Lisinopril Dosage

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Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Hypertension

Initial dose: 10 mg orally once a day, in patients not receiving a diuretic.
Maintenance dose: 20 to 40 mg orally once a day.
Some patients appear to have a further response to 80 mg, but experience with this dose is limited.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 5 mg orally once a day (If on diuretic, the diuretic dose should be reduced).
Maintenance dose: 5 to 20 mg orally once a day.

Usual Adult Dose for Myocardial Infarction

Initial dose: 5 mg orally (within 24 hours of the onset of acute myocardial infarction).
Subsequent doses: 5 mg orally after 24 hours.
10 mg orally after 48 hours.
Maintenance dose: 10 mg orally once a day. Dosing should continue for six weeks.
Patients with a low systolic blood pressure (<=120 mm Hg) when treatment is started or during the first 3 days after the infarct should be given a lower 2.5 mg oral dose of lisinopril. If hypotension occurs (systolic blood pressure <=100 mm Hg) a daily maintenance dose of 5 mg may be given with temporary reductions to 2.5 mg if needed. If prolonged hypotension occurs (systolic blood pressure <90 mm Hg for more than 1 hour), lisinopril should be withdrawn.

Usual Adult Dose for Diabetic Nephropathy

Initial dose: 10 to 20 mg orally once a day.
Maintenance dose: 20 to 40 mg orally once a day.
Dosage may be titrated upward every 3 days.

Usual Geriatric Dose for Hypertension

Initial dose: 2.5 to 5 mg orally once a day.
Maintenance dose: Dosages should be increased at 2.5 to 5 mg/day increments at 1 to 2 week intervals.
Maximum dose: 40 mg/day.

Usual Pediatric Dose for Hypertension

Pediatric patients greater than or equal to 6 years of age:
Initial dose: 0.07 mg/kg once daily (Maximum initial dose is 5 mg once daily)
Maintenance dose: Dosage should be adjusted according to blood pressure response at 1 to 2 week intervals.
Maximum dose: Doses above 0.61 mg/kg or greater than 40 mg have not been studied in pediatric patients.

Renal Dose Adjustments

CrCl 10 to 30 mL/min:
Initial dose: 5 mg orally once a day.
Dosage may be titrated upward until blood pressure is controlled or to a maximum total daily dose of 40 mg.

CrCl < 10 mL/min:
Initial dose: 2.5 mg orally once a day.
The dosage may be titrated upward until blood pressure is controlled or to a maximum of 40 mg/day.

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

The antihypertensive effect may diminish toward the end of the dosing interval regardless of the administered dose, but most commonly with a dose of 10 mg daily. This can be evaluated by measuring blood pressure just prior to dosing to determine whether satisfactory control is being maintained for 24 hours. If it is not, an increase in dose should be considered. If blood pressure is not adequately controlled with lisinopril alone, a diuretic may be added. After the addition of a diuretic, it may be possible to reduce the dose of lisinopril.

Precautions

In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of lisinopril. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with lisinopril. Then, if blood pressure is not controlled with lisinopril alone, diuretic therapy should be resumed. If diuretic therapy cannot be discontinued, an initial dose of 5 mg of lisinopril should be used with careful medical supervision for several hours and until blood pressure has stabilized.

Safety and effectiveness have not been established in pediatric patients less than 6 years of age.

Dialysis

Lisinopril can be removed by hemodialysis.

Other Comments

Lisinopril is indicated as adjunctive therapy with diuretics and digitalis for treating heart failure.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

Following first-time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.

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