From the Guidelines
When converting from losartan 25mg to lisinopril, the equivalent dose is approximately 10mg of lisinopril once daily, as indicated in the most recent guidelines 1. This conversion should be done under medical supervision, with careful monitoring of blood pressure and kidney function during the transition. The switch should not be abrupt; it's often recommended to stop losartan for 24 hours before starting lisinopril to avoid potential overlapping effects. Some key points to consider during this conversion include:
- Monitoring kidney function and potassium levels, especially in patients with diabetes, kidney disease, or those taking potassium supplements or potassium-sparing diuretics 1.
- Being aware of the different side effect profiles of losartan and lisinopril, with lisinopril more commonly associated with a dry cough than losartan 1.
- Regularly checking blood pressure after the conversion to ensure the new medication is providing adequate control 1. It's essential to prioritize the patient's safety and adjust the dosage as needed to minimize potential adverse effects while maintaining effective blood pressure control. The goal is to achieve the best possible outcome in terms of morbidity, mortality, and quality of life, and this can be accomplished by carefully managing the conversion process and monitoring the patient's response to the new medication.
From the Research
Losartan to Lisinopril Conversion
- The conversion from losartan to lisinopril is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies provide information on the efficacy and safety of both losartan and lisinopril in the management of hypertension.
- Losartan is an angiotensin II receptor antagonist, while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor 2, 3.
- A study comparing the effectiveness and safety of twice-daily versus once-daily lisinopril and losartan found no significant differences in blood pressure control between the two dosing regimens 4.
- Another study reported a case of acute renal failure during combined therapy with lisinopril and losartan for proteinuria, highlighting the need for close surveillance of renal function and blood pressure during such therapy 5.
- The risk of hyperkalemia associated with renin-angiotensin system blockade, including ACE inhibitors and angiotensin receptor blockers, is a concern in patients with chronic renal insufficiency 6.
Dosing Considerations
- The typical starting dose of losartan is 50mg once daily, while the typical starting dose of lisinopril is 10mg once daily 2, 4.
- The dose of losartan can be increased to 100mg once daily if necessary, while the dose of lisinopril can be increased to 20mg or 30mg once daily if necessary 2, 4.
- When converting from losartan to lisinopril, the dose of lisinopril should be individualized based on the patient's response to therapy and tolerance to the medication.
Safety Considerations
- Both losartan and lisinopril can cause adverse effects, including dizziness, headache, and cough 2, 3, 4.
- The risk of renal dysfunction and hyperkalemia should be carefully monitored in patients taking either losartan or lisinopril, especially in those with underlying renal disease or diabetes 3, 5, 6.