What is the maximum dose of Lisinopril (Angiotensin-Converting Enzyme Inhibitor)?

From the Guidelines

The maximum dose of lisinopril is 40 mg daily. This recommendation is based on the most recent and highest quality evidence available, which suggests that doses above 40 mg daily do not provide additional benefits and may increase the risk of adverse effects 1. Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly used to treat hypertension and heart failure. The dosing typically starts at 10 mg daily and can be gradually increased as needed based on blood pressure response.

Key Considerations

• Patients with kidney impairment may require lower maximum doses, often not exceeding 10-20 mg daily.
• Side effects may include dry cough, dizziness, and rarely angioedema.
• Blood pressure and kidney function should be monitored regularly while taking this medication, especially when approaching maximum doses.
• The goal dose should be at the higher end of the dose range when possible, as higher levels of blood pressure are associated with more rapid progression of kidney disease 1.

Evidence-Based Recommendations

• The American Journal of Kidney Diseases recommends a goal dose of 20-40 mg daily for lisinopril 1.
• The Circulation journal suggests a maximum dose of 20-40 mg once daily for lisinopril 1.
• Both studies support the use of lisinopril as an effective treatment for hypertension and heart failure, with a maximum dose of 40 mg daily.

Clinical Implications

• Clinicians should carefully monitor patients taking lisinopril, especially when approaching maximum doses.
• Patients with severe hypertension or those who haven't responded adequately to lower doses may require higher doses, but this should be done with caution and close monitoring.
• The benefits of lisinopril in reducing blood pressure and slowing the progression of kidney disease should be weighed against the potential risks of adverse effects.

From the FDA Drug Label

DOSAGE & ADMINISTRATION 2. 1 Hypertension ... Doses up to 80 mg have been used but do not appear to give greater effect Pediatric Patients 6 years of age and older with hypertension ... up to a maximum of 0.61 mg per kg (up to 40 mg) once daily. 2. 2 Heart Failure ... Increase as tolerated to a maximum of 40 mg once daily. 2. 4 Dose in Patients with Renal Impairment ... Up titrate as tolerated to a maximum of 40 mg daily.

The maximum dose of Lisinopril is 80 mg per day for adults with hypertension, and 40 mg per day for other conditions, including heart failure and pediatric patients 2.

From the Research

Lisinopril Maximum Dose

• The maximum dose of lisinopril varies depending on the condition being treated.
• For essential hypertension, the maximum dose is 80 mg once daily 3.
• For congestive heart failure, the maximum dose is 35-40 mg once daily 4, 5.
• In elderly patients, the maximum dose tends to range from 2.5 to 40 mg/day, with lower doses usually needed in patients with significant renal impairment 6.
• The dose of lisinopril should be individualized according to the patient's response and tolerance 3, 4, 5, 6, 7.

Factors Affecting Maximum Dose

• Renal impairment: lower doses are usually needed in patients with significant renal impairment 6.
• Age: elderly patients may require lower doses due to decreased renal function and other age-related factors 6.
• Concomitant medications: interactions with other medications, such as diuretics or lithium, may affect the maximum dose of lisinopril 6.

Clinical Efficacy and Safety

• Lisinopril has been shown to be effective in reducing blood pressure and improving symptoms in patients with hypertension and congestive heart failure 3, 4, 5, 6, 7.
• The drug is generally well-tolerated, with common adverse events including dizziness, headache, hypotension, and diarrhea 4, 6.