Recommended Dosing of Lisinopril for Hypertension and Heart Failure
For hypertension, the recommended initial dose of lisinopril is 10 mg once daily with titration to 20-40 mg daily as a target dose; for heart failure, start with 5 mg once daily (or 2.5 mg in patients with hyponatremia) and titrate to a maximum of 40 mg once daily. 1
Dosing for Hypertension
Initial Dosing
- Standard initial dose: 10 mg once daily 1
- With diuretics: 5 mg once daily (when adding to existing diuretic therapy) 1
- Renal impairment (CrCl ≤30 mL/min): Start with 5 mg once daily 1
- Hemodialysis patients (CrCl <10 mL/min): Start with 2.5 mg once daily 1
Maintenance and Target Dosing
- Usual dosage range: 20-40 mg once daily 1
- Maximum dose: Up to 80 mg daily has been used but provides minimal additional benefit 1
- Dose adjustment: Titrate according to blood pressure response at intervals of not less than 2 weeks 2
Pediatric Dosing (≥6 years)
- Starting dose: 0.07 mg/kg once daily (up to 5 mg total) 1
- Maximum dose: 0.61 mg/kg once daily (up to 40 mg) 1
- Not recommended for children <6 years or with GFR <30 mL/min/1.73m² 1
Dosing for Heart Failure
Initial Dosing
- Standard initial dose: 5 mg once daily 1, 3
- With hyponatremia (serum sodium <130 mEq/L): 2.5 mg once daily 1
- Renal impairment (CrCl 10-30 mL/min): 2.5 mg once daily 1
- Hemodialysis patients (CrCl <10 mL/min): 2.5 mg once daily 1
Maintenance and Target Dosing
- Target dose: 20-35 mg once daily 3, 2
- Maximum dose: 40 mg once daily 1
- Titration: Double the dose at intervals of not less than 2 weeks 2
Monitoring and Dose Adjustment
Parameters to Monitor
- Blood pressure (target <140/90 mmHg) 3
- Renal function (serum creatinine)
- Serum potassium
- Signs of heart failure (for heart failure patients)
Dose Adjustment Considerations
- Hypotension: Consider dose reduction if symptomatic hypotension occurs 2
- Hyperkalemia: Monitor for potassium >5.0 mmol/L 2
- Renal function: Acceptable increases include up to 50% increase in creatinine or maximum of 3 mg/dL 2
Important Considerations
Efficacy Evidence
- Higher doses of lisinopril (32.5-35 mg daily) demonstrated 24% fewer hospitalizations for heart failure compared to low doses (2.5-5 mg daily) in the ATLAS study 4
- Lisinopril improves cardiac function indices in heart failure patients resistant to conventional therapy 5
Contraindications
- History of angioedema
- Pregnancy
- Bilateral renal artery stenosis 2
Drug Interactions
- Avoid potassium-sparing diuretics during initiation
- Avoid NSAIDs and COX-2 inhibitors when possible 2
Common Side Effects
By following these dosing recommendations and monitoring parameters, lisinopril can effectively manage both hypertension and heart failure while minimizing adverse effects.