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Benicar vs Bystolic

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Comparative Analysis


For individuals with hypertension or high blood pressure, specific drugs that regulate the flow of blood within the body and control heart rate can assist in managing symptoms and preventing complications. Benicar and Bystolic are two such medications prescribed for this condition. They each have different mechanisms of action but both aid in controlling high blood pressure levels effectively.

Benicar is an angiotensin II receptor blocker (ARB), which works by inhibiting a substance in the body that causes the blood vessels to tighten. As a result, it helps lower blood pressure by making the vessels relax and widen, thereby improving overall circulatory function.

Bystolic, on the other hand, is classified as a beta-blocker. It primarily affects heart rate and heartbeat strength by blocking certain chemicals—epinephrine (adrenaline) specifically—that make your heart pump harder than necessary. This leads to decreased heart workload and lowers your overall blood pressure.

Benicar vs Bystolic Side By Side

Brand NameBenicarBystolic
ContraindicationsShould not be taken with certain other types of medications like alpha-blockers or antihypertensive drugs. Not recommended for children under the age of one year due to risk of kidney problems.Should not be taken with certain other types of medications like alpha-blockers or antihypertensive drugs.
CostFor brand name, around $180 for 30 tablets of 20 mg. Generic olmesartan medoxomil costs between $15 and $60 for thirty 20mg or 40mg tablets.For brand name, about $155 for 30 tablets of 5 mg. Generic nebivolol hydrochloride ranges from about $12 - $55.
Generic NameOlmesartanNebivolol
Most Serious Side EffectSigns of a serious allergic reaction, rapid weight gain due to fluid retention, chest pain, unusual tiredness or weakness, little or no urination, high potassium levels, low blood sugar.Allergic reaction, changes in heartbeat, signs of low blood sugar, shortness of breath with mild exertion, swelling in legs and ankles, sudden weight gain, abnormally cold hands and feet.
Severe Drug InteractionsAlpha-blockers, antihypertensive drugs.Alpha-blockers, antihypertensive drugs.
Typical DoseStarts at 20 mg/day, may be increased to 40 mg/day.Typically initiated at 5 mg/day, can be increased to 10 mg/day, up to a maximum of 40 mg/day.

What is Benicar?

Olmesartan (the generic name for Benicar) is an angiotensin II receptor antagonist and was a significant advancement from the earlier class of blood pressure medications known as beta blockers. Olmesartan was first approved by the FDA in 2002. Benicar blocks the action of a hormone that narrows blood vessels, effectively helping to relax and dilate vessels for better circulation. It's commonly prescribed for treating hypertension. Unlike other antihypertensive drugs, Benicar selectively inhibits angiotensin II type 1 receptors with minimal effects on bradykinin metabolism or prostaglandins, which results in it having fewer side effects like coughing than ACE inhibitors.

Nebivolol (the generic name for Bystolic), on the other hand, belongs to a newer class of selective beta-1 adrenergic receptor blockers. Nebivolol not only reduces heart rate but also increases nitric oxide availability which causes vasodilation improving overall circulation while lowering blood pressure effectively making it another choice drug for managing hypertension.

What conditions is Benicar approved to treat?

Benicar and Bystolic are both approved for the treatment of various forms of hypertension:

  • Benicar (olmesartan) is used to treat high blood pressure (hypertension) in adults and children who are at least 6 years old. It may also be used as part of a combination therapy, which means you may need to take it with other medications.

  • Bystolic (nebivolol) is used to treat hypertension either on its own or in conjunction with other medications. In addition, it's often included as a part of a complete program that includes diet, exercise, and weight control.

How does Benicar help with these illnesses?

Benicar assists in managing high blood pressure by preventing the hormone angiotensin II from constricting the blood vessels, thereby widening them. This process is facilitated through blocking the action of specific receptors for this hormone in the body, allowing a smooth flow and reducing hypertension. Angiotensin II is a potent vasoconstrictor - it plays an important role in controlling blood volume and systemic vascular resistance, which help regulate cardiac output and arterial pressure. Elevated levels of angiotensin II can lead to increased water retention and elevated blood pressure; hence, by inhibiting its function, Benicar helps reduce these risks.

