What is the upper limit per day of lisinopril (angiotensin-converting enzyme inhibitor) for adults with hypertension?

Maximum Daily Dose of Lisinopril

The upper limit of lisinopril is 80 mg per day for adults with hypertension, though doses above 40 mg do not appear to provide greater blood pressure reduction. 1

FDA-Approved Maximum Dosing

• The FDA label explicitly states that doses up to 80 mg have been used, establishing this as the absolute upper limit 1
• However, the usual dosage range is 20 to 40 mg per day administered as a single daily dose 1
• Doses exceeding 40 mg do not appear to give greater antihypertensive effect, making higher doses clinically unnecessary in most cases 1

Clinical Context for Dosing

For hypertension management, the typical therapeutic range is 20-40 mg once daily, with 10 mg as the recommended starting dose. 1

• If blood pressure is not controlled with lisinopril alone, adding a low-dose diuretic (such as hydrochlorothiazide 12.5 mg) is more effective than increasing lisinopril beyond 40 mg 1
• After adding a diuretic, it may be possible to reduce the lisinopril dose 1

Special Populations Requiring Dose Adjustment

Patients with renal impairment require lower maximum doses:

• For creatinine clearance ≥10 mL/min and ≤30 mL/min: start at 5 mg and titrate to a maximum of 40 mg daily 1
• For hemodialysis patients or creatinine clearance <10 mL/min: start at 2.5 mg once daily 1
• No dose adjustment needed when creatinine clearance >30 mL/min 1

Other Indications

For heart failure, the maximum dose is 40 mg once daily when used with diuretics and digitalis, starting at 5 mg once daily (or 2.5 mg in patients with hyponatremia) 1

For acute myocardial infarction, the target maintenance dose is 10 mg once daily (not exceeding this), initiated within 24 hours of symptom onset in hemodynamically stable patients 1

Key Clinical Caveat

The 80 mg upper limit exists as a safety boundary, but clinical evidence does not support routine use above 40 mg for hypertension due to lack of additional efficacy 1, 2, 3. If blood pressure remains uncontrolled at 40 mg, combination therapy is the appropriate next step rather than dose escalation 1.