ACE Inhibitors: Comprehensive List
The most commonly used ACE inhibitors include captopril, enalapril, lisinopril, ramipril, fosinopril, quinapril, perindopril, benazepril, trandolapril, and moexipril. 1
Primary ACE Inhibitors with Established Clinical Evidence
The following ACE inhibitors are supported by major cardiovascular guidelines and have extensive clinical trial data:
Short-Acting ACE Inhibitors
- Captopril: 6.25 mg three times daily (initial) to 50 mg three times daily (maximum); requires multiple daily dosing due to short half-life of approximately 1 hour 1, 2, 3
Intermediate-Acting ACE Inhibitors
- Enalapril: 2.5 mg twice daily (initial) to 10-20 mg twice daily (maximum) 1, 4
- Quinapril: 5 mg twice daily (initial) to 20 mg twice daily (maximum) 1
- Benazepril: 10 mg daily (initial) to 20-40 mg daily in 1-2 divided doses (maximum) 1
Long-Acting ACE Inhibitors (Once-Daily Dosing)
- Lisinopril: 2.5-5 mg once daily (initial) to 20-40 mg once daily (maximum); unique among ACE inhibitors for its linear dose-response curve 1, 5
- Ramipril: 1.25-2.5 mg once daily (initial) to 10 mg once daily (maximum); has trough-to-peak ratio exceeding 50% 1, 6
- Fosinopril: 5-10 mg once daily (initial) to 40 mg once daily (maximum); has both renal and hepatic elimination routes 1, 3
- Perindopril: 2 mg once daily (initial) to 8-16 mg once daily (maximum) 1
- Trandolapril: 1 mg once daily (initial) to 4 mg once daily (maximum); has trough-to-peak ratio exceeding 50% 1, 5
Additional ACE Inhibitors Available
- Moexipril: 7.5 mg daily (initial) to 7.5-30 mg daily in 1-2 divided doses (maximum); should be taken 1 hour before meals and requires dosage reduction in elderly and hepatically impaired patients 1, 5
- Cilazapril: Available internationally with similar efficacy profile 3, 5
- Delapril: Available in select markets 5
- Spirapril: Has longest half-life (approximately 30 hours) among ACE inhibitors 3
- Temocapril: Requires dosage reduction in elderly patients 5
- Imidapril: Requires dosage reduction in renal impairment; digoxin coadministration decreases its bioavailability 5
Key Pharmacologic Distinctions
All ACE inhibitors except captopril and lisinopril are administered as prodrugs requiring hepatic activation. 3, 7
- Bioavailability ranges from 11% (trandolapril) to over 60% (captopril) 3
- Renal elimination predominates for most agents, but benazepril, fosinopril, ramipril, spirapril, and trandolapril have significant hepatic elimination pathways 3
- Dosage adjustment in renal insufficiency is required only when creatinine clearance falls below 30 mL/min for most agents 3
Clinical Application Considerations
Despite pharmacokinetic differences, clinical trials demonstrate no significant heterogeneity in mortality reduction among different ACE inhibitors when used for heart failure. 5
- Most ACE inhibitors exhibit flat dose-response curves, with lisinopril being the notable exception showing linear dose-response 5
- Only fosinopril, ramipril, and trandolapril achieve trough-to-peak effect ratios exceeding 50%, making them more suitable for true once-daily dosing 5
- In patients with hepatic disease, renally excreted drugs like lisinopril should be preferred 3