From the Guidelines
The maximum recommended 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 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1. According to this study, the target dose for lisinopril is 20 mg once daily, but it can be increased up to 40 mg once daily if needed and tolerated.
Key Considerations
- Lisinopril should typically be started at a lower dose (usually 5-10 mg daily for hypertension, 2.5-5 mg daily for heart failure) and gradually increased as needed based on blood pressure response and tolerability.
- Patients with renal impairment require lower doses, with a maximum of 10-20 mg daily depending on creatinine clearance.
- Lisinopril works by inhibiting angiotensin-converting enzyme (ACE), which reduces the production of angiotensin II, a potent vasoconstrictor, resulting in vasodilation and decreased blood pressure.
- Common side effects include dry cough, dizziness, and hyperkalemia.
- Blood pressure, renal function, and potassium levels should be monitored regularly, especially after dose adjustments.
Monitoring and Adjustments
- Regular monitoring of blood pressure, renal function, and potassium levels is crucial to ensure safe and effective use of lisinopril.
- Dose adjustments may be necessary based on the patient's response to treatment and the presence of any side effects.
- Patients should be educated on the importance of adhering to their medication regimen and reporting any changes in their condition to their healthcare provider. Some older studies, such as the 2013 ACCF/AHA guideline for the management of heart failure 1 and the 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure 1, also support the use of lisinopril in the treatment of heart failure, but the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1 provides the most up-to-date and relevant guidance on the use of lisinopril in clinical practice.
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 for adults with hypertension, and 40 mg for other conditions, including heart failure and pediatric patients 2.
From the Research
Maximum Dose of Lisinopril
The maximum dose of lisinopril varies depending on the patient's condition and the study.
- In the ATLAS study, high doses of lisinopril ranged from 32.5 to 35mg, administered once daily 3.
- In another study, lisinopril was shown to be effective at doses of 10 to 80mg given once daily in patients with essential and secondary hypertension caused by renal artery stenosis 4.
- A study on elderly patients with mild to moderate hypertension found that most patients required a daily dose of 20-40mg of lisinopril for effective 24-h blood pressure control 5.
Safety and Efficacy
The safety and efficacy of lisinopril have been assessed in various studies.
- The ATLAS study found that high doses of lisinopril were associated with a higher incidence of adverse events, such as hypotension and worsening renal function, but these events were generally well managed by altering the dose of lisinopril or concomitant medications 3.
- A retrospective cohort study found that twice-daily administration of lisinopril was associated with greater systolic blood pressure reductions compared to once-daily administration 6.
- A study on elderly patients found that once-daily lisinopril monotherapy reduced blood pressure safely without affecting heart rate 5.
Comparison with Other Medications
Lisinopril has been compared to other medications in various studies.
- The ATLAS study found that high doses of lisinopril were more effective than low doses in reducing the risk of major clinical events in patients with heart failure 3.
- A study found that diuretics, such as chlorthalidone, were superior to calcium channel blockers and angiotensin-converting enzyme inhibitors, such as lisinopril, in preventing heart failure in hypertensive individuals 7.