Lisinopril Elimination Timeline
Lisinopril takes approximately 2.5 to 3 days (60-72 hours) to be substantially eliminated from your system in patients with normal kidney function, based on its 12-hour half-life. 1
Pharmacokinetic Basis for Elimination
The effective half-life of lisinopril is 12 hours with multiple dosing. 1 This means that every 12 hours, half of the drug remaining in your body is eliminated.
Standard Elimination Timeline (Normal Kidney Function)
- After 12 hours (1 half-life): 50% remains in your system 1
- After 24 hours (2 half-lives): 25% remains in your system 1
- After 36 hours (3 half-lives): 12.5% remains in your system 1
- After 48 hours (4 half-lives): 6.25% remains in your system 1
- After 60 hours (5 half-lives): 3.1% remains in your system 1
By 60-72 hours (5-6 half-lives), over 96% of the drug is eliminated, which is considered clinically insignificant levels. 1, 2
Critical Factors That Prolong Elimination
Kidney Function Impact
Impaired renal function significantly delays lisinopril elimination since the drug is excreted unchanged entirely through the kidneys. 1
- Normal kidney function (GFR >30 mL/min): Elimination half-life remains approximately 12 hours 1
- Severe renal impairment (GFR ≤30 mL/min): Significant accumulation occurs with markedly prolonged elimination 1, 2, 3
- Severe renal failure: The drug accumulates substantially and elimination can take considerably longer than 3 days 3
The elimination becomes clinically prolonged only when glomerular filtration rate drops below 30 mL/min. 1
Unique Pharmacokinetic Characteristics
Lisinopril is not metabolized by the liver and is excreted completely unchanged in the urine, making it entirely dependent on kidney function for elimination. 1, 2
The drug exhibits a prolonged terminal phase representing saturable binding to ACE enzyme, but this does not contribute to drug accumulation. 1
Steady state is achieved in 2-3 days with once-daily dosing, indicating that elimination reaches equilibrium within this timeframe. 2, 4
Clinical Implications
Peak serum concentrations occur within 6-7 hours after oral administration, but the antihypertensive effect persists for at least 24 hours. 1, 2
Lisinopril can be removed by hemodialysis, which may accelerate elimination in patients with severe renal impairment. 1
Abrupt withdrawal of lisinopril is not associated with rapid rebound hypertension, as the drug gradually clears from the system. 1
Common Pitfalls
Do not assume the same elimination timeline in elderly patients or those with any degree of renal impairment—always assess kidney function before estimating clearance time. 1, 3
The bioavailability of lisinopril is only approximately 25%, with large intersubject variability (6-60%), but this does not affect the elimination half-life once the drug is absorbed. 1, 2
Food does not alter lisinopril bioavailability or elimination. 1, 2