In contrast, Bystolic works differently: instead of targeting angiotensin receptors like Benicar does, Bystolic primarily targets beta-1 adrenergic receptors. These are found mainly in heart muscle cells but also throughout other parts of the body. By blocking these receptors' response to stress hormones such as adrenaline (also known as epinephrine), Bystolic reduces both heart rate and force of contraction which leads to lowering of high blood pressure.

What is Bystolic?

Bystolic, whose generic name is nebivolol, is a beta-blocker that functions by shrinking the effects of adrenaline and other stress hormones on your heart. In doing so, it reduces the speed at which your heart beats and lowers blood pressure levels. Bystolic was first approved by the FDA in 2007. Unlike angiotensin receptor blockers (ARBs) like Benicar, Bystolic does not inhibit angiotensin II from binding to receptors in blood vessel walls. This means its side-effect profile differs from ARBs’, particularly because it can cause fatigue and slow heartbeat as opposed to fluid imbalance or kidney problems often seen with some ARBs such as Benicar. The unique properties of Bystolic can be beneficial for managing hypertension, especially when patients do not respond well to "typical" antihypertensive drugs such as Benicar.

What conditions is Bystolic approved to treat?

Bystolic is a drug that has received FDA approval for the treatment of:

  • Hypertension (high blood pressure)

It's important to note, however, that Bystolic does not cure high blood pressure. It merely helps to control it. Therefore, it must be taken regularly and continuously as directed by your healthcare provider in order for you to get the full benefit from the medication.

How does Bystolic help with these illnesses?

Nebivolol, known by the brand name Bystolic, works as a beta-blocker and impacts the heart and blood flow. It helps to lower stress on certain parts of the body by reducing strain on blood vessels and slowing heart rate. This contributes to its use in managing hypertension or high blood pressure. Conversely, Benicar targets angiotensin receptors to help relax blood vessels. The specific action of Bystolic on beta-receptors can also bring about other benefits such as reduced anxiety due to its impact on physical symptoms like rapid heartbeat which are often associated with anxious states. As it does not significantly affect levels of renin (a hormone involved in regulating blood pressure), it is sometimes prescribed when a patient does not respond well to typical angiotensin receptor blockers (ARBs) such as Benicar or may be combined with ARBs for optimum effect.

How effective are both Benicar and Bystolic?

Both olmesartan (Benicar) and nebivolol (Bystolic) have established histories of success in treating patients with hypertension, and they were initially approved by the FDA just a few years apart. Since they act on different mechanisms within the cardiovascular system, they may be prescribed under varying circumstances. The effectiveness of Benicar in reducing blood pressure was directly studied in several double-blind clinical trials; it exhibited robust efficacy at managing symptoms of hypertension as well as a promising safety profile. In these studies, none of the metrics used to measure efficacy differed significantly between patients receiving olmesartan or placebo.

A 2004 review demonstrated that Benicar is effective in lowering blood pressure from the first week treatment onwards, has a favorable side effect profile compared to many other antihypertensive medications, and is well-tolerated even by elderly populations. This review also indicated that Benicar has become one of the most commonly prescribed angiotensin receptor blockers worldwide.

On the other hand, nebivolol (Bystolic), which acts primarily through selective beta-1 adrenergic antagonism coupled with vasodilatory actions appears to be more effective than placebo when it comes to treating hypertension according to a 2016 meta-analysis review. Nonetheless, Bystolic is generally considered only after or alongside first-line treatments such as diuretics or calcium channel blockers for managing high blood pressure. Significant research on its use involves Bystolic being co-prescribed alongside another class of antihypertensive medication so data confirming its efficacy as stand-alone treatment isn't yet as extensive compared to that for Benicar. However due to its unique pharmacology combining both cardioselective beta-blockade with nitric oxide-potentiating vasodilator effects makes Nebivolol an optimal choice especially for hypertensive patients who require heart rate control or those prone having adverse metabolic effects associated with traditional non-selective beta-blockers.

