What is the equivalent dose of lisinopril (Angiotensin-Converting Enzyme (ACE) inhibitor) for benazepril (ACE inhibitor) 20 milligrams?

Equivalent Dose of Lisinopril to Benazepril 20 mg

The equivalent dose of lisinopril to benazepril 20 mg is 20 mg once daily. 1

Dose Equivalence Rationale

According to the KDOQI Clinical Practice Guidelines, ACE inhibitors have established dosing equivalencies for treating hypertension and kidney disease. The guidelines provide a comprehensive table of ACE inhibitor dosing that clearly shows:

• Benazepril: Goal dose of 20-40 mg/day in 1-2 divided doses
• Lisinopril: Goal dose of 20-40 mg daily 1

This equivalence is supported by clinical practice and pharmacological properties of both medications:

Pharmacological Considerations

• Both medications are ACE inhibitors with similar mechanisms of action
• Benazepril is a prodrug that requires conversion to its active metabolite benazeprilat
• Lisinopril is directly active and doesn't require metabolic conversion 2
• Both medications are dosed once daily for hypertension management

Dosing Recommendations

When switching from benazepril 20 mg to lisinopril:

1. Start with lisinopril 20 mg once daily
2. Monitor blood pressure within 1-2 weeks after switching
3. Titrate dose if needed based on blood pressure response
4. Maximum dose of lisinopril is 40 mg daily 1

Clinical Considerations

Efficacy

• Both medications effectively lower blood pressure in hypertensive patients
• Lisinopril produces gradual blood pressure reduction with effects lasting at least 24 hours 2
• Some patients may achieve better blood pressure control with twice-daily dosing of lisinopril, though this is not standard practice 3

Special Populations

• In patients with impaired renal function, dose adjustment may be necessary for both medications
• Lisinopril is eliminated unchanged in urine, so accumulation can occur in severe renal impairment 2, 4
• Start with lower doses in elderly patients or those with heart failure 5

Common Pitfalls and Caveats

1. Pregnancy risk: Both medications are contraindicated in pregnancy (Category D)
2. Hyperkalemia risk: Monitor potassium levels, especially when used with potassium-sparing diuretics
3. Angioedema: Prior history of angioedema with any ACE inhibitor contraindicates use of either medication
4. Renal function: Check baseline and follow-up renal function, particularly in patients with pre-existing kidney disease

Combination Therapy

If blood pressure control is inadequate with lisinopril monotherapy:

• Consider adding a thiazide diuretic (e.g., hydrochlorothiazide)
• Fixed-dose combinations are available for improved adherence 1
• Avoid combining ACE inhibitors with ARBs or direct renin inhibitors

The evidence clearly supports that when switching from benazepril 20 mg to lisinopril, the appropriate equivalent dose is 20 mg once daily, with the option to titrate to 40 mg if needed for optimal blood pressure control.