From the Guidelines
The maximum recommended dose of lisinopril is 40 mg once daily for most indications, including hypertension, heart failure, and post-myocardial infarction. However, treatment typically starts at lower doses (5-10 mg daily for hypertension, 2.5-5 mg daily for heart failure) and is gradually titrated upward based on blood pressure response and tolerability. Patients with renal impairment (creatinine clearance <30 mL/min) should receive lower doses, generally not exceeding 10-20 mg daily. Lisinopril works by inhibiting angiotensin-converting enzyme (ACE), which prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to decreased peripheral resistance, reduced sodium and water retention, and ultimately lower blood pressure. Common side effects include dry cough, dizziness, and hyperkalemia. Blood pressure, renal function, and potassium levels should be monitored regularly, especially during dose adjustments. The medication is typically taken at the same time each day, with or without food, to maintain consistent blood levels. According to the most recent guidelines, including the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1, and the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, the recommended target dose for lisinopril is 20 mg once daily, with a maximum dose of 40 mg once daily.
Some key points to consider when prescribing lisinopril include:
- Starting with a low dose and titrating upward as needed and tolerated
- Monitoring blood pressure, renal function, and potassium levels regularly
- Adjusting the dose based on individual patient response and tolerability
- Being aware of potential side effects, such as dry cough, dizziness, and hyperkalemia
- Considering the use of alternative agents, such as angiotensin receptor blockers (ARBs), in patients who are intolerant of ACE inhibitors.
It's also important to note that the use of lisinopril in patients with heart failure is supported by several studies, including the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 1, and the ACC/aha 2005 guideline update for the diagnosis and management of chronic heart failure in the adult 1.
In terms of specific dosing recommendations, the following are some key points to consider:
- The usual dose range for lisinopril is 10-40 mg once daily
- The maximum recommended dose is 40 mg once daily
- Patients with renal impairment should receive lower doses, generally not exceeding 10-20 mg daily.
Overall, the use of lisinopril in the treatment of hypertension, heart failure, and post-myocardial infarction is supported by a large body of evidence, and the medication is generally well-tolerated and effective. However, as with any medication, it's essential to carefully consider the individual patient's needs and circumstances, and to monitor them closely for potential side effects and interactions.
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 recommended dose of Lisinopril is 80 mg per day for adults with hypertension, and 40 mg per day for other conditions, including heart failure and reduction of mortality in acute myocardial infarction, as well as for pediatric patients 6 years of age and older with hypertension 2.
From the Research
Maximum Recommended Dose of Lisinopril
The maximum recommended dose of Lisinopril varies depending on the condition being treated.
- For essential hypertension, the maximum dose is 80 mg once daily 3.
- For congestive heart failure, the maximum dose is 35-40 mg once daily, as demonstrated in the Assessment of Treatment with Lisinopril and Survival (ATLAS) study 4.
- In some studies, doses up to 40 mg once daily were used to treat mild to moderate essential hypertension 5.
Dosage Range
The dosage range for Lisinopril is:
- 20 to 80 mg once daily for essential hypertension 3
- 2.5 to 20 mg once daily for congestive heart failure 3
- 2.5 to 35 mg once daily for congestive heart failure, as demonstrated in the ATLAS study 4
Titration
The dose of Lisinopril can be titrated to achieve the desired blood pressure reduction.
- In one study, the dose was increased weekly to a maximum of 40 mg once daily until the treatment goal of diastolic blood pressure of less than 90 mmHg was reached 5.