How to taper lisinopril from 40mg to 10mg?

Tapering Lisinopril from 40mg to 10mg

To taper lisinopril from 40mg to 10mg, reduce the dose by 10mg every 2-4 weeks, monitoring blood pressure at each step to ensure it remains controlled. 1

Recommended Tapering Schedule

• Start with reducing from 40mg to 30mg daily and maintain this dose for 2-4 weeks 1
• If blood pressure remains controlled, further reduce to 20mg daily for another 2-4 weeks 1
• Finally, reduce to the target dose of 10mg daily 1

Monitoring During Tapering

• Check blood pressure regularly during the tapering process, ideally within 1-2 weeks after each dose reduction 1
• Target blood pressure should remain below 130/80 mmHg for most patients 1
• Monitor for symptoms of worsening hypertension such as headache, dizziness, or visual changes 1

Rationale for Gradual Tapering

• Gradual tapering helps prevent rebound hypertension that can occur with abrupt discontinuation 2
• The long half-life of lisinopril (12.6 hours) allows for once-daily dosing and provides a smoother transition during tapering 2, 3
• Stepwise tapering has been shown to be more effective than single-step or abrupt discontinuation in minimizing withdrawal symptoms across multiple drug classes 4

Special Considerations

• If blood pressure increases significantly at any step, return to the previous well-tolerated dose 4
• Patients with heart failure or kidney disease may require more cautious tapering with smaller incremental reductions 5
• Consider more frequent monitoring in elderly patients, as they may be more sensitive to dose changes 5

Common Pitfalls to Avoid

• Avoid tapering too quickly, which may lead to rebound hypertension 4
• Do not discontinue lisinopril abruptly, especially in patients with coronary artery disease or heart failure 5
• Be aware that patients on diuretics may require adjustment of their diuretic dose during lisinopril tapering 1

Alternative Approaches

• If blood pressure control is inadequate during or after tapering, consider adding a thiazide diuretic or other antihypertensive agent from a different class 1
• For patients requiring continued ACE inhibitor therapy but at a lower dose, ensure the final 10mg dose is taken consistently at the same time each day 2