Enalapril to Lisinopril Dose Equivalency
Based on guideline evidence and clinical trial data, enalapril 10 mg twice daily (20 mg total daily) is approximately equivalent to lisinopril 20 mg once daily.
Evidence-Based Dose Conversion
The most reliable dose equivalency comes from major heart failure trials where both drugs demonstrated mortality benefit 1, 2:
- Enalapril: Target dose 10 mg twice daily (20 mg total daily)
- Lisinopril: Target dose 20-40 mg once daily
The practical conversion ratio is approximately 1:1 when comparing total daily doses (e.g., enalapril 20 mg/day ≈ lisinopril 20 mg/day) 3, 4, 5.
Detailed Conversion Table
Based on guideline-recommended dosing 1, 2, 5:
| Enalapril Daily Dose | Equivalent Lisinopril Daily Dose |
|---|---|
| 5 mg (2.5 mg BID) | 5 mg once daily |
| 10 mg (5 mg BID) | 10 mg once daily |
| 20 mg (10 mg BID) | 20 mg once daily |
| 40 mg (20 mg BID) | 40 mg once daily |
Clinical Context
For Heart Failure
- Enalapril: Evidence-based target is 10 mg twice daily (mean achieved dose 16.6-18.4 mg/day in trials) 1, 2
- Lisinopril: Evidence-based target is 20-40 mg once daily (mean achieved dose 32.5-35 mg/day in ATLAS trial) 1, 2
For Hypertension
Both drugs show similar efficacy at equivalent total daily doses, though some studies suggest lisinopril may provide slightly more sustained 24-hour blood pressure control at equal doses 6, 7.
For Post-MI
- Enalapril: 10 mg twice daily was the target dose used in PARADIGM-HF 8
- Lisinopril: 10 mg once daily is the typical target post-MI 9
Important Conversion Considerations
When switching between these agents:
Start conservatively: Begin with the equivalent or slightly lower dose, especially in patients with:
Titration schedule: Increase dose every 1-2 weeks as tolerated to reach target doses 4, 5
Monitoring: Check blood pressure, renal function, and potassium within 1-2 weeks after conversion 1
Pharmacokinetic differences:
Renal Dosing Adjustments
For creatinine clearance 10-30 mL/min 10, 11:
- Enalapril: Start 2.5 mg daily
- Lisinopril: Start 2.5-5 mg daily
For hemodialysis or CrCl <10 mL/min:
- Both: Start 2.5 mg daily
Comparative Effectiveness
A large propensity-matched cohort study found no significant mortality difference between enalapril, lisinopril, and ramipril when given at equivalent doses in heart failure patients 13. This supports the 1:1 total daily dose equivalency for clinical outcomes.