Enalapril Vs Losartan

[Phil Conners]

I take a combination of 50mg Atenolol and 10mg Enalapril once daily for high blood pressure, but the Enalapril gives me the dreaded dry "ACE cough", particularly during exercises. I'm considering replacing the Enalapril with Losartan which is suggested as a replacement.

I'm wondering about the dosage though. I haven't been able to find any tables comparing the doses between the two. I'm considering starting with 50mg/day, does that seem to make sense? Or would it be better to start of at 25mg/day and then monitor the blood pressure over a couple of weeks to determine if a higher dose is needed?

[FBN]

They are both in the same drug group so no guarantee that the cough will disappear. Essentially, not a good idea to self-medicate or make changes to medication under these circumstances. Best to sit down with a good internist or cardiologist and work through this together.

[Phil Conners]

Sent you a PM

[PMNL]

I agree with the idea of starting Losartan 25 mg first then step up to 50 mg after a week or so if the blood pressure is not well controlled.

It is unlikely to have dry cough from ARB and I think that is why your doctor suggested you Loranta as an alternative to ACE.

[Sheryl]

You can get cough with Angiotensis II inhibitors, but it is less frequently encountered than with the ACEs.

Usual starting dose of losartan is 50mg and given what his dose of enalapril was I doubt 25 would suffice. if it were me, I'd start with 50mg. He had a recent stent placement and is thus most likely on anticoagulants --->higher than average risk.

Phil, as PMNL alluded, there is a locally made brand called Loranta, much less expensive than the imports and fine in quality. I take it myself.

[Phil Conners]

Thanks for the inputs!

So Losartan 50mg is more or less equivalent to 10mg Enalapril?

For anticoagulants I'm just on Aspirin 300mb/day, and I take Bestatin 20mg/day. That's all.

[Sheryl]

There is no direct equivalent. However, the usual dose for enalapril for someone on combined therapy (2 or more drugs) is 5-10mg, although it can be given at higher doses than that if necessary. You were on 10mg i,e. not the lowest usual dose.

The usual starting dose of losartan is 50 mg and maintanence doses can range from 25 to 100 mg daily.

Since you were on 10 of enalapril (i.e. the higher end of the usual range), my guess is that you will need at least 50 mg of losartan to obtain an equal level of control. You might possibly need more, but I doubt you would need less.

This is just guesswork, though, so be sure to closely monitor your BP.

And of course discuss with your cardiologist.

[Phil Conners]

Thanks and of course

[PMNL]

Did you eventually figure out the optimal dosage for yourself?

[Phil Conners]

I finally got around to trying Losartan, replacing my 10mg Enaril with 50mg Losartan daily for 10 days now. Not a very good result, the dry cough hasn't stopped but my BP has gone up from the usual 12x/8x to 14x/9x. It seems I'll have to look for a replacement in a group that works better for me.

[lopburi3]

I am taking Atenolol 25mg (was 50mg when taking alone) combined with amlodipine 2.5mg and has been working well for last several years. Also aspirin at 81mg and was on Bestatin 20mg but now more expensive (insurance pays most) Lipitor

[Sheryl]

As you have ischemic heart disease, I would not advise trying a different class of drug (particularly a beta blocker) without first consulting your cardiologist.

[Phil Conners]

I appreciate your concern Sheryl, but I was always on beta blockers, on the doctors suggestion. To recap: 50mg Atenolol + 10mg Enalapril, which seems to stabilize my BP at a reasonable 12x/8x. Perhaps you meant calcium channel blockers?

The Atenolol is fine but the Enalapril seems to give me this really annoying, bad, dry cough (listed as one of the common side effects). I was hoping that changing to Losartan would make it disappear but alas, it didn't, so back to the old Atenolol/Enalapril mix for now.

Not sure about Amlodipine, it seems to have some awfully scary side effects. What other options might there be?

[PMNL]

I appreciate your concern Sheryl, but I was always on beta blockers, on the doctors suggestion. To recap: 50mg Atenolol + 10mg Enalapril, which seems to stabilize my BP at a reasonable 12x/8x. Perhaps you meant calcium channel blockers?

The Atenolol is fine but the Enalapril seems to give me this really annoying, bad, dry cough (listed as one of the common side effects). I was hoping that changing to Losartan would make it disappear but alas, it didn't, so back to the old Atenolol/Enalapril mix for now.

Not sure about Amlodipine, it seems to have some awfully scary side effects. What other options might there be?

I dont know why your blood pressure went up but normally it takes a couple weeks for ACEI dry cough side effect to go away, I have seen this in many cases switched from ACE to ARB.

You may try to take losartan for a longer period of time,1 month for example, and see how is the blood pressure and the dry cough.

Do you split the atenolol as twice a day dose or once a day? In Angina and IHD, most cardologist recommended twice a day dosage.

A low dose of diuretic is not a bad idea to add on to control your BP ( Such as ATENOLOL 50 mg a day Loranta 25 mg a day plus Hydropchlorothiazide 12.5 mg a day)but as Sheryl mention to leave the ACEI ARB isnt a good idea.

Hope you figure out the right regimen for yourself soon.

Good Luck

Edited May 22, 2011 by PMNL

[Sheryl]

I appreciate your concern Sheryl, but I was always on beta blockers, on the doctors suggestion. To recap: 50mg Atenolol + 10mg Enalapril, which seems to stabilize my BP at a reasonable 12x/8x. Perhaps you meant calcium channel blockers?

Actually I mean t beta blocker because I didn't go back and read from the 1st post, but the same would apply to calcium blockers. These drugs have complex cardiac effects and should not bne taken without a cardiologist's advice.

I also failed to read your post closely enough to catch that it had only been 10 days. In that case, as PMNL suggests, it might be worth waiting. The cough might or might not improve, but 10 days is insuifficient time to tell

That your BP is less well controlled, could be addressed by increasing the Losartan but you probably want to wait on that given the cough.

[Phil Conners]

Ok, I'll give Losartan some more time.

I don't know why the BP suddenly shot up, nothing else (i.e. diet, exercise, stress or anything) changed so I kinda assumed that it had to do with the change to Losartan.

I take the Atenolol once a day on the doctors suggestion.

I still have some HCTZ so will try to throw that in to see if that might help lowering it a bit. HCTZ is pretty benign stuff.

Thanks for the recommendations/suggestions, I very much appreciate it!

[Sheryl]

The main concern with HCTZ, especially in this climate, is the loss of potassium. So up your potassium intake (bananas are very good).

[Phil Conners]

Will keep that in mind, thanks!

[Phil Conners]

Just a quick update to close the topic: Ended up on 50mg Atenolol + 50mg Loranta + 25mg HCTZ. My BP is now a reasonable 130/80 and the dry cough gone. No other noticeable side effects. Thanks for all the input, appreciate it!