Are you taking lisinopril or considering it? Whether you’ve just been prescribed this medication or taken it for a while, knowing how to dose it correctly is essential. Lisinopril is a commonly used medication for managing high blood pressure, heart failure, and diabetic kidney disease.
Getting the most out of it requires careful attention to timing, dosage, and potential side effects. Missing doses, taking the wrong amount, or ignoring key precautions can reduce its effectiveness or even lead to serious complications.
In this article, you’ll learn how to take lisinopril safely and effectively, including the best time to take it, handling missed doses, and tips for managing side effects.
| 🔑Key Takeaways ➤ Take lisinopril once a day, at the same time, with or without food. This helps keep its effects steady. ➤ If you miss a dose, take it as soon as you remember. But if it’s close to your next dose, skip it and stick to your schedule. Never take two doses at once. ➤ Overdosing can cause dizziness, drowsiness, or a fast heartbeat. Get medical help immediately if this happens. ➤ Your dose depends on your condition, age, and overall health. Always follow your doctor’s exact instructions. ➤ Combining lisinopril with certain drugs, like diuretics or NSAIDs, can increase risks like low blood pressure or kidney issues. Be sure to discuss all your medications with your doctor. ➤ For children or elderly patients, lower starting doses may be recommended to reduce side effects. ➤ Lisinopril isn’t safe during pregnancy. It can harm your baby, especially in the second and third trimesters. |
Recommended Dosage
The recommended lisinopril dosage varies based on the condition being treated and the patient’s needs.
| Condition | Initial Dose | Maintenance Dose | Maximum Dose |
| Hypertension (Adults) | 10 mg once daily (5 mg if on diuretics) | 20–40 mg once daily | 80 mg once daily (rarely needed) |
| Hypertension (Geriatric) | 2.5–5 mg once daily | Adjust in 2.5–5 mg steps every 1–2 weeks (max 40 mg) | 40 mg once daily |
| Hypertension (Pediatric, ≥6 yrs) | 0.07 mg/kg once daily (max 5 mg) | Adjust every 1–2 weeks (max 0.61 mg/kg or 40 mg) | 40 mg once daily |
| Congestive Heart Failure | 2.5–5 mg once daily | Increase gradually as tolerated (max 40 mg) | 40 mg once daily |
| Myocardial Infarction | 5 mg within 24 hours, then 5 mg after 24 hours | 10 mg once daily for 6 weeks | 10 mg once daily |
| Diabetic Nephropathy (Off-label) | 10–20 mg once daily | 20–40 mg once daily | 40 mg once daily |
| Renal Dose Adjustments | CrCl >30 mL/min: No adjustment; CrCl 10–30 mL/min: Half usual dose; CrCl <10 mL/min or dialysis: 2.5 mg once daily | Adjust upward as tolerated (max 40 mg daily) | 40 mg once daily |
| Liver Dose Adjustments | Discontinue if jaundice or significant liver enzyme elevation | N/A | N/A |
Hypertension in Adults
For hypertension in adults, the usual starting dose is 10 mg orally once a day. However, if you take diuretics, the initial dose could be 5 mg daily to reduce the risk of low blood pressure. The maintenance dose typically ranges from 20 to 40 mg daily, but the maximum is 80 mg.
It’s worth noting that doses above 40 mg don’t generally provide additional benefits. If your blood pressure isn’t well-controlled with lisinopril alone, your doctor might add a low-dose diuretic, such as hydrochlorothiazide (12.5 mg). After adding a diuretic, your lisinopril dose might need to be adjusted.
Congestive Heart Failure
For congestive heart failure, the starting dose is between 2.5 and 5 mg orally once daily. The maintenance dose should be gradually increased as your body tolerates it, up to 40 mg daily.
If you are also taking diuretics, their dosage may need to be adjusted to prevent low blood volume, which can cause low blood pressure. Careful adjustments can allow for continued treatment even if you experience low blood pressure with the first dose.
Myocardial Infarction
For myocardial infarction (heart attack), the initial dose is 5 mg orally within the first 24 hours of the event. After 24 hours, you should take another 5 mg dose, followed by 10 mg after 48 hours.
The maintenance dose is 10 mg orally once daily for at least six weeks. If your systolic blood pressure is low (between 100–120 mmHg), the starting dose should be 2.5 mg. However, if your blood pressure drops below 90 mmHg for over one hour, treatment should be stopped.
Diabetic Nephropathy
For diabetic nephropathy (an off-label use), the initial dose is 10 to 20 mg daily, with a maintenance range of 20 to 40 mg daily.
Depending on your doctor’s recommendation, doses can be adjusted every three days as needed.
Elderly Patients with Hypertension
In elderly patients with hypertension, the initial dose is lower, typically between 2.5 and 5 mg orally once daily. The maintenance dose can be increased in 2.5 to 5 mg increments every 1 to 2 weeks, up to a maximum of 40 mg daily.
Older adults require more cautious dose adjustments to reduce the risk of low blood pressure.