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At what dose is Benicar typically prescribed?

Oral dosages of Benicar for adults typically start at 20 mg/day to treat high blood pressure, but studies have shown that a dose as low as 20 mg/day can be effective. Dosage may be increased to 40 mg/day if the desired blood pressure isn't achieved. Adolescents aged over 16 years can also take this medication starting from a dosage of 20mg once daily. However, children under the age of one year should not use this medication due to risk of kidney problems. It's important that patients do not exceed the maximum recommended dosage of 40 mg/day.

On the other hand, Bystolic is usually started at a dose of 5 mg once daily for adults with hypertension and it can be adjusted upwards within therapeutic range until optimal blood pressure control is achieved up to a maximum dose of no more than 40mg per day according to patient tolerance and response.

Remember: Always consult your healthcare provider before beginning any new treatment regimen or making changes to an existing one; they will guide you based on your specific circumstances and health needs.

At what dose is Bystolic typically prescribed?

Bystolic treatment is typically initiated at a dosage of 5 mg/day. The dose can then be gradually increased to 10 mg/day, taken once daily. In some cases, depending on the patient's response and tolerance, the dose may be further increased up to a maximum of 40 mg/day. This higher dose should only be considered if there's no significant improvement in blood pressure control after several weeks on the lower doses. As with all medications, it's important that Bystolic is taken consistently and exactly as prescribed by your healthcare provider for optimal efficacy.

What are the most common side effects for Benicar?

Common side effects of Benicar may include:

  • Dizziness or lightheadedness as your body adjusts to the medication
  • Diarrhea or stomach pain
  • Back pain, joint or muscle aches
  • Changes in urination (more frequent urge)
  • Dry skin, rashes
  • Mild itching

On the other hand, Bystolic may cause some common side effects such as:

  • Headache and dizziness
  • Tiredness and slow heartbeat
  • Nausea and stomach discomfort
  • Shortness of breath -Swelling in your hands/ankles/feet (water retention)

Always consult with your healthcare provider for any persistent symptoms.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Benicar?

While both Benicar and Bystolic are used to treat high blood pressure, they can cause different side effects. If you're taking Benicar or Bystolic, be aware of the following potential severe symptoms:

  • Signs of a serious allergic reaction: hives, difficulty breathing, swelling in your face or throat
  • Rapid weight gain due to fluid retention
  • Chest pain that spreads to your jaw or shoulder with rapid heartbeats
  • Unusual tiredness or weakness; feeling light-headed like you might pass out
  • Little or no urination; painful or difficult urination; lower back pain
  • High potassium levels - slow heart rate, weak pulse, muscle weakness
  • Low blood sugar - headache, hunger, sweating

Also note that while rare, these medications may cause a breakdown of skeletal muscle tissue leading to kidney failure. Symptoms include unexplained muscle pain or tenderness. Always consult your doctor immediately if any adverse reactions occur.

What are the most common side effects for Bystolic?

Bystolic, used to treat hypertension, can cause the following side effects:

  • Headache
  • Tiredness and fatigue
  • Stomach upset or nausea
  • Shortness of breath
  • Slow heart rate (bradycardia)
  • Swelling in your ankles or feet (edema)
  • Dizziness or feeling faint
  • Difficulty sleeping due to vivid dreams or nightmares
    These symptoms are usually mild and manageable but it's essential that you consult with your healthcare provider if any persist. Remember, do not stop taking Bystolic without first discussing this with your doctor as abrupt discontinuation can lead to serious issues such as chest pain, irregular heartbeat, or heart attack.

Are there any potential serious side effects for Bystolic?

Bystolic, like any medication, has potential side effects that you should be aware of. While not everyone will experience these adverse reactions, it is important to know the signs and symptoms so you can seek immediate medical attention if they occur:

  • Allergic reaction: This could include hives, difficulty breathing or swallowing due to throat swelling
  • Changes in heartbeat: Bystolic may cause slow or uneven heartbeats
  • Signs of low blood sugar such as dizziness, sweating or shaking
  • Shortness of breath with mild exertion
  • Swelling in your legs and ankles
  • Sudden weight gain
  • Abnormally cold feeling in your hands and feet.

