What is the maximum dose of lisinopril (Angiotensin-Converting Enzyme inhibitor)?

From the Guidelines

The maximum dose of lisinopril is 40 mg once daily for most indications, including hypertension and heart failure. This is based on the most recent and highest quality study available, which is the 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults 1.

Key Points to Consider

• Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that works by preventing the conversion of angiotensin I to angiotensin II, thereby reducing blood pressure and decreasing cardiac workload.
• When starting lisinopril, it's essential to begin with a lower dose (usually 2.5 to 5 mg) and gradually increase as needed to reach the target blood pressure or therapeutic effect, as recommended in the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1.
• Dose adjustments are necessary for patients with kidney impairment, with lower maximum doses recommended.
• Patients should take lisinopril at the same time each day, and blood pressure and kidney function should be monitored regularly, especially after dose increases.
• Common side effects include dry cough, dizziness, and headache, while serious but rare side effects include angioedema and hyperkalemia.

Monitoring and Follow-Up

• Regular monitoring of blood pressure and kidney function is crucial, especially after dose increases.
• Patients should be educated on the importance of adhering to their medication regimen and reporting any side effects or concerns to their healthcare provider.
• The use of lisinopril in combination with other medications, such as aspirin, should be carefully considered, as there may be potential interactions that can affect the efficacy and safety of the treatment, as discussed in the ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in adults 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 ... Dosage should be adjusted according to blood pressure response 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, as higher doses do not appear to give greater effect 2
• 40 mg per day for:
  • Pediatric patients 6 years of age and older with hypertension 2
  • Patients with heart failure 2
  • Patients with renal impairment, with creatinine clearance ≥ 10 mL/min and ≤ 30 mL/min, or those on hemodialysis 2

From the Research

Maximum Dose of Lisinopril

• The maximum dose of lisinopril is not explicitly stated in the provided studies, but the dose range for various conditions is mentioned:
  • For essential hypertension, dosages of 20 to 80 mg once daily are effective in lowering blood pressure 3
  • In patients with congestive heart failure, lisinopril 2.5 to 20 mg once daily improved indices of cardiac function 3
  • In elderly patients with hypertension, the dose of lisinopril could be titrated upwards to a maximum of 40 mg daily according to blood pressure response 4
• The median dose of lisinopril given in one study was 20 mg daily, with a range of 5-40 mg daily 4
• Another study compared the efficacy of lisinopril alone (mean dose 68 +/- 12 mg daily) with lisinopril plus hydrochlorothiazide (mean dose 48 +/- 6 mg daily) in essential hypertension, with both regimens being equally effective in lowering blood pressure 5