From the Guidelines
The recommended starting dose of Lisinopril for adults with hypertension is 10 mg daily. According to the KDOo clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease 1, the starting dose for Lisinopril is 10 mg daily, with a goal dose of 20-40 mg daily.
Key Considerations
- The dose can be adjusted based on blood pressure response, usually at intervals of 1-2 weeks.
- A lower initial dose may be advised for patients with certain conditions, such as renal impairment or volume depletion.
- The maximum recommended daily dose is 40 mg.
Mechanism of Action
Lisinopril works by inhibiting angiotensin-converting enzyme (ACE), which prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
Administration
Patients should take Lisinopril at approximately the same time each day, with or without food, and should be advised that the full therapeutic effect may take several weeks to develop.
Monitoring
Blood pressure monitoring is essential during dose adjustment periods. Some key points to consider when prescribing Lisinopril include:
- Its effectiveness in slowing the progression of kidney disease characterized by microalbuminuria in hypertensive patients with type 1 or type 2 diabetes 1.
- The importance of achieving a goal dose at the higher end of the dose range when possible 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. The recommended starting dose for Lisinopril in adults with hypertension is 10 mg once a day 2.
- The dose should be adjusted according to blood pressure response.
- The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose.
- However, if the patient is taking diuretics, the recommended starting dose is 5 mg once per day.
From the Research
Recommended Starting Dose for Lisinopril
The recommended starting dose for Lisinopril in adults with hypertension is:
- 2.5 to 5 mg once daily, as indicated by studies 3, 4
- This dose can be increased to a maximum of 40 mg once daily as required, with most patients achieving adequate blood pressure reduction with doses between 20 to 40 mg once daily 3, 4
Considerations for Specific Patient Populations
- In elderly patients with mild to moderate hypertension, a starting dose of 5 mg once daily is considered safe, with most patients requiring a daily dose of 20-40 mg 4
- There is no direct evidence to suggest a different starting dose for other specific patient populations, such as those with congestive heart failure or renal impairment
Comparison of Once-Daily and Twice-Daily Dosing
- Studies have compared the efficacy and safety of once-daily and twice-daily dosing of Lisinopril, with one study finding that twice-daily dosing was associated with greater systolic blood pressure reductions compared to once-daily dosing 5
- However, the majority of studies have used once-daily dosing, and this remains the most commonly recommended dosing regimen 3, 6, 7, 4