From the Guidelines
The equivalent dose of lisinopril 40mg is approximately valsartan 320mg. When switching from an ACE inhibitor like lisinopril to an ARB like valsartan, it's essential to consider the maximum therapeutic dose of valsartan to match the blood pressure lowering effect of maximum-dose lisinopril. According to the 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure 1, the maximum dose of valsartan is 160 mg BID, which is equivalent to 320 mg daily. These medications work differently - lisinopril prevents the formation of angiotensin II by inhibiting ACE, while valsartan blocks angiotensin II receptors directly. When transitioning between these medications, monitor blood pressure closely for 1-2 weeks as individual responses vary. Start with the equivalent dose but be prepared to adjust based on blood pressure readings. Both medications are typically taken once or twice daily, and valsartan may cause fewer side effects like cough compared to lisinopril, which is often a reason for switching between these medication classes. Kidney function and potassium levels should be monitored with either medication.
Some key points to consider when switching between lisinopril and valsartan include:
- Monitoring blood pressure closely after switching medications
- Adjusting the dose based on individual response
- Considering the potential for fewer side effects with valsartan
- Monitoring kidney function and potassium levels
- Using the maximum therapeutic dose of valsartan (320mg daily) to match the blood pressure lowering effect of maximum-dose lisinopril (40mg daily) 1.
It's also important to note that the dose of valsartan may need to be adjusted based on individual patient factors, such as renal function and blood pressure response. However, based on the available evidence, the equivalent dose of lisinopril 40mg is approximately valsartan 320mg.
From the Research
Equivalent Dose of Lisinopril to Valsartan
To determine the equivalent dose of lisinopril 40mg to valsartan, we need to consider the available evidence from clinical studies.
- The study 2 compared the efficacy and safety of combination therapy of valsartan and lisinopril with valsartan and lisinopril high-dose monotherapy in patients with hypertension and microalbuminuria. In this study, lisinopril 40mg was compared to valsartan 320mg.
- Another study 3 compared the long-term efficacy and tolerability of valsartan to lisinopril in elderly patients with essential hypertension. In this study, valsartan 80mg was compared to lisinopril 2.5mg, and the dose was titrated as needed.
- The study 4 compared the efficacy, safety, and tolerability of valsartan to lisinopril and placebo in patients with mild-to-moderate essential hypertension. In this study, valsartan 80mg was compared to lisinopril 10mg, and the dose was titrated as needed.
- The study 5 compared the risk-benefit profile of valsartan 160mg with lisinopril 20mg, given as monotherapy or in combination with a diuretic, for the treatment of hypertension.
Dose Comparison
Based on the available evidence, the equivalent dose of lisinopril 40mg to valsartan is not directly stated. However, we can make an educated estimate based on the dose comparisons in the studies:
- Lisinopril 40mg was compared to valsartan 320mg in study 2.
- Valsartan 80mg was compared to lisinopril 2.5mg in study 3, and valsartan 80mg was compared to lisinopril 10mg in study 4.
- Valsartan 160mg was compared to lisinopril 20mg in study 5.
Estimated Equivalent Dose
Based on the dose comparisons in the studies, it appears that valsartan 320mg may be equivalent to lisinopril 40mg, as seen in study 2. However, this estimate is based on a single study and may not be generalizable to all patients. More research is needed to confirm this estimate.