Is lisinopril (angiotensin-converting enzyme inhibitor) given twice daily?

Lisinopril Dosing Frequency

Lisinopril is typically administered once daily, not twice daily, for the treatment of hypertension and other cardiovascular conditions. 1

Evidence-Based Dosing Information

According to the FDA drug label and clinical guidelines, lisinopril is designed for once-daily administration:

• The FDA-approved drug information indicates that lisinopril has a long duration of action, with effects still present 24 hours after administration, allowing for once-daily dosing 1
• In the European Heart Journal guidelines, lisinopril is specifically listed with a dosing interval of "once daily" with a target dose of 30-35 mg daily 2
• The elimination half-life of lisinopril is approximately 12.6 hours, which supports once-daily dosing in patients with normal renal function 3

Dosing Recommendations

For hypertension management:

• Initial dose: 2.5-5.0 mg once daily 2
• Target dose: 30-35 mg once daily 2
• Maximum dose: 40 mg once daily 1

For heart failure:

• Initial dose: 2.5 mg once daily (particularly in patients who may be volume-depleted) 2
• Target dose: Up to 20-40 mg once daily 4

Pharmacokinetic Considerations

Lisinopril's pharmacokinetic properties support once-daily dosing:

• Peak serum concentrations occur 6-8 hours after oral administration 3
• Antihypertensive effect begins within 2 hours, peaks around 6 hours, and lasts for at least 24 hours 3
• The drug is not metabolized and is excreted unchanged in the urine 3
• Steady state is achieved in 2-3 days with little accumulation 3

Special Populations

In patients with impaired renal function (creatinine clearance ≤30 ml/min), lisinopril has a longer half-life and may accumulate. Dosage adjustment may be necessary, but the frequency remains once daily 5.

Clinical Outcomes with Once-Daily Dosing

Clinical trials have demonstrated that once-daily lisinopril effectively:

• Reduces blood pressure in all grades of essential hypertension 6
• Improves cardiac function in patients with congestive heart failure 4
• Provides 24-hour blood pressure control 3

Common Pitfalls

1. Confusing with other ACE inhibitors: Unlike captopril, which requires dosing every 8-12 hours, lisinopril has a longer duration of action allowing for once-daily dosing 5

2. Inadequate dose adjustment: In patients with renal impairment, the dose should be reduced, but the once-daily frequency is maintained 5

3. Misinterpreting peak effect timing: Although the peak effect occurs 6-8 hours after administration, the duration of action extends beyond 24 hours, supporting once-daily dosing 3

In conclusion, based on the pharmacokinetic profile and clinical evidence, lisinopril should be administered once daily for optimal efficacy and patient adherence.