From the Guidelines
The maximum dose of lisinopril is 40 mg once daily for most indications, including hypertension and heart failure, as recommended by the most recent guidelines 1.
Key Considerations
- The dose of lisinopril may need to be adjusted based on the patient's blood pressure response and tolerability.
- Patients with kidney impairment should start at lower doses (2.5-5 mg) with careful titration.
- Lisinopril, an ACE inhibitor, works by preventing the conversion of angiotensin I to angiotensin II, thereby reducing blood vessel constriction and decreasing blood pressure.
- Common side effects include dry cough, dizziness, and headache.
- Blood pressure and kidney function should be monitored regularly during treatment.
Clinical Guidelines
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends a target dose of 20-40 mg once daily for lisinopril 1.
- The kdoqi clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease also recommend a goal dose of 20-40 mg daily for lisinopril 1.
Important Notes
- Patients should be aware that lisinopril may cause a significant drop in blood pressure when starting treatment, especially with the first dose, so it's often recommended to take the initial dose at bedtime.
- In some cases, particularly for patients with severe hypertension or significant heart failure, doses up to 80 mg daily may be used, but this is less common and typically requires specialist supervision.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension ... Doses up to 80 mg have been used but do not appear to give greater effect Pediatric Patients 6 years of age and older with hypertension ... Dosage should be adjusted according to blood pressure response up to a maximum of 0.61 mg per kg (up to 40 mg) once daily. 2. 2 Heart Failure ... Increase as tolerated to a maximum of 40 mg once daily. 2. 3 Reduction of Mortality in Acute Myocardial Infarction ... Dosing should continue for at least six weeks. 2. 4 Dose in Patients with Renal Impairment ... Up titrate as tolerated to a maximum of 40 mg daily.
The maximum dose of Lisinopril is 80 mg for adults with hypertension, and 40 mg for other indications, including heart failure, reduction of mortality in acute myocardial infarction, and patients with renal impairment 2.
From the Research
Maximum Dose of Lisinopril
The maximum dose of Lisinopril varies depending on the condition being treated.
- For essential hypertension, the maximum dose is 80 mg once daily 3, 4.
- For congestive heart failure, the maximum dose is 35 mg once daily 5 and 20-40 mg daily in other studies 4, 6, 7.
- In patients with impaired renal function, the dose may need to be lower, with a maximum dose of 40 mg daily 6.
- In elderly patients, the dose tends to range from 2.5 to 40 mg/day 7.
Key Findings
- Lisinopril is effective in lowering blood pressure in all grades of essential hypertension 3.
- High doses of Lisinopril (32.5 to 35mg) are more effective than low doses (2.5 to 5mg) in reducing the risk of major clinical events in patients with heart failure 5.
- Lisinopril is well tolerated, with few serious adverse effects being reported 3, 5, 4, 6, 7.