Maximum Daily Dose of Lisinopril

The maximum recommended daily dose of lisinopril is 80 mg, though doses above 40 mg do not appear to provide greater antihypertensive effect. 1

FDA-Approved Maximum Dosing

The FDA label states that doses up to 80 mg have been used in clinical practice, establishing this as the absolute maximum daily dose. 1
However, the usual dosage range for hypertension is 20–40 mg per day administered as a single daily dose, because doses exceeding 40 mg do not appear to give greater blood pressure reduction. 1

The recommended initial dose is 10 mg once daily, with titration according to blood pressure response up to the usual maximum of 40 mg daily. 1
When combined with a diuretic (e.g., hydrochlorothiazide 12.5 mg), the starting dose should be reduced to 5 mg once daily. 1

The maximum dose for systolic heart failure is 40 mg once daily when used with diuretics and digitalis. 1
The ATLAS study demonstrated that high-dose lisinopril (32.5–35 mg once daily) produced clinically important advantages over low doses (2.5–5 mg once daily), including a 12% lower risk of death or hospitalization (P = 0.002) and 24% fewer heart failure hospitalizations (P = 0.002). 2
Titrate upward as tolerated to the maximum of 40 mg daily, adjusting diuretic doses to minimize hypovolemia and hypotension. 1

The maximum maintenance dose is 10 mg once daily, continued for at least 6 weeks after the infarct. 1
A daily maintenance dose of 5 mg may be given if hypotension occurs (systolic BP ≤ 100 mmHg), with temporary reductions to 2.5 mg if needed. 1

Creatinine clearance > 30 mL/min: No dose adjustment required; the full 40 mg maximum applies. 1
Creatinine clearance 10–30 mL/min: Reduce the initial dose to half the usual recommended dose (hypertension: 5 mg; heart failure: 2.5 mg; acute MI: 2.5 mg) and titrate as tolerated to a maximum of 40 mg daily. 1
Hemodialysis or creatinine clearance < 10 mL/min: Start at 2.5 mg once daily and titrate cautiously. 1
Importantly, the effectiveness of lisinopril is not diminished by renal impairment (serum creatinine > 71.6 mg/dL), and renal function is preserved during long-term therapy in elderly patients. 3, 4

Effective dosages in elderly patients range from 2.5–40 mg/day, with no clinically significant age-related differences in antihypertensive efficacy. 5
Lisinopril is just as effective in older patients as in younger patients and maintains renal function during long-term use. 3, 4
The median effective dose in elderly hypertensive patients is 20 mg daily (range 5–40 mg), with only a minority requiring addition of a diuretic. 4

The maximum dose is 0.61 mg/kg once daily (up to 40 mg total); doses above this have not been studied in children. 1

High doses of lisinopril (32.5–35 mg daily) were associated with a higher incidence of hypotension and worsening renal function in the ATLAS trial, but these events were generally well managed by dose adjustment or modification of concomitant medications. 2
Despite the higher incidence of some adverse events with high doses, the frequency of treatment discontinuation was the same in high- and low-dose groups. 2
When blood pressure is not controlled with lisinopril alone at 40 mg, add a low-dose diuretic (hydrochlorothiazide 12.5 mg) rather than exceeding the 40 mg dose, because higher doses do not provide additional antihypertensive benefit. 1