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

From the Guidelines

The maximum dose of lisinopril is 40 mg once daily for most indications, including hypertension and heart failure, as recommended by the most recent guidelines 1. This dose is typically achieved by starting at a lower dose, such as 2.5-5 mg once daily, and gradually increasing as needed based on blood pressure response and tolerability. The medication works by inhibiting angiotensin-converting enzyme (ACE), which reduces the production of angiotensin II, a potent vasoconstrictor, resulting in blood vessel relaxation and lower blood pressure. Some key points to consider when prescribing lisinopril include:

• Monitoring blood pressure and kidney function regularly while taking lisinopril
• Adjusting the dose based on individual patient response and tolerability
• Considering lower maximum doses for patients with kidney impairment, typically not exceeding 10-20 mg daily depending on their creatinine clearance
• Being aware of common side effects, such as dry cough, dizziness, and headache. It's also important to note that the use of higher doses of lisinopril, up to 80 mg daily, may be considered in certain cases, but this is less common and generally considered off-label 1. Overall, the goal of lisinopril therapy is to achieve consistent blood pressure control while minimizing adverse effects, and the most recent guidelines provide a framework for achieving this goal 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

Lisinopril Dosage

• The maximum dose of lisinopril varies depending on the patient's condition and response to treatment, but studies have used doses up to 40 mg once daily 3, 4.
• In one study, patients with mild to moderate hypertension received doses of 10,20, and 40 mg once-daily lisinopril, with some patients requiring the maximum dose of 40 mg 3.
• Another study used a dose of 5 mg as a starting point for elderly patients, increasing to a maximum of 40 mg once daily as required 4.
• A retrospective cohort study compared the efficacy and safety of twice- vs once-daily dosing of lisinopril, with patients receiving either 40 mg once daily or 20 mg twice daily 5.

Efficacy and Safety

• Studies have shown that lisinopril is effective in reducing blood pressure in patients with mild to moderate hypertension, with significant reductions in systolic and diastolic blood pressure 3, 6, 7.
• Lisinopril has been shown to be well-tolerated, with few side effects reported in clinical trials 3, 6, 4, 7.
• The antihypertensive effect of lisinopril has been sustained throughout the 24-hour period, without any significant effect on heart rate 6, 7.

Dosage Comparison

• A study compared the efficacy of once-daily and twice-daily dosing of lisinopril, with twice-daily dosing associated with greater systolic blood pressure reductions 5.
• However, other studies have shown that once-daily lisinopril is effective in reducing blood pressure, with significant reductions in systolic and diastolic blood pressure 3, 6, 7.