What can I replace olmesartan with? Exploring Your Options

October 8, 2025 •

5 min read

It's estimated that the number of people with hypertension worldwide will increase to 1.5 billion by 2025 [1.8.1]. If you're managing this condition, you may be asking, 'What can I replace olmesartan with?' This guide explores the available alternatives.

Quick Summary

Find potential replacements for olmesartan by exploring other drug classes like ARBs, ACE inhibitors, calcium channel blockers, and beta-blockers. Understand the reasons for switching and the importance of consulting your healthcare provider.

Key Points

Consult a Doctor: Never change or stop your blood pressure medication without consulting a healthcare professional [1.3.2].
Reasons for Switching: Patients may switch from olmesartan due to side effects like dizziness or the rare but severe sprue-like enteropathy, lack of efficacy, or cost [1.3.1, 1.4.5].
ARBs as a Direct Alternative: Other Angiotensin II Receptor Blockers (ARBs) like losartan and valsartan are common alternatives that work similarly to olmesartan [1.2.6].
Multiple Medication Classes: Other major classes of blood pressure medications include ACE Inhibitors, Calcium Channel Blockers, Diuretics, and Beta-Blockers [1.5.3].
ACE Inhibitors vs. ARBs: ACE Inhibitors (e.g., lisinopril) are very effective but are associated with a higher incidence of dry cough compared to ARBs [1.2.5, 1.6.5].
First-Line Therapies: ARBs, ACE inhibitors, calcium channel blockers, and thiazide diuretics are all considered first-line therapies for most patients with hypertension [1.5.4].
Lifestyle is Crucial: Diet (like the DASH diet), regular exercise, weight management, and limiting alcohol are essential for controlling blood pressure, with or without medication [1.7.6].

Important Disclaimer

The information provided in this article is for informational purposes only and does not constitute medical advice. The decision to switch medications should only be made in consultation with a qualified healthcare professional who can assess your individual health needs and medical history. Never stop or change your medication dosage without your doctor's guidance [1.3.2].

Understanding Olmesartan and Reasons for Replacement

Olmesartan, also known by the brand name Benicar, is a widely prescribed medication for treating high blood pressure (hypertension) [1.3.1]. It belongs to a class of drugs called Angiotensin II Receptor Blockers (ARBs) [1.5.3]. These drugs work by blocking a chemical called angiotensin II from binding to its receptors, which causes blood vessels to relax and widen, thereby lowering blood pressure [1.5.3].

While effective for many, there are several reasons a patient and their doctor might consider a switch:

Side Effects: The most common side effect of olmesartan is dizziness [1.4.5]. However, a more serious, though rare, side effect is a condition called "sprue-like enteropathy." This can cause severe, chronic diarrhea and significant weight loss, appearing months or even years after starting the medication [1.3.1, 1.3.6]. Other side effects can include back pain, headache, and flu-like symptoms [1.3.2].
Lack of Efficacy: For some individuals, olmesartan may not lower their blood pressure to the target level, even at maximum doses. Most people require two or more different types of antihypertensives to effectively manage their blood pressure [1.2.3].
Cost and Insurance Coverage: While generic olmesartan is available, cost can still be a factor, and insurance formularies may prefer other medications [1.2.6].
Co-existing Conditions: The presence of other medical conditions, such as kidney disease or diabetes, might make another class of medication a better choice [1.3.2, 1.6.6].

Pharmacological Alternatives to Olmesartan

If you and your doctor decide a change is necessary, there are several classes of antihypertensive medications available. The choice depends on your specific health profile, tolerance for side effects, and other medications you take [1.5.6].

Other Angiotensin II Receptor Blockers (ARBs)

Switching to another drug within the same class is often a straightforward option. Other ARBs work similarly to olmesartan but may have a different side effect profile or cost [1.2.6]. In general, all ARBs are considered effective at lowering blood pressure [1.2.6].

Losartan (Cozaar): The most commonly prescribed ARB, losartan is also approved to reduce stroke risk in certain patients [1.2.6, 1.5.6].
Valsartan (Diovan): Besides hypertension, valsartan is also FDA-approved to treat heart failure [1.2.6].
Telmisartan (Micardis): This ARB has a long duration of action in the body and may have favorable effects on blood glucose and lipid profiles [1.2.7].
Irbesartan (Avapro) and Candesartan (Atacand) are other available options [1.2.6].

Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors are another first-line treatment for hypertension [1.5.4]. They work by preventing the production of angiotensin II in the first place [1.5.3]. Studies have shown that ARBs (like olmesartan) have a better tolerability profile and present a better safety profile than ACE inhibitors, particularly regarding cough and angioedema (swelling) [1.6.3, 1.6.5].

Lisinopril (Prinivil, Zestril): A very commonly prescribed ACE inhibitor, also used for heart failure and improving survival after a heart attack [1.2.5]. A well-known side effect is a persistent dry cough [1.2.5].
Enalapril (Vasotec) [1.2.3]
Ramipril (Altace) [1.2.3]
Benazepril (Lotensin) [1.5.4]

Calcium Channel Blockers (CCBs)

CCBs lower blood pressure by preventing calcium from entering the cells of your heart and arteries, which allows blood vessels to relax and open [1.5.5]. They are a first-choice medication for many, especially if an ACE inhibitor or ARB is not suitable [1.5.1].