Children 6 Years and Older with Hypertension
For children 6 years and older with hypertension, the starting dose is 0.07 mg per kilogram of body weight (up to a maximum of 5 mg daily). The dose can be adjusted based on how well blood pressure is controlled, with adjustments made every 1 to 2 weeks.
The maximum dose is 0.61 mg per kilogram or 40 mg daily, whichever is lower. This drug is not recommended for children under 6 years old or those with a glomerular filtration rate below 30 mL/min.
Kidney Issues
If you have kidney issues, dose adjustments are necessary. For a creatinine clearance (CrCl) greater than 30 mL/min, no changes are needed. For a CrCl between 10 and 30 mL/min, your doctor will likely recommend starting at half the usual dose (e.g., 5 mg for hypertension or 2.5 mg for heart failure).
If your CrCl is less than 10 mL/min or you are on dialysis, the initial dose is usually 2.5 mg daily.
Liver Issues
For liver issues, treatment should stop if you develop jaundice or severe increases in liver enzymes. Always consult your doctor if you notice any concerning symptoms.
Timing of Administration
If you’re just starting, your doctor might suggest taking it once a day before bedtime to help prevent dizziness. After that, you can take it any time but try to take it simultaneously each day to keep the levels steady in your body.
Remember to take the first dose at bedtime if your doctor recommends it to avoid dizziness. Keeping a regular schedule is essential. Taking lisinopril at the same time each day helps maintain consistent blood pressure control and prevents missed doses.
Best Practices for Lisinopril Use
These best practices ensure lisinopril’s safe and effective use while minimizing side effects and improving health outcomes.
Missed and Overdoses
If you forget to take a dose of lisinopril, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed one. Never take two doses simultaneously to make up for a missed dose.
What should you do if you take too much lisinopril? You might feel:
- Dizzy
- Sleepy
- Have a pounding heartbeat
If these symptoms are severe, seek urgent medical attention. When you get help, bring your lisinopril package or the information leaflet, any leftover medicine, and a list of other medications you are taking.
Staying on schedule is essential for your treatment to work well. If you have any questions about missed doses or overdoses, talk to your healthcare provider. They can give you the best advice to keep you safe and healthy.
Long-Term Use
You might feel fine, but continuing to take it is critical. According to studies, simplifying how often you take your medication can help you stick to it. For example, in seven out of nine studies, switching to once-a-day dosing improved adherence by 8% to 19.6%. This simple change can make it easier to manage your condition every day.
Skipping doses might seem harmless, but it can make the treatment less effective. Studies estimate that only 50% to 70% of people take blood pressure medications as prescribed. This lack of consistency is a major reason hypertension is often poorly controlled. Adding strategies like reminder charts or involving family support can also improve adherence, with some methods showing up to a 41% success rate.
Taking lisinopril consistently does more than control your blood pressure. Research shows that treating high blood pressure can lower your risk of stroke by 31% to 45% and reduce your chance of a heart attack by 8% to 23%. These numbers highlight why staying on track with your medication matters. It helps you stay healthier and avoid complications in the long run.
Illness and Lisinopril Use
If you experience illness, such as fever, severe vomiting, diarrhea, or dehydration, consult your doctor, as these conditions may necessitate temporarily stopping lisinopril use until you recover and are eating and drinking usually.
Warnings and Contradictions
Lisinopril is subjected to several warnings and contradictions, as discussed below.
Pregnancy
If you are pregnant, do not take lisinopril. A study shows that taking lisinopril in the second and third trimesters can seriously harm your baby. This medicine lowers the amount of amniotic fluid around the baby, vital for growth and healthy lungs and kidneys. Low amniotic fluid can lead to birth defects, such as underdeveloped skull bones and kidney problems.
In severe cases, babies exposed to lisinopril before birth might suffer from kidney failure, low blood pressure, or even death. These newborns may need urgent medical care like dialysis.
If you are pregnant or planning to become pregnant, talk to your doctor about the risks of using lisinopril to protect your baby’s health.
Drug Interactions
Lisinopril should not be taken or used with caution with certain drugs that may have interactions with lisinopril such as the following:
Diuretics
Combining lisinopril with diuretics is common for controlling blood pressure, however this combination could cause your blood pressure to drop too low. According to studies, combining lisinopril with diuretics, especially thiazide or potassium-sparing types like spironolactone or amiloride, can increase your risk of hypotension. This happens because both medications work to lower blood pressure, and the effect can sometimes be too strong.
In certain situations, the combination of lisinopril with potassium sparing diuretics can cause elevated potassium levels (hyperkalemia). This is a significant, serious condition which requires careful surveillance to prevent.
If you need to take both, frequent monitoring of your potassium levels is important to prevent complications. Talk to your doctor about how to safely manage these medications and monitor your health.
Diabetic Medications
If you take medications to treat diabetes, like insulin or oral hypoglycemics, along with lisinopril, your blood sugar levels could drop too low. According to a study, the use of ACE inhibitors is associated with increased insulin sensitivity in diabetic patients. While this effect might help manage certain conditions, it also raises the risk of hypoglycemia.
The study found that diabetic patients using ACE inhibitors had a significantly higher risk of hospital admission for hypoglycemia, with an odds ratio of 2.8 for insulin users and 4.1 for those on oral antidiabetic drugs. This means ACE inhibitors might account for as many as 13.8% of all hospitalizations for hypoglycemia.
If you’re taking both lisinopril and antidiabetic medications, it’s crucial to monitor your blood sugar levels closely and discuss any concerns with your doctor.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
Taking NSAIDs, such as ibuprofen or naproxen, with lisinopril can reduce how well lisinopril lowers your blood pressure. According to studies, this interaction is particularly risky for older adults, those on diuretics, or people with kidney problems. NSAIDs can interfere with the blood-pressure-lowering effects of ACE inhibitors like lisinopril and may increase the risk of kidney damage.
Combining NSAIDs with ACE inhibitors and diuretics can significantly increase the risk of acute kidney injury. Even without diuretics, NSAIDs pose a risk, especially if used for long periods or at high doses.
If you need both NSAIDs and lisinopril, it’s important to use them cautiously and under close medical supervision to protect your kidneys. Always consult your doctor before combining these medications.
Renin-Angiotensin System Blockers
Using lisinopril with other renin-angiotensin system blockers, such as ARBs or aliskiren, can lead to serious complications. According to the FDA, combining these medications increases the risks of:
- High potassium levels (hyperkalemia)
- Low blood pressure (hypotension)
- Kidney issues
This is particularly dangerous for individuals with diabetes or kidney impairment, as the combination is contraindicated for these patients.
The ALTITUDE trial highlighted these risks, showing that patients using aliskiren along with an ARB or ACE inhibitor experienced higher rates of renal impairment (12.4% vs. 10.4%), hypotension (18.6% vs. 14.8%), and hyperkalemia (36.9% vs. 27.1%) compared to those taking a placebo. Based on these findings, the FDA advises avoiding this combination in patients with moderate to severe kidney impairment (GFR < 60 mL/min) to prevent serious adverse effects.
If you’re taking these medications, talk to your doctor to ensure your treatment plan is safe.
Lithium
Taking lisinopril with lithium can increase lithium levels in your blood, leading to lithium toxicity. According to studies, the addition of ACE inhibitors like lisinopril has been associated with a higher risk of toxicity. In one case, a patient experienced symptoms such as nausea, tremors, and confusion within weeks of starting lisinopril.
Their lithium levels rose from a therapeutic range (0.8 mmol/L) to a toxic level (2.0 mmol/L), alongside a significant decline in kidney function.
Lithium toxicity can occur because lisinopril reduces the filtration rate of your kidneys, making it harder for lithium to be excreted. Reports show this interaction can cause toxicity in as many as 20% of patients using both medications.
If you’re taking lithium and start lisinopril, it’s essential to have your lithium levels and kidney function monitored closely. Reach out to your doctor immediately if you notice any symptoms of toxicity.
Final Words
Taking lisinopril correctly ensures it works effectively for conditions like high blood pressure, heart failure, or diabetic kidney disease. Timing and dosage matter. Take it once daily, ideally at the same time, with or without food. For missed doses, take it as soon as you remember unless it’s close to your next dose. Never double up. If you overdose, seek medical help immediately.
Dosages depend on your condition and age. For adults, the starting dose is often 10 mg daily, adjusted as needed. Children, elderly individuals, or those with kidney or liver issues require specific adjustments.
Drug interactions, including certain diuretics, NSAIDs, or diabetic medications, can cause complications. Consult your doctor for tailored advice, and stick to their guidance to stay safe and healthy.
Frequently Asked Questions
What should I do if I miss a dose?
Take the missed dose as soon as you remember unless it’s almost time for your next dose. Never take two doses at once.
Are there any foods or supplements I should avoid?
Avoid salt substitutes and potassium supplements unless your doctor advises otherwise.
Can I take lisinopril if I’m pregnant or breastfeeding?
No, lisinopril can harm an unborn baby. Do not use it during pregnancy or while breastfeeding.
Can I stop taking lisinopril if I feel better?
No, continue taking it as prescribed, even if you feel well, to keep your blood pressure under control.
Sources
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- Mother To Baby. (2024). Lisinopril. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK582793
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- U.S. Food and Drug Administration. (2012). FDA drug safety communication: New warning and contraindication for blood pressure medicines containing aliskiren (Tekturna). Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-new-warning-and-contraindication-blood-pressure-medicines-containing
- Schneir, A., & Masom, C. P. (2020). Lithium toxicity from the addition of an ACE inhibitor with an unexpected Type I Brugada pattern ECG: Case files of the medical toxicology fellowship at the University of California, San Diego. Journal of Medical Toxicology, 16(3), 321–328. https://doi.org/10.1007/s13181-020-00773-9