What is the recommended dosage of Lisinopril (Angiotensin-Converting Enzyme Inhibitor)?

From the Guidelines

Lisinopril dosing typically starts at 10 mg once daily for hypertension, though some patients may begin at 5 mg if they're at risk for hypotension, and can be gradually increased to 20-40 mg daily based on blood pressure response, with the maximum recommended dose being 40 mg per day, as recommended by the most recent guidelines 1.

Key Considerations

• The dose can be adjusted based on blood pressure response, with a goal of achieving optimal blood pressure control to reduce the risk of morbidity and mortality.
• For heart failure patients, treatment usually begins at 2.5-5 mg daily, potentially increasing to 20-40 mg daily as tolerated, with a target dose of 20 mg once daily 1.
• Patients with kidney impairment require lower initial doses, and their kidney function should be monitored regularly while taking this medication.

Mechanism of Action and Side Effects

• As an ACE inhibitor, lisinopril works by preventing the conversion of angiotensin I to angiotensin II, thereby relaxing blood vessels and reducing blood pressure.
• Common side effects include dry cough, dizziness, and elevated potassium levels, which should be monitored regularly while taking this medication.

Monitoring and Follow-up

• Blood pressure and kidney function should be monitored regularly while taking this medication to adjust the dose as needed and minimize the risk of adverse effects.
• The patient's response to treatment should be evaluated regularly, and the dose adjusted accordingly to achieve optimal blood pressure control and minimize the risk of morbidity and mortality.

From the FDA Drug Label

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. The recommended starting dose in adult patients with hypertension taking diuretics is 5 mg once per day. For pediatric patients with glomerular filtration rate > 30 mL/min/1.73m2, the recommended starting dose is 0. 07 mg per kg once daily (up to 5 mg total). 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. 2. 3 Reduction of Mortality in Acute Myocardial Infarction In hemodynamically stable patients within 24 hours of the onset of symptoms of acute myocardial infarction, give lisinopril tablets 5 mg orally, followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg once daily. 2. 4 Dose in Patients with Renal Impairment No dose adjustment of lisinopril tablets is required in patients with creatinine clearance > 30 mL/min.

The recommended dosage of Lisinopril varies based on the condition being treated:

• Hypertension: 10 mg once a day, with a usual dosage range of 20 mg to 40 mg per day
• Hypertension with diuretics: 5 mg once per day
• Pediatric patients: 0.07 mg per kg once daily (up to 5 mg total)
• Heart Failure: 5 mg once daily
• Acute Myocardial Infarction: 5 mg orally, followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg once daily
• Renal Impairment: No dose adjustment required for creatinine clearance > 30 mL/min, with reduced initial doses for lower creatinine clearance 2

From the Research

Lisinopril Dosage Information

• The typical dosage of lisinopril varies depending on the patient's condition and renal function 3, 4, 5.
• For patients with normal renal function, the usual starting dose is 5-10 mg once daily, with a maximum dose of 40 mg daily 3, 4.
• In patients with severe renal impairment (creatinine clearance less than or equal to 30 ml/min), the starting dose should be 2.5 mg once daily, with careful monitoring of renal function and adjustment of the dose as needed 4, 5.
• The effective half-life of lisinopril is doubled and tripled in patients with mild and severe renal impairment, respectively, compared to patients with normal renal function 5.

Dosage Adjustments

• Dosage adjustments may be necessary based on the patient's response to treatment and renal function 3, 4, 5.
• In patients with congestive heart failure, high doses of lisinopril (32.5-35 mg once daily) have been shown to be more effective than low doses (2.5-5 mg once daily) in reducing the risk of major clinical events 6.
• Twice-daily dosing of lisinopril has been associated with greater systolic blood pressure reductions compared to once-daily dosing with the same total daily dose 7.

Special Considerations

• Lisinopril is not metabolized or bound to protein, and its bioavailability is not significantly affected by food, age, or coadministration of other medications 3.
• Patients with renal impairment should be monitored closely for signs of worsening renal function, and the dose of lisinopril should be adjusted accordingly 4, 5.
• Lisinopril has been shown to be well tolerated in patients with hypertension and congestive heart failure, with a low incidence of adverse events 3, 4, 6.