Amlodipine (Norvasc): A widely used CCB, taken once daily [1.5.6]. Common side effects can include swelling in the ankles and palpitations [1.5.6].
Diltiazem (Cardizem) [1.2.3]
Nifedipine (Procardia) [1.2.3]

Diuretics (Water Pills)

Diuretics work by helping your kidneys remove excess sodium and water from the body, reducing blood volume [1.5.3]. They are often one of the first medications prescribed for high blood pressure and are frequently used in combination with other drugs [1.5.3, 1.5.4].

Hydrochlorothiazide (HCTZ): A very common thiazide diuretic [1.5.6].
Chlorthalidone: Preferred by some guidelines due to its long-lasting effect [1.5.2].
Furosemide (Lasix): A more powerful loop diuretic, often used for patients with heart failure or kidney issues [1.2.3].

Beta-Blockers

Beta-blockers lower blood pressure by making the heart beat more slowly and with less force [1.5.5]. They are no longer considered a first-line treatment for hypertension alone but are essential for patients who also have conditions like coronary artery disease or certain types of heart failure [1.6.4].

Metoprolol (Lopressor, Toprol-XL) [1.2.3]
Atenolol (Tenormin) [1.2.3]
Carvedilol (Coreg) [1.2.4]

Comparison of Main Alternative Classes


Medication Class	How It Works	Common Side Effects	Key Considerations
Other ARBs	Blocks angiotensin II receptors, relaxing blood vessels [1.5.3].	Dizziness, high potassium levels [1.5.5].	Generally well-tolerated. Good alternative if olmesartan is effective but causes side effects [1.6.3].
ACE Inhibitors	Prevents the formation of angiotensin II [1.5.3].	Dry cough, dizziness, high potassium levels, angioedema (swelling) [1.2.5, 1.6.5].	Very effective, but the cough can be bothersome for many patients [1.2.5].
Calcium Channel Blockers	Prevents calcium from entering heart and blood vessel cells, causing relaxation [1.5.5].	Headache, ankle swelling, flushing, palpitations [1.5.5, 1.5.6].	A good first-line option, particularly for older patients and Black patients [1.5.2].
Diuretics	Helps kidneys remove excess salt and water [1.5.3].	Increased urination, low potassium levels, dizziness, muscle cramps [1.5.3, 1.5.5].	Very effective and often used in combination therapies [1.2.3].
Beta-Blockers	Slows heart rate and reduces the force of heartbeats [1.5.5].	Fatigue, cold hands/feet, dizziness [1.6.4].	Not typically a first choice for hypertension alone, but vital for specific heart conditions [1.6.4].

Non-Pharmacological Approaches: Lifestyle is Key

Regardless of medication, lifestyle modifications are fundamental to managing hypertension [1.7.6]. In some cases, these changes can be so effective that they reduce the need for medication.

Diet: Adopting the DASH (Dietary Approaches to Stop Hypertension) eating plan, which is rich in fruits, vegetables, and whole grains, and low in sodium, can be as effective as a single medication [1.7.3, 1.7.6].
Exercise: Aim for at least 150 minutes of moderate aerobic activity per week. Regular exercise strengthens the heart and improves blood flow [1.7.6].
Weight Management: Losing even a small amount of weight (3% to 5%) can significantly improve blood pressure [1.7.3].
Limit Alcohol and Quit Smoking: Alcohol can raise blood pressure, and smoking damages blood vessels [1.7.2, 1.7.6].
Stress Management: Chronic stress can contribute to high blood pressure. Practices like meditation and deep breathing can help [1.7.5].

Conclusion

Deciding what you can replace olmesartan with is a significant decision that requires professional medical guidance. There is a wide array of effective alternatives, from other ARBs and ACE inhibitors to calcium channel blockers and diuretics. Each class has a unique profile of benefits and potential side effects. The best choice is highly individual and depends on your overall health, other conditions, and how your body responds to treatment. Partnering with your healthcare provider and embracing heart-healthy lifestyle changes will provide the most effective path to controlling your blood pressure and protecting your long-term health.

For more information on managing high blood pressure through lifestyle changes, you can visit the American Heart Association.

Frequently Asked Questions

The most commonly reported side effect of olmesartan is dizziness [1.4.5]. A rare but serious side effect is sprue-like enteropathy, which causes severe, chronic diarrhea and weight loss [1.3.6].

Yes, losartan can be a suitable replacement. Both are in the same drug class (ARBs) and work similarly to lower blood pressure. Losartan is the most commonly used ARB and may be preferred by your doctor or insurance plan [1.2.6].

Both are effective first-line treatments for high blood pressure. The main difference in side effects is that ACE inhibitors are more likely to cause a persistent dry cough, while ARBs are not [1.2.5]. ARBs are generally considered to have a better safety and tolerability profile [1.6.5].

No. You should never stop taking a blood pressure medication suddenly without talking to your doctor. Doing so can cause your blood pressure to rise sharply, increasing your risk of a heart attack or stroke [1.3.2].

Lifestyle changes are a critical part of managing high blood pressure. These include a healthy diet (like the DASH diet), regular exercise, losing weight, limiting alcohol, and quitting smoking. For some people, these changes can significantly lower blood pressure, but they should be seen as a complement to, not a replacement for, medication unless advised by a doctor [1.7.6].

Diuretics, often called 'water pills,' help your body get rid of excess salt and water to lower blood pressure [1.5.3]. They are a first-line treatment for hypertension and can be used as an alternative to or in combination with olmesartan, depending on your doctor's recommendation [1.5.4].

A doctor might recommend a calcium channel blocker (like amlodipine) if an ARB or ACE inhibitor is not well-tolerated or is less effective for a particular patient. Guidelines sometimes recommend CCBs as a first-choice medication, particularly for Black patients [1.5.2, 1.5.6].