Losartan 50mg to Lisinopril Dose Equivalency
Losartan 50mg is approximately equivalent to lisinopril 10-20mg daily based on current guideline recommendations. 1
Recommended Conversion Table
The following dose equivalencies are recommended by the American Heart Association, American College of Cardiology, and Heart Failure Society of America 1:
| Lisinopril Dose | Losartan Equivalent Dose |
|---|---|
| 2.5-5 mg | 25-50 mg |
| 10-20 mg | 50 mg |
| 20-40 mg | 100 mg |
For your specific question: Losartan 50mg corresponds to lisinopril 10-20mg daily. 1
Important Clinical Context
Target Dosing Considerations
- Losartan 50mg represents only the starting dose, not the target dose for optimal cardiovascular outcomes. 2, 1
- The target dose of losartan for heart failure is 100-150mg daily, while the target dose for lisinopril is 20-40mg daily. 1
- The HEAAL trial demonstrated that losartan 150mg daily was superior to 50mg daily, with a 10% relative risk reduction in death or heart failure hospitalization. 3, 2, 1
Efficacy Differences Between Agents
- Lisinopril 20mg once daily demonstrated similar antihypertensive effects to losartan 50mg once daily in comparative trials. 4
- However, the ELITE II trial showed that losartan 50mg daily was not as effective as captopril 50mg three times daily for heart failure outcomes, suggesting that 50mg losartan may be suboptimal dosing. 3
- More than one-third of patients show discordant blood pressure responses between ACE inhibitors and ARBs, meaning response to one does not reliably predict response to the other. 5
Critical Conversion Pitfalls to Avoid
Do Not Combine These Medications
- Never use lisinopril and losartan simultaneously. This combination increases the risk of hyperkalemia and renal dysfunction without providing additional cardiovascular benefit. 2, 1
- The VALIANT trial demonstrated increased adverse events with combined ACE inhibitor and ARB therapy. 3, 1
Monitor During Transition
- Check blood pressure within 1-2 weeks after conversion to ensure adequate control. 1
- Monitor serum creatinine and potassium within 1-2 weeks, especially in patients with baseline renal impairment or systolic BP <80 mmHg. 2
Uptitration is Essential
- Do not assume equivalent dosing provides equivalent outcomes. Both medications require uptitration to target doses for maximum mortality and morbidity benefits. 2, 1
- Adjust therapy no more frequently than every 2 weeks when uptitrating to target doses. 2
- Less than 25% of patients in clinical practice are ever titrated to target doses, representing a major treatment gap. 2
Dosing Frequency Considerations
- Losartan 50mg can be administered once daily, though the maximum recommended daily dose is 100mg. 2, 6
- At higher doses (150mg total daily), losartan may require twice-daily dosing for optimal blood pressure control. 1
- Lisinopril can be given once or twice daily, though real-world evidence does not support improved effectiveness with twice-daily dosing. 7