Maximum recommended dose of lisinopril
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Maximum Recommended Dose of Lisinopril in Hypertension
Large clinical studies in patients with mild to moderate essential hypertension have shown that lisinopril is typically started at 10 mg per day, with dose adjustments made to achieve optimal blood pressure control. The maximum recommended dose in these studies was 40 mg per day, and only a small percentage of patients required this highest dose to achieve blood pressure targets. Most patients responded to lower doses, and lisinopril was generally well tolerated at doses up to 40 mg daily, with adverse effects such as cough, dizziness, and headache being relatively uncommon and mostly mild .
Lisinopril Dosing in Heart Failure
In heart failure, clinical trials have compared low and high doses of lisinopril. The high-dose group in the ATLAS trial received up to 32.5–35 mg once daily, which is considered the upper end of the recommended dosing range for heart failure. These higher doses were associated with a reduction in heart failure hospitalizations, though not a significant reduction in mortality. Side effects such as dizziness and worsening renal function were more common at higher doses, so the recommendation is to titrate lisinopril to the maximum tolerated dose, not exceeding 35 mg daily in most cases 34.
Lisinopril Dose in Renal Impairment and Nephropathy
For patients with renal impairment, lisinopril is started at a lower dose (2.5–5 mg daily), with careful titration up to a maximum of 40 mg daily based on blood pressure response and tolerability. Studies in diabetic nephropathy and chronic kidney disease have shown that increasing lisinopril up to 40 mg daily provides additional benefits in reducing proteinuria and blood pressure, but doses above 40 mg (such as 60 mg) do not offer further benefit and may increase the risk of side effects. Therefore, 40 mg daily is generally considered the maximum recommended dose for renoprotection 2679.
Dose-Response Relationship and Safety
Dose-response studies in hypertension have demonstrated that the antihypertensive effect of lisinopril increases with higher doses, up to 80 mg daily, but most clinical benefit is achieved at doses of 10–40 mg daily. Doses above 40 mg are rarely used in practice due to the lack of additional benefit and increased risk of adverse effects . In heart failure and chronic kidney disease, the maximum tolerated dose should be used, but this typically does not exceed 40 mg daily 47.
Conclusion
The maximum recommended dose of lisinopril for most indications—including hypertension, heart failure, and renal protection—is 40 mg once daily. Higher doses do not provide additional clinical benefit and may increase the risk of side effects. Dose titration should be individualized based on patient response and tolerability, with careful monitoring for adverse effects, especially in those with renal impairment or at risk for hypotension 12345678+1 MORE.
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