What dose of amlodipine (calcium channel blocker) is equivalent to lisinopril (angiotensin-converting enzyme inhibitor)?

Equivalent Dosing of Amlodipine and Lisinopril

When converting from lisinopril to amlodipine, 10 mg of lisinopril is equivalent to 5 mg of amlodipine for blood pressure control. 1

Dosing Equivalence and Rationale

Amlodipine and lisinopril belong to different antihypertensive medication classes with distinct mechanisms of action:

• Amlodipine: A calcium channel blocker that works by blocking calcium channels in vascular smooth muscle, causing vasodilation
• Lisinopril: An angiotensin-converting enzyme (ACE) inhibitor that reduces angiotensin II production

The standard dosing equivalence is:

• Lisinopril 10 mg = Amlodipine 5 mg 1
• Lisinopril 20 mg = Amlodipine 10 mg 1

Clinical Evidence Supporting This Equivalence

The American Academy of Pediatrics guidelines indicate that when converting from lisinopril to amlodipine, the appropriate starting dose is 5 mg of amlodipine when switching from 10 mg of lisinopril 2, 1.

In clinical trials comparing these medications:

• In a double-blind crossover study, amlodipine 5 mg produced similar blood pressure control to lisinopril 10 mg, with both achieving target blood pressure in approximately 70% of patients 3
• The ALLHAT study used amlodipine 2.5-10 mg and lisinopril 10-40 mg as comparable treatment arms, supporting this dosing relationship 2

Considerations When Switching Between Medications

When converting between these medications, consider:

1. Monitoring: Check blood pressure 1-2 weeks after switching to ensure adequate control

2. Side effect profiles:

   • Amlodipine: Peripheral edema, headache, flushing
   • Lisinopril: Cough, hyperkalemia, angioedema

3. Special populations:

   • In patients with heart failure, ACE inhibitors like lisinopril are generally preferred over calcium channel blockers 1
   • In black patients, amlodipine may provide better blood pressure control than lisinopril 2

Titration Algorithm

1. Start with amlodipine 5 mg once daily when converting from lisinopril 10 mg
2. Assess blood pressure response after 1-2 weeks
3. If target blood pressure is not achieved, increase to amlodipine 10 mg daily (maximum recommended dose)
4. If blood pressure remains uncontrolled on maximum amlodipine dose, consider adding a thiazide diuretic, which has been shown to be more effective than adding a beta-blocker when combined with amlodipine 4

Important Caveats

• Individual patient response may vary based on comorbidities, age, race, and other factors
• The ALLHAT study demonstrated that while both medications effectively lower blood pressure, there were differences in secondary outcomes (stroke was higher with lisinopril compared to diuretics, especially in black patients) 2
• Maximum doses are amlodipine 10 mg daily and lisinopril 40 mg daily for hypertension

Remember that while these medications are considered equivalent for blood pressure control at the stated doses, their different mechanisms of action may make one more suitable than the other for specific patients based on comorbidities and risk factors.