If you notice any unusual physical changes while taking Bystolic - whether listed here or not - it's always a good idea to discuss them with your healthcare provider promptly.

Contraindications for Benicar and Bystolic?

Both Benicar and Bystolic, similar to most other hypertension medications, may cause side effects. If you experience any severe reactions such as dizziness, lightheadedness, fainting or irregular heartbeat after taking these drugs, seek immediate medical attention.

Neither Benicar nor Bystolic should be taken if you are using certain other types of medications like alpha-blockers (used for prostate problems or high blood pressure) or antihypertensive drugs. Always inform your physician about the medication you're currently on; some medicines may require a certain period to eliminate from your system before starting with Benicar or Bystolic to avoid potentially hazardous interactions.

Remember that abruptly stopping either medicine could lead to serious health complications including worsening of hypertension symptoms. Instead, consult with your doctor who will guide you on how best to discontinue usage safely.

How much do Benicar and Bystolic cost?

For the brand name versions of these drugs:

  • The price of 30 tablets of Benicar (20 mg) averages around $180, which works out to approximately $6/day.
  • The price for 30 tablets of Bystolic (5 mg) is about $155, translating into roughly $5.16/day.

So if you are in a higher dosage range for Benicar (i.e., 40mg per day), then brand-name Bystolic tends to be less expensive on a per-day treatment basis. However, cost should not be your primary consideration when determining which medication is right for you.

In terms of generic options:

  • Generic olmesartan medoxomil (the active ingredient in Benicar) typically costs between $15 and $60 for thirty 20mg or 40mg tablets respectively, with daily costs ranging from as low as $.50 up to about $2.
  • Nebivolol hydrochloride, the generic form of Bystolic ranges from about $12 - $55 depending upon dosage strength and quantity required; this results in an approximate daily cost between $.40 and just under two dollars.

Again remember that while generics can provide significant savings, your healthcare provider's advice regarding efficacy should always take precedence over pricing concerns alone.

Popularity of Benicar and Bystolic

Olmesartan, in generic form as well as the brand name Benicar, was estimated to have been prescribed to about 8.4 million people in the US in 2020. Olmesartan accounted for approximately 11% of angiotensin II receptor blocker (ARB) prescriptions in the US, a class of drugs used primarily for treating high blood pressure and heart failure. The prescription rate of olmesartan has been generally stable since its introduction.

Nebivolol, including brand versions such as Bystolic, was prescribed to roughly 3.9 million people in the USA in 2020. In the US, nebivolol accounts for just under 7% of beta-blocker prescriptions - another class of medications used for conditions like high blood pressure and heart problems - and around 2% of overall cardiovascular drug prescriptions. Nebivolol's prevalence has seen an upward trend over recent years due to its unique properties among beta-blockers including vasodilation capability.


Both Benicar (olmesartan) and Bystolic (nebivolol) are widely used for the treatment of high blood pressure, with a wealth of clinical evidence supporting their effectiveness over placebo treatments. At times, these drugs may be used in combination to achieve optimal control of hypertension, but this requires careful consideration by a physician due to differences in their mechanisms of action: Benicar is an angiotensin receptor blocker that inhibits the effect of angiotensin II on blood vessels, while Bystolic belongs to the class of beta-blockers that work by slowing down heart rate and reducing cardiac output.

Both medications come in generic forms providing substantial cost savings for patients paying out-of-pocket. The onset or noticeable effects from taking either drug might not be immediate as your body adjusts to them.

The side effect profiles show similarities between both medications; however, they feature distinct adverse reactions based on their pharmacological properties. While both are generally well-tolerated, Benicar can cause dizziness or lightheadedness due to lowered blood pressure while Bystolic may lead more commonly to fatigue and bradycardia (slow heart rate). Regardless of which medication is chosen for managing hypertension, it's critical that patients monitor any changes in health closely upon initiation and throughout therapy - seeking medical attention promptly if any concerning symptoms arise.