II. Indications

III. Mechanism

  1. See ACE Inhibitor
  2. Synthetic Lysine derivative of Enalaprilat (active form of Enalapril)
  3. Angiotensin Converting Enzyme (ACE) inhibitor
    1. Long acting ACE Inhibitor that may be dosed daily
    2. Other ACE Inhibitors (other than Enalapril) often are best dosed more than once daily

IV. Dosing: Adults

  1. Hypertension
    1. Start 10 mg orally daily
    2. Target 20 to 40 mg/day
    3. Maximum 40 mg/day
  2. Congestive Heart Failure (CHF)
    1. Start 2.5 to 5 mg orally daily
    2. Target 5 to 20 mg/day
    3. Maximum 40 mg/day
  3. Acute MI
    1. Start 5 mg orally daily for 2 days then increase to 10 mg orally daily
  4. Diabetic Nephropathy
    1. Take 10 to 20 mg orally daily
  5. Renal Dosing
    1. GFR 10-30
      1. Start 2.5 to 5 mg orally daily
    2. GFR <10 or on Hemodialysis
      1. Start 2.5 mg orally daily to start
  6. Maximum 80 mg/day (but no added benefit above 40 mg/day)

V. Dosing: Children (age >=6 years)

  1. Contraindicated under age 6 years or GFR <30 ml/min
  2. Hypertension
    1. Give 0.07 mg/kg up to 5 mg/day orally daily

VI. Supplied

  1. Available as generic/Prinivil scored tablets (10, 20 and 40 mg)
  2. Available as generic/Zestril unscored tabs (2.5, 5, 10, 20, 30 and 40 mg)
  3. Available as oral solution 1 mg/ml (Qbrelis)

VII. Metabolism

  1. Primarily renal excretion

VIII. Adverse Effects

IX. Safety

  1. See ACE Inhibitor
  2. Pregnancy Category X
  3. Avoid in Lactation

XI. References

  1. (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

lisinopril (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LISINOPRIL 10 MG TABLET Generic $0.02 each
LISINOPRIL 2.5 MG TABLET Generic $0.02 each
LISINOPRIL 20 MG TABLET Generic $0.02 each
LISINOPRIL 30 MG TABLET Generic $0.06 each
LISINOPRIL 40 MG TABLET Generic $0.05 each
LISINOPRIL 5 MG TABLET Generic $0.01 each
LISINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB Generic $0.03 each
LISINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB Generic $0.05 each
LISINOPRIL-HYDROCHLOROTHIAZIDE 20-25 MG TAB Generic $0.05 each
qbrelis (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
QBRELIS 1 MG/ML SOLUTION $3.76 per ml