From the Guidelines
The maximum dose of lisinopril is 40 mg once daily. This dose is typically reached through gradual titration, starting from lower doses such as 10 mg daily, as indicated in the guidelines for the treatment of patients with heart failure with low ejection fraction 1. For hypertension, many patients achieve adequate blood pressure control at 20 mg daily, but doses up to 40 mg may be used if needed. In heart failure, the target dose is often 20-40 mg daily. It's essential to note that kidney function can affect dosing, and patients with renal impairment may require lower doses. The maximum dose should be administered under close medical supervision, with regular monitoring of blood pressure, kidney function, and electrolytes, particularly potassium levels. Higher doses increase the risk of side effects such as hypotension and hyperkalemia. The 40 mg maximum is based on the balance between achieving therapeutic effects and minimizing risks associated with ACE inhibition.
Key considerations for dosing lisinopril include:
- Starting dose: 10 mg daily
- Goal dose: 20-40 mg daily
- Maximum dose: 40 mg once daily
- Monitoring: regular checks of blood pressure, kidney function, and electrolytes, especially potassium levels
- Special considerations: patients with renal impairment may require lower doses, and those with heart failure may require closer monitoring of their condition. The guidelines from the American College of Cardiology/American Heart Association Task Force on Practice Guidelines support the use of lisinopril up to 40 mg daily for the treatment of heart failure with low ejection fraction 1. Additionally, the American Journal of Kidney Diseases provides guidance on the doses of ACE inhibitors, including lisinopril, for adults with diabetes and chronic kidney disease, recommending a goal dose of 20-40 mg daily 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 for adults with hypertension, and 40 mg for other indications, including heart failure, and for pediatric patients 2.
From the Research
Maximum Dose of Lisinopril
The maximum dose of lisinopril varies depending on the patient's condition and response to treatment.
- In patients with hypertension, the maximum dose of lisinopril is up to 80 mg once daily 3.
- In patients with congestive heart failure, high doses of lisinopril (32.5 to 35mg, administered once daily) have been used in the Assessment of Treatment with Lisinopril and Survival (ATLAS) study 4.
- In patients with hypertension associated with impaired renal function, the maximum dose of lisinopril was 40 mg daily according to blood pressure response 5, 6.
- In elderly patients, dosages effective in lowering blood pressure tend to range from 2.5 to 40 mg/day, with lower dosages usually needed in patients with significant renal impairment 7.