What is the equivalent dose of lisinopril (Angiotensin-Converting Enzyme Inhibitor) to losartan (Angiotensin II Receptor Antagonist)?

From the Guidelines

Lisinopril 20 mg is approximately equivalent to losartan 50 mg in terms of blood pressure lowering effects. These medications work differently - lisinopril is an ACE inhibitor while losartan is an angiotensin II receptor blocker (ARB) - but they achieve similar antihypertensive results at these doses 1. When switching between these medications, patients should be monitored closely as individual responses vary. The transition should be done under medical supervision, with blood pressure checks within 2-4 weeks after changing medications.

Key Considerations

• Losartan may be preferred in patients who experience ACE inhibitor-induced cough, as ARBs rarely cause this side effect.
• Both medications are typically taken once daily, and neither should be stopped abruptly.
• The goal dose for losartan is 25-100 mg daily in 1-2 divided doses, while the goal dose for lisinopril is 20-40 mg daily 1.
• It's essential to consider the potential risks and benefits of each medication, including the risk of hyperkalemia with ARBs in patients with chronic kidney disease (CKD) or those taking potassium supplements 1.
• The choice between lisinopril and losartan should be based on individual patient factors, such as medical history, comorbidities, and potential side effects.

Monitoring and Follow-up

• Patients should be monitored closely for changes in blood pressure, kidney function, and potential side effects when switching between these medications.
• Regular follow-up appointments with a healthcare provider are crucial to ensure the safe and effective use of these medications.

From the Research

Equivalent Dosing of Lisinopril and Losartan

• The equivalent dosing of lisinopril and losartan is not directly stated in the provided studies, but we can look at the dosages used in the studies to get an idea of the equivalent doses.
• In the study 2, lisinopril 10mg BID was compared to lisinopril 20mg QDay, suggesting that 20mg of lisinopril QDay is equivalent to 10mg BID.
• In the study 3, losartan 100mg QDay was used, but no direct comparison to lisinopril was made.
• In the study 4, lisinopril 80mg QDay was used in combination with losartan 100mg QDay or spironolactone 25mg QDay, but no direct comparison of the doses of lisinopril and losartan was made.

Comparison of Lisinopril and Losartan

• The study 2 compared the effectiveness and safety of twice-daily versus once-daily dosing of lisinopril and losartan, but did not directly compare the two drugs.
• The study 4 compared the effects of lisinopril, losartan, and spironolactone on serum potassium levels, and found that spironolactone raised serum potassium more than losartan, despite similar renal sodium and potassium excretion.
• The study 5 found that losartan and enalapril may be beneficial in pediatric kidney transplant recipients by decreasing blood pressure and proteinuria, but may be associated with serious adverse events including hyperkalemia and life-threatening acidosis.

Hyperkalemia Risk

• The study 6 found that the risk of hyperkalemia increased gradually in relation to declining eGFR, with no apparent threshold for contraindicating ACE-inhibitors.
• The study 3 found that aliskiren added to losartan reduced albuminuria and renal dysfunction, but was associated with an increased risk of hyperkalemia in patients with stage 3 CKD.
• The study 4 found that spironolactone raised serum potassium more than losartan in patients with diabetic nephropathy receiving lisinopril, despite similar renal sodium and potassium excretion.
• The study 5 found that losartan and enalapril may be associated with serious adverse events including hyperkalemia and life-threatening acidosis in pediatric kidney transplant recipients.