Adults

Hypertension: Initial 10 mg once daily; usual maintenance 20-40 mg once daily. Heart Failure: Initial 2.5-5 mg once daily; usual maintenance 5-20 mg once daily. Post-MI: Initial 5 mg, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg once daily.

Elderly

Lower initial dose may be considered, especially with impaired renal function. Usually, no specific dosage adjustment is required based on age alone.

Renal_impairment

Initial dose should be adjusted based on creatinine clearance (CrCl). For CrCl 10-30 mL/min, initial dose 2.5-5 mg once daily. For CrCl <10 mL/min, initial dose 2.5 mg once daily.

Onset

Within 1 hour for blood pressure lowering effect.

Excretion

Excreted almost exclusively by the kidneys as the unchanged drug.

Half life

Effective half-life for accumulation is 12 hours. Terminal half-life is approximately 30 hours.

Absorption

Approximately 25-30% of an oral dose is absorbed, with variability. Absorption is not affected by food.

Metabolism

Lisinopril is not metabolized and is excreted unchanged.

Lithium

Increased serum lithium concentrations and lithium toxicity.

Aliskiren

Concomitant use is contraindicated in patients with diabetes or renal impairment due to increased risk of hyperkalemia, hypotension, and renal impairment.

Diuretics

Increased risk of symptomatic hypotension, especially after initiating lisinopril.

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

May reduce the antihypertensive effect of lisinopril and increase the risk of renal impairment.

Potassium-sparing diuretics/Potassium supplements

Increased risk of hyperkalemia.