From the Guidelines
The lowest available dose of lisinopril is 2.5 mg taken once daily. This dose is recommended for patients who may be more sensitive to blood pressure medications, such as those with kidney impairment, the elderly, or patients who are also taking diuretics 1. For most adults with hypertension, the usual starting dose is 10 mg once daily, with dosage adjustments made based on blood pressure response. Lisinopril is an ACE inhibitor that works by preventing the conversion of angiotensin I to angiotensin II, thereby relaxing blood vessels and reducing blood pressure. It's essential to take lisinopril at the same time each day, and patients should be aware that the full effect of the medication may take several weeks to develop. Common side effects include dry cough, dizziness, and headache. Blood pressure and kidney function should be monitored regularly while taking this medication, especially when first starting treatment or after dose adjustments. Key considerations for lisinopril dosing include:
- Starting dose: 2.5 mg once daily for sensitive patients
- Usual starting dose: 10 mg once daily for most adults with hypertension
- Dosage adjustments: made based on blood pressure response
- Monitoring: regular blood pressure and kidney function checks, especially when starting treatment or adjusting dosage. The American College of Cardiology/American Heart Association guideline update for the diagnosis and management of chronic heart failure in adults provides evidence-based recommendations for the use of ACE inhibitors, including lisinopril, in the treatment of heart failure 1.
From the FDA Drug Label
The recommended starting dose in adult patients with hypertension taking diuretics is 5 mg once per day. For pediatric patients with glomerular filtration rate > 30 mL/min/1.73m2, the recommended starting dose is 0. 07 mg per kg once daily (up to 5 mg total). 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. The recommended starting dose in these patients with hyponatremia (serum sodium < 130 mEq/L) is 2. 5 mg once daily. 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. For patients on hemodialysis or creatinine clearance < 10 mL/min, the recommended initial dose is 2.5 mg once daily.
The lowest dose of Lisinopril is 2.5 mg once daily, as seen in patients with hyponatremia, systolic heart failure, or acute myocardial infarction, and in patients with renal impairment 2.
From the Research
Lowest Dose of Lisinopril
The lowest dose of Lisinopril, an Angiotensin-Converting Enzyme (ACE) inhibitor, is discussed in several studies:
- In patients with congestive heart failure, the lowest dose of Lisinopril used was 2.5 mg once daily 3, 4.
- In elderly patients with hypertension, dosages of Lisinopril effective in lowering blood pressure tended to range from 2.5 to 40 mg/day 4.
- In patients with impaired renal function, the starting dose of Lisinopril was 2.5 mg in patients with a GFR of less than 30 ml/min, and 5 mg in all other patients 5.
- The ATLAS study demonstrated that low doses of Lisinopril (2.5 to 5mg, administered once daily) were used in the treatment of congestive heart failure 6.
Key Points
- The lowest dose of Lisinopril used in various studies was 2.5 mg once daily.
- This dose was used in patients with congestive heart failure, elderly patients with hypertension, and patients with impaired renal function.
- The effectiveness and tolerability of Lisinopril at this dose were evaluated in several studies 3, 4, 5, 6.