What is the appropriate dosing for Lisinopril (Lisinopril)?

From the Guidelines

Lisinopril dosing should start at 10 mg daily and aim for a goal dose of 20-40 mg daily.

Key Considerations

• The initial dose of Lisinopril is 10 mg daily as indicated in the guidelines for the treatment of patients with heart failure and hypertension 1.
• The goal dose of Lisinopril should be 20-40 mg daily, with the higher end of the dose range preferred when possible, as suggested by the KDOQI clinical practice guidelines 1.
• The dosing of Lisinopril may vary depending on the specific clinical context, such as heart failure or hypertension, but 20-40 mg daily is a commonly recommended target dose 1.
• It's essential to consider the patient's renal function and adjust the dose accordingly, as Lisinopril is renally excreted.

Clinical Context

• In patients with heart failure, Lisinopril has been shown to reduce mortality and morbidity, with a target dose of 20 mg once daily 1.
• For patients with hypertension, the goal is to achieve a blood pressure of less than 130/80 mmHg, with Lisinopril dosing adjusted accordingly 1.
• The ATLAS trial demonstrated the benefits of high-dose Lisinopril (32.5-35 mg daily) in patients with heart failure, but this dose may not be suitable for all patients 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION 2.1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose. Doses up to 80 mg have been used but do not appear to give greater effect ... 2.2 Heart Failure The recommended starting dose for lisinopril tablets, when used with diuretics and (usually) digitalis as adjunctive therapy for systolic heart failure, is 5 mg once daily. ... 2.3 Reduction of Mortality in Acute Myocardial Infarction In hemodynamically stable patients within 24 hours of the onset of symptoms of acute myocardial infarction, give lisinopril tablets 5 mg orally, followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg once daily. ... 2.4 Dose in Patients with Renal Impairment No dose adjustment of lisinopril tablets is required in patients with creatinine clearance > 30 mL/min. In patients with creatinine clearance ≥ 10 mL/min and ≤ 30 mL/min, reduce the initial dose of lisinopril tablets to half of the usual recommended dose i.e., hypertension, 5 mg; systolic heart failure, 2.5 mg and acute MI, 2.5 mg.

The appropriate dosing for Lisinopril is as follows:

• Hypertension: Initial dose of 10 mg once daily, with a usual dosage range of 20-40 mg per day
• Heart Failure: Initial dose of 5 mg once daily
• Acute Myocardial Infarction: Initial dose of 5 mg orally, followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg once daily
• Renal Impairment: No dose adjustment needed for creatinine clearance > 30 mL/min; for creatinine clearance ≥ 10 mL/min and ≤ 30 mL/min, reduce initial dose to half of the usual recommended dose 2

From the Research

Dosing Information for Lisinopril

The dosing for Lisinopril varies depending on the condition being treated.

• For patients with heart failure, high doses (32.5 to 35mg, administered once daily) of lisinopril have demonstrated clinically important advantages over low doses (2.5 to 5mg, administered once daily) in reducing the risk of major clinical events 3.
• In patients with essential hypertension, lisinopril is effective at dosages of 20 to 80 mg once daily 4, 5, 6.
• For congestive heart failure, doses of 2.5-20 mg/d appear to provide hemodynamic effects comparable to those of captopril 5.
• 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.

Special Considerations

• The elimination half-life of lisinopril is 12.6 hours and is prolonged in renal impairment, which may require dose adjustments 5, 6.
• Combining lisinopril with hydrochlorothiazide produces a greater degree of blood pressure reduction, but caution should be used when administering lisinopril with diuretics, nifedipine, or agents that may increase concentrations of potassium 4, 5, 6.
• The usual initial oral dosage of lisinopril is 10 mg once a day, with a range of 20-40 mg/day, and lower dosages may be necessary in certain patient populations such as those with renal impairment or congestive heart failure, elderly persons, and those receiving diuretics 6.