Benazepril to Lisinopril Conversion Dosing
When converting from benazepril to lisinopril, the equivalent dose is 40 mg of benazepril to 20 mg of lisinopril (2:1 ratio). 1
Dosing Equivalence Table
| Benazepril Dose | Lisinopril Equivalent Dose |
|---|---|
| 10 mg | 5 mg |
| 20 mg | 10 mg |
| 40 mg | 20 mg |
Conversion Rationale
- ACE inhibitors have similar clinical effects but differ in dosing, pharmacokinetics, and administration frequency 1
- The 2020 ACC/AHA guidelines provide specific target doses for ACE inhibitors in heart failure management, with benazepril's target dose being 40 mg daily and lisinopril's target dose being 20 mg daily 1
- This establishes a 2:1 conversion ratio between benazepril and lisinopril 1
- Both medications are effective ACE inhibitors with established benefits in hypertension and heart failure management 1
Clinical Considerations for Conversion
- Start with a low dose of lisinopril (2.5-5 mg) when converting from low doses of benazepril (10 mg) 1
- Titrate lisinopril gradually, doubling the dose at not less than 2-week intervals 1
- Monitor blood pressure, renal function (creatinine), and potassium levels within 1-2 weeks of initiating therapy 1
- Both medications can be administered once daily, simplifying the conversion process 1
Special Population Considerations
- In patients with renal impairment (creatinine >2.5 mg/dL), lower initial doses of lisinopril are recommended 1, 2
- Elderly patients may require lower initial doses (2.5-5 mg of lisinopril) with careful titration 2, 3
- In heart failure patients, aim for target doses (lisinopril 20-35 mg daily) for optimal mortality benefits 1
Common Pitfalls to Avoid
- Avoid abrupt discontinuation of benazepril before starting lisinopril 1
- Do not simultaneously administer both medications 1
- Monitor for hypotension, especially in patients who are volume-depleted or on diuretics 1
- Watch for hyperkalemia, particularly in patients with renal dysfunction or those taking potassium supplements or potassium-sparing diuretics 1
- Be aware that cough is a class effect and may persist with the switch to another ACE inhibitor 1, 4