Lisinopril to Amlodipine Dosage Equivalency

Lisinopril 5 mg is approximately equivalent to amlodipine 2.5 mg for blood pressure management. 1

Dosage Comparison Based on Guidelines

According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, amlodipine's usual dosage range is 2.5-10 mg daily, while lisinopril's usual range is 10-40 mg daily 1
The standard starting dose for amlodipine is 2.5 mg, which corresponds to the lower end of ACE inhibitor dosing (such as lisinopril 5 mg) 1
For hypertension management, amlodipine 5 mg daily is generally equivalent to moderate doses of lisinopril (10-20 mg) 1, 2

Lisinopril is an Angiotensin-Converting Enzyme (ACE) inhibitor that works by preventing the conversion of angiotensin I to angiotensin II, thereby reducing peripheral resistance 1
Amlodipine is a dihydropyridine calcium channel blocker that acts primarily through peripheral arterial dilation with minimal effects on heart rate or AV conduction 1
These different mechanisms explain why direct mg-to-mg equivalence is not applicable 1

In comparative studies, amlodipine 2.5 mg has shown similar blood pressure lowering effects to lisinopril 5 mg when used as monotherapy 2, 3
The ALLHAT study demonstrated that amlodipine (starting at 2.5 mg, titrated to 10 mg) was as effective as lisinopril (starting at 10 mg, titrated to 40 mg) in preventing the primary outcome of coronary heart disease, though with some differences in secondary outcomes 1
Clinical trials have shown that the combination of low-dose amlodipine (2.5 mg) with low-dose lisinopril (5 mg) produces more significant blood pressure lowering than either agent alone at higher doses 2, 3

In patients with chronic kidney disease, lisinopril dosing requires adjustment based on renal function, while amlodipine generally does not require significant dose adjustment 1
For elderly patients, starting with lower doses of both medications is recommended - typically amlodipine 2.5 mg or lisinopril 2.5-5 mg 1
In patients with heart failure, ACE inhibitors like lisinopril are generally preferred as first-line therapy, with amlodipine being a suitable add-on therapy rather than a direct substitute 1

Avoid abrupt switching between drug classes without appropriate monitoring, as the peak antihypertensive effect of amlodipine may take 1-2 weeks to develop fully 1
Be aware that amlodipine is more likely to cause peripheral edema (especially at higher doses), while lisinopril is more likely to cause cough and angioedema 1
In Black patients, amlodipine may provide better blood pressure control than lisinopril as monotherapy, as demonstrated in the ALLHAT study where stroke incidence was greater with lisinopril than with chlorthalidone or amlodipine in this population 1
When converting between these medications, start with the lower equivalent dose and titrate based on blood pressure response rather than assuming exact equivalence 2, 3

For patients with isolated systolic hypertension, particularly in the elderly, calcium channel blockers like amlodipine may be more effective than ACE inhibitors 1
In patients with comorbid conditions such as diabetes or chronic kidney disease, an ACE inhibitor like lisinopril may offer additional benefits beyond blood pressure control 1
The ALLHAT study showed that amlodipine had a higher incidence of heart failure compared to diuretics, while lisinopril had a higher incidence of stroke compared to diuretics 1