From the Guidelines
The starting dose of lisinopril is 2.5 to 5 mg once daily, as recommended for patients with heart failure or those taking diuretics, to minimize the risk of first-dose hypotension, according to the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1. This dose is also suitable for elderly patients and those with kidney impairment. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that works by preventing the conversion of angiotensin I to angiotensin II, thereby reducing blood pressure by decreasing vasoconstriction and sodium retention. Some key points to consider when initiating lisinopril therapy include:
- Monitoring blood pressure and kidney function, especially in the first two weeks
- Being aware of common side effects such as dry cough, dizziness, and headache
- Seeking immediate medical attention if symptoms of angioedema occur, such as swelling of the face, lips, or throat The medication should be taken at the same time each day to maintain consistent blood levels, and it may take several weeks to achieve full therapeutic effect. Other studies, such as the 2005 ACC/aha guideline update for the diagnosis and management of chronic heart failure in the adult 2, and the 2001 practical recommendations for the use of ACE inhibitors, beta-blockers and spironolactone in heart failure 3, also support the use of lisinopril in the treatment of heart failure, but the 2013 guideline provides the most recent and highest quality evidence.
From the FDA Drug Label
DOSAGE & ADMINISTRATION 2. 1 Hypertension Initial Therapy in adults: The recommended initial dose is 10 mg once a day. The recommended starting dose in adult patients with hypertension taking diuretics is 5 mg once per day. For pediatric patients with glomerular filtration rate > 30 mL/min/1.73m2, the recommended starting dose is 0. 07 mg per kg once daily (up to 5 mg total).
- 2 Heart Failure The recommended starting dose for lisinopril tablets, when used with diuretics and (usually) digitalis as adjunctive therapy for systolic heart failure, is 5 mg once daily.
- 3 Reduction of Mortality in Acute Myocardial Infarction In hemodynamically stable patients within 24 hours of the onset of symptoms of acute myocardial infarction, give lisinopril tablets 5 mg orally
The starting dose of lisinopril is:
- 10 mg once a day for adults with hypertension
- 5 mg once a day for adults with hypertension taking diuretics
- 0.07 mg per kg once daily (up to 5 mg total) for pediatric patients with glomerular filtration rate > 30 mL/min/1.73m2
- 5 mg once daily for heart failure
- 5 mg orally for reduction of mortality in acute myocardial infarction 4
From the Research
Starting Dose of Lisinopril
The starting dose of lisinopril varies based on the patient's condition.
- For patients with a glomerular filtration rate (GFR) of less than 30 ml/min, the starting dose is 2.5 mg 5, 6.
- For all other patients, the starting dose is 5 mg 5, 6.
General Information
Lisinopril is an orally active angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and congestive heart failure 7, 8.
- It is effective in lowering blood pressure in all grades of essential hypertension 7.
- Lisinopril is well tolerated, with few serious adverse effects being reported 7, 8.
Dosage and Administration
The dosage of lisinopril can be titrated upward to 40 mg daily according to blood pressure response 5, 6.