 3, losartan was increased to 50 mg twice daily at week 8, which can be considered as a potential transition dose.
• However, it's crucial to note that the optimal transition dose may vary depending on individual patient factors, such as blood pressure response and tolerability.
• The study 6 suggests that olmesartan has a superior blood pressure-lowering efficacy compared to losartan, which may impact the transition dose.

Dosage Considerations

• The study 2 used losartan 50 mg for 4 weeks, then increased to 100 mg for 4 weeks, which can be considered as a potential dosage regimen.
• The study 4 used losartan 50 mg for 4 weeks, then increased to 100 mg for 4 weeks, similar to the study 2.
• The study 5 compared the efficacy of olmesartan 20 mg with losartan 50 mg, which may not be directly applicable to the transition from olmesartan 5mg twice daily.

Clinical Implications

• When transitioning from olmesartan to losartan, healthcare providers should closely monitor blood pressure and adjust the dosage as needed to achieve optimal blood pressure control.
• The studies 2, 3, 4, 5, 6 provide valuable insights into the efficacy and safety of olmesartan and losartan, which can inform clinical decision-making.
• However, the optimal transition dose and dosage regimen may vary depending on individual patient factors and clinical circumstances.