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Lisinopril Dosage Guide

1. Overview

Lisinopril (Prinivil, Zestril) is an antihypertensive agent that belongs to a class of drugs known as angiotensin-converting enzyme inhibitors (ACE inhibitors).

Lisinopril is used in the treatment of high blood pressure, kidney disease and heart failure.

Lisinopril (Zestril) acts by preventing the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor), and thus, decreases blood pressure.

Lisinopril is also available in combination with hydrochlorothiazide (diuretic) under the brand name Zestoretic.

2. Dosage forms & Strengths

Lisinopril is available as:

Tablets

  • 2.5 mg
  • 5 mg
  • 10 mg
  • 20 mg

Oral solution (sugar-free)

  • 5 mg/5mL

3. Lisinopril dosage and indications

Hypertension (using Lisinopril alone)

Adults:

Lisinopril initial dose: 10 mg/day, 5 mg/ day orally (if the patient is taking diuretics).

Maintenance dose: 20mg – 80mg once daily.

Lisinopril maximum dose: 80mg once daily.

Elderly:

Initial dose: 2.5 –5 mg once daily.

Maximum dose: 40 mg once daily.

Children of 6 years and older:

Initial dose: 0.07 mg/kg once daily (up to 5 mg).

Maximum dose: 40 mg once daily.

Hypertension (using Lisinopril in combination with diuretics)

Adults and Elderly:

Initial dose: 2.5–5 mg once daily.

Maintenance dose: 10–40 mg once daily.

Heart failure

b>Adults and Elderly:

Initial dose: 2.5–5 mg once daily. The dose is increased in steps of up to 10 mg once daily at intervals of 2 weeks, to a target maximum dose of 20–40 mg once daily.

Acute myocardial infarction

Orally: 5-10 mg once daily for six weeks.

Improving survival in patients after myocardial Infarction

Adults and Elderly:

Initially give 5 mg, then 5 mg after 24 hours, and 10 mg after 48 hrs. Then 10 mg once daily for 6 weeks.

For patients with a systolic blood pressure of greater than 100–120 mm Hg, give 2.5 mg once daily for 3 days, and then 2.5–5 mg once daily.

Discontinue the drug if the systolic blood pressure is less than 90 mm Hg for more than 1 hour.

Diabetic nephropathy

Adults:

Initial dose: 2.5 -5mg once daily, adjust the dose according to the patient blood pressure response. The usual dose is 10 -20mg once daily.

4. Renal dose adjustment

If creatinine clearance (CrCl) is greater than 30 mL/min: No dose adjustment is recommended.

Hypertension

If creatinine clearance (CrCl) is 10–30 mL/min: the initial dose will be 5 mg.

If creatinine clearance (CrCl) is less than 10 mL/min or Dialysis: the initial dose will be 2.5 mg.

Heart failure

 

If creatinine clearance (CrCl) is less than 30 mL/min or serum creatinine greater than 3 mg/dL: the initial dose will be 2.5 mg.

Acute Myocardial infarction

If creatinine clearance (CrCl) is 30 mL/min or less: the initial dose will be 2.5 mg.

5. Dosage in hepatic impairment

No dose adjustment.

References

1. Kizior, R.J. and Hodgson, B.B. (2018). Saunders nursing drug handbook 2019. Philadelphia: Saunders.

2. Williams and Wolters Kluwer Health (2012). Nursing 2012 drug handbook. Philadelphia, Pa.: Wolters Kluwer Health/Lippincott Williams & Wilkins.

3. Joint formulary committee, BNF 80 (The British National Formulary), 80th Revised edition, Pharmaceutical Press, London, United Kingdom, [2020]

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