From the Guidelines
The maximum dose of lisinopril is 20 mg once daily for most indications, including hypertension and heart failure, as recommended by the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1.
Key Considerations
- Lisinopril is typically started at lower doses (5-10 mg daily for hypertension, 2.5-5 mg daily for heart failure) and titrated upward every 1-2 weeks based on blood pressure response or clinical improvement.
- Patients with renal impairment require lower maximum doses, generally not exceeding 10-20 mg daily depending on creatinine clearance.
- Elderly patients may also need lower doses due to potentially reduced kidney function.
- The medication works by inhibiting angiotensin-converting enzyme (ACE), which prevents the formation of angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure and decreasing cardiac workload.
Monitoring and Side Effects
- Patients should be monitored for potential side effects including cough, angioedema, hyperkalemia, and changes in renal function, particularly when approaching maximum dosages.
- The use of an ACEI can also minimize or eliminate the need for long-term potassium supplementation, as noted in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1.
Clinical Guidelines
- The 2020 ACC/AHA clinical performance and quality measures for adults with heart failure provide target doses for guideline-directed medical therapies, including lisinopril 1.
- The 2013 ACCF/AHA heart failure clinical practice guideline and the 2017 ACC/AHA/HFSA heart failure guideline update also provide recommendations for the use of ACE inhibitors in heart failure 1.
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 dosing of Lisinopril is 80 mg per day for adults with hypertension, and 40 mg per day for pediatric patients 6 years of age and older with hypertension, as well as for patients with heart failure or renal impairment 2.
From the Research
Lisinopril Dosing Maximum
- The maximum dosing of lisinopril varies depending on the patient population and the specific condition being treated, as seen in studies 3, 4, 5.
- In patients with essential hypertension, the maximum dose of lisinopril is 80 mg once daily, as reported in a study published in the journal Drugs 3.
- In elderly patients with hypertension, the maximum dose of lisinopril is 40 mg daily, with a starting dose of 5 mg in patients with a glomerular filtration rate (GFR) of 30-60 ml/min and 10 mg in patients with a GFR greater than 60 ml/min, as seen in a study published in the Journal of cardiovascular pharmacology 4.
- In a controlled multicenter study, the maximum dose of lisinopril was 80 mg once daily, with doses titrated upwards to achieve blood pressure control 5.
- There is no direct information on the maximum dosing of lisinopril in the studies 6, 7, which focus on combination therapy and the effects of different antihypertensive drug combinations on blood pressure and arterial stiffness.