Patients with Hypertension
The initial dose of lisinopril at patients with mild hypertension is 10 mg/daily. The dose is adapted individually depending upon the blood pressure response. Usually, 20-40 mg/daily into one dose are sufficient. The dose might be increased into weekly intervals up to 80 mg/daily. In case of a period of 1-3 months, a satisfactory hypotensive effect is not reached, it is recommended to include a diuretic, calcium antagonist or beta-blocker together with lisinopril. The increase in the dosage of lisinopril gives milder results. It is the best to add diuretic hydrochlorothiazide into a dose of 12.5 mg once daily. Patients with renovascular hypertension, the initial dose of lisinopril should be lower since these patients are very sensitive to the ACE inhibition. The initial dose of lisinopril should be 5mg or less. The dosage is individual and the usual maintenance dose is 20 mg/daily once per day.
Patients with Congestive Heart Weakness
At patients with congestive heart weakness the initial dose should be lower and to be 2.5 mg/daily once per day. The dose is gradually increased up to the maintenance dose that is mostly from 5-20 mg/daily. The dosage titration is accomplished in all cases in a period from 2-4 weeks.
Patients with Acute Infract of the Myocardium
At haemodynamic stable patients in the first 24 hours of the acute infarct of the myocardium, lisinopril is administered according to the following scheme: Patients with systolic blood pressure above 120 mmHg, the therapy starts in the first 24 hours from the beginning of the symptoms with a dose of 5mg once daily in a period of 2 days, and then the dose is increased to 10 mg once daily in the next 6 weeks. Patients with low systolic blood pressure (100-120 mmHg), the first two doses of lisinopril should be 2.5 mg each and the next doses of 5 mg in the next 6 weeks. In case hypotension appears after the administration of lisinopril (systolic blood pressure under 100 mmHg), the daily dose of 5mg is decreased to 2.5 mg. In case the hypotension (systolic blood pressure under 90 mmHg) is maintained in a period longer than 1 hour, the therapy with lisinopril should be terminated. At patients with acute infarct of the myocardium, lisinopril is given in a period of 6 weeks.
Patients with Diabetic Nephropathy
The initial dosage of lisinopril is 2.5 mg/daily and it is adapted individually in order to reach a diastolic blood pressure under 100 mmHg at normotensive insulin-depending patients or blood pressure under 9 0mmHg at hypertensive insulin-independent patients.
Patients with Kidney Insufficiency