Lisinopril dosage, forms, and strengths

Lisinopril is a generic drug (brand names: Prinivil, Zestril) commonly used to treat high blood pressure but is also prescribed to help improve life expectancy in people with certain types of heart failure or who have experienced a heart attack. Lisinopril belongs to a family of drugs called angiotensin-converting enzyme inhibitors, or ACE inhibitors for short. ACE inhibitors block the production of a protein that causes blood vessels to tighten.

Lisinopril is taken by mouth once per day. Although most people will be prescribed generic lisinopril tablets, some may instead be given brand-name Zestril or Prinivil. For those unable to take a tablet, a lisinopril oral solution is available under the brand name Qbrelis.

Lisinopril forms and strengths

Lisinopril is taken orally as a tablet or oral solution.

• Tablets: 2.5 milligrams (mg), 5 mg, 10 mg, 20 mg, 30 mg, 40 mg

• Oral solution: 1 mg per milliliter (mL)

Lisinopril dosage for adults

Lisinopril is FDA-approved to reduce blood pressure in people diagnosed with hypertension (high blood pressure). When prescribed for heart failure with a reduced ejection fraction—a condition in which the heart does not pump enough blood—lisinopril helps increase blood flow out of the heart. Lisinopril is also used as an add-on treatment to increase blood flow to the heart after a heart attack.

Lisinopril dosage for high blood pressure

ACE inhibitors such as lisinopril are first-line therapies for most cases of hypertension. ACE inhibitors work by blocking an enzyme called an angiotensin-converting enzyme, a protein that drives the body’s production of angiotensin II, a molecule that causes blood vessels to tighten and narrow. Without angiotensin II, blood vessels widen and blood pressure goes down. Lisinopril is a long-acting ACE inhibitor, requiring only a single daily dose to be effective at controlling blood pressure. It also dissolves in water, allowing it to be taken as an oral solution for people who cannot swallow a tablet. 

• Standard dosage for high blood pressure: 10–80 mg taken orally once per day

• Maximum dosage for high blood pressure: 80 mg per day

Lisinopril dosage for heart failure

Lisinopril is used along with other drugs (such as digoxin) to increase survival in people with congestive heart failure with reduced left ventricular ejection fraction, a condition in which the heart does not pump enough blood to the body. Lisinopril widens blood vessels, increasing the flow of blood to the body. The reduced stress on the heart helps to slow down progressive changes to the heart that worsen heart failure.

• Standard dosage for heart failure: 2.5–5 mg taken orally once per day

• Maximum dosage for heart failure: 40 mg per day

Lisinopril dosage for heart attack

Lisinopril increases the chances of survival when given within 24 hours of a heart attack (myocardial infarction), particularly the most severe type of heart attack when an artery to the heart is completely blocked. The goal of lisinopril therapy is to increase blood flow to the heart muscle to prevent further damage. Patients will be given a starting dose of 5 mg within 24 hours of the heart attack—2.5 mg in people with low blood pressure. The initial dose is followed by a second 5 mg dose (or 2.5 mg in people with low blood pressure) the day after. Then, lisinopril will be taken every day for at least six weeks. People who experience prolonged symptomatic hypotension (systolic blood pressure below 90 mm Hg) will be taken off lisinopril.

• Standard dosage for heart attack: 10 mg taken orally once per day (2.5–5 mg per day in people with low blood pressure)

• Maximum dosage for heart attack: Not specified

Lisinopril dosage for children

Lisinopril is FDA-approved to treat hypertension in children as young as 6 years of age. Dosages will be determined by weight but will typically start with a low dose.

Lisinopril dosage restrictions

Lisinopril is not metabolized by the body, so 100% of the drug is eliminated through the urine. People with liver dysfunction will not receive a dose adjustment. People with kidney disease or impaired renal function will require lower doses to prevent the drug from building up too much in the body. However, even people with renal failure can be given lisinopril.

• Renally impaired patients—dose adjustment: 

  • Serum creatinine clearance > 30 mL/min: No dosage adjustment

  • Creatinine clearance 10–30 mL/min: 5 mg/day to a maximum of 40 mg daily

  • Creatinine clearance < 10 mL/minute: start 2.5 mg/day to a maximum of 40 mg daily

  • Hemodialysis: start 2.5 mg/day to a maximum of 40 mg daily; no supplement

  • Parenteral dialysis: not specified

Lisinopril dosage for pets

ACE inhibitors such as lisinopril are commonly used in animals to treat high blood pressure or heart failure. Lisinopril is less commonly used and is not available in veterinary formulations. Dogs and cats that have hypertension are usually given an ACE inhibitor that is better-studied in animals than lisinopril, but veterinarians may use lisinopril for heart failure in dogs and cats. Dosages will depend on weight, typically 0.25–0.5 mg/kg of body weight.

How to take lisinopril

Lisinopril is taken once per day by mouth. For people unable to take a tablet, Lisinopril can be prescribed as an oral solution.

• Take the medicine as directed.

• Read and follow the patient instructions that come with this medicine.

• Lisinopril can be taken with or without food.

• Store Lisinopril tablets or oral suspension at room temperature (68°–77°F) protected from moisture, extreme heat, and freezing temperatures.

Tablets

• Swallow the tablet whole with a glass of water. Do not crush, chew, or break the tablet.

Oral solution

• Shake the oral solution well before using it.

• Use the metered dosing syringe or other dose-measuring device provided with the medicine to measure out the liquid. Do not use kitchen spoons, cups, measuring spoons, or measuring cups.

• Swallow the full dose.

Make sure to drink plenty of water when taking lisinopril. Because lisinopril may cause high blood potassium, avoid taking potassium supplements or salt substitutes containing potassium.

Lisinopril dosage FAQs

How long does it take lisinopril to work?

A dose of lisinopril can start affecting blood pressure about an hour after being taken. The drug hits its peak concentration in six to eight hours. Taking lisinopril with or without food does not affect the body’s absorption of the drug. 

How long does lisinopril stay in your system?

Lisinopril has a long duration of action, allowing it to be taken only once per day. Its effective half-life of 12 hours means that lisinopril’s effects on blood pressure are significantly reduced 24 hours after taking a dose. Because lisinopril is entirely removed by the kidneys, renal impairment will increase the concentration and duration of lisinopril in the body.

Although lisinopril’s effective half-life is 12 hours, it takes much longer for the body to completely clear the drug. Lisinopril’s terminal half-life—the length of time required to get rid of half the dose from the body—is 46 hours.  This means that it can take several days for lisinopril to fall to undetectable levels in the blood, though its effects on blood pressure diminish about a day after a dose is taken. As a result, suddenly stopping lisinopril will not precipitate a rapid rise in blood pressure as is true of other blood pressure medications.

What happens if I miss a dose of lisinopril?

Take a missed dose as soon as it’s remembered. However, if it is nearly time to take the next scheduled dose, skip the missed dose and take the next dose as scheduled. Do not take extra medicine or double the dose to make up for a missed dose.

How long can you take lisinopril?

ACE inhibitors such as lisinopril are taken long-term to treat high blood pressure or heart failure. Some people may take lisinopril or related medications for the rest of their lives. However, for people taking lisinopril after a heart attack, therapy is meant to be temporary. People taking lisinopril for a heart attack will take this medicine for at least six weeks. After that time, a doctor or other healthcare provider will decide if ACE inhibitor therapy needs to be continued or should be terminated.

How do I stop taking lisinopril?

Lisinopril can be stopped at any time without causing withdrawal symptoms, side effects, or a sudden rise in blood pressure. A variety of reasons may require discontinuation of lisinopril: hypersensitivity, high blood potassium, angioedema, jaundice, pregnancy, or taking certain types of prescription drugs (such as aliskiren or sacubitril) that can cause serious drug interactions with lisinopril. 

What is the maximum dosage for lisinopril?

For people taking lisinopril for high blood pressure, the maximum daily dose is 80 mg. This maximum is lower—40 mg daily—for people taking lisinopril for heart failure. The FDA has not defined a maximum daily dose for people receiving lisinopril after a heart attack. In general, however, people taking lisinopril for heart attack are not given high doses.

What happens when you mix lisinopril and alcohol?

Healthcare providers discourage drinking in people taking lisinopril. One of the adverse effects of lisinopril is dizziness. Drinking alcohol while taking lisinopril increases the risk and severity of dizziness. Alcohol also lowers blood pressure, so drinking while taking any antihypertensive carries a risk of blood pressure dropping too far. For most people, antihypertensive treatment is meant to be long-term, so it’s a good idea to rethink alcohol as a lifestyle choice when taking any blood pressure medication.

Is it safe to take lisinopril during pregnancy?

Lisinopril should not be taken during pregnancy. The drug can cause birth defects or fetal or neonatal death, particularly if taken during the second and third trimesters. Lisinopril also reduces amniotic fluid (oligohydramnios), which can cause lung and bone problems in the baby. 

Women on lisinopril who are breastfeeding will be advised to stop breastfeeding or switch to a different medication. Although the effects of lisinopril on a nursing infant are not well-known, lisinopril has the potential to cause severe problems in the infant if it is present in breast milk.

Related resources for lisinopril dosages:

• ACE inhibitors

• Lisinopril monograph

• Lisinopril

• Lisinopril compound summary

• Lisinopril tablet prescribing information

• Qbrelis prescribing information