What is the dose range for Lisinopril (Angiotensin-Converting Enzyme Inhibitor)?

From the Guidelines

Lisinopril is typically prescribed in a dose range of 2.5 to 40 mg once daily for most adults, with a usual maintenance dose of 20-40 mg once daily for hypertension and 5-20 mg daily for heart failure, as recommended by the most recent guidelines 1. The dose range of lisinopril can vary depending on the patient's condition and response to treatment.

• For hypertension, the dose can be gradually increased every 1-2 weeks based on blood pressure response and tolerability, with a goal dose of 20-40 mg once daily.
• For heart failure, the dose typically ranges from 5-20 mg daily, with some studies suggesting a target dose of 30-35 mg once daily 1.
• For patients who have recently experienced a heart attack, treatment often starts at 5 mg, increasing to 10 mg after 24 hours, then to a maintenance dose of 10 mg daily. Some key points to consider when prescribing lisinopril include:
• Lower initial doses (2.5-5 mg) are recommended for elderly patients, those with renal impairment (creatinine clearance <30 mL/min), or patients who are volume-depleted.
• Lisinopril works by inhibiting angiotensin-converting enzyme (ACE), which reduces the formation of angiotensin II, a potent vasoconstrictor, resulting in vasodilation and decreased blood pressure.
• Patients should take lisinopril at the same time each day, and should be monitored for potential side effects including dry cough, dizziness, hyperkalemia, and rarely angioedema, as noted in various studies 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose. Doses up to 80 mg have been used but do not appear to give greater effect 2. 2 Heart Failure The recommended starting dose for lisinopril tablets, when used with diuretics and (usually) digitalis as adjunctive therapy for systolic heart failure, is 5 mg once daily... Increase as tolerated to a maximum of 40 mg once daily. 2. 3 Reduction of Mortality in Acute Myocardial Infarction ...Dosing should continue for at least six weeks... If hypotension occurs (systolic blood pressure ≤ 100 mmHg) a daily maintenance dose of 5 mg may be given with temporary reductions to 2. 5 mg if needed. 2. 4 Dose in Patients with Renal Impairment ...In patients with creatinine clearance ≥ 10 mL/min and ≤ 30 mL/min, reduce the initial dose of lisinopril tablets to half of the usual recommended dose i.e., hypertension, 5 mg; systolic heart failure, 2.5 mg and acute MI, 2. 5 mg. Up titrate as tolerated to a maximum of 40 mg daily.

The lisinopril dose range is:

• Hypertension: 20 mg to 40 mg per day, with a maximum dose of 80 mg per day
• Heart Failure: up to a maximum of 40 mg once daily
• Acute Myocardial Infarction: 5 mg to 10 mg once daily, with a maximum dose of 10 mg once daily
• Renal Impairment: up to a maximum of 40 mg daily 2

From the Research

Lisinopril Dose Range

• The dose range of lisinopril for the treatment of hypertension is between 10 to 80 mg given once daily 3.
• Lisinopril has been shown to be an effective antihypertensive agent at these doses in patients with essential and secondary hypertension caused by renal artery stenosis 3.
• The effectiveness of lisinopril is comparable to that with diuretics, beta blockers, and calcium-channel antagonists 3.
• In patients who are unresponsive to maximal doses of lisinopril alone, addition of another antihypertensive agent may be beneficial 3.

Combination Therapy

• Combination antihypertensive drugs, including ACE inhibitors like lisinopril, are often needed to achieve adequate blood pressure control 4, 5.
• ACE inhibitors and diuretics are one of the combinations used in the treatment of hypertension 4.
• In patients with heart failure with reduced ejection fraction, treatment should include an ACEI or ARB, and in patients with chronic kidney disease and proteinuria, treatment should include an ACEI or ARB plus a thiazide diuretic or a calcium channel blocker 5.

Specific Studies

• A study found that adding a diuretic to lisinopril and amlodipine was more effective than adding a beta-blocker in hypertensive patients not controlled on amlodipine and lisinopril 6.
• Another study compared outcomes and adverse events between ACE inhibitors and ARBs in patients with hypertension, and found no difference in efficacy but fewer adverse events with ARBs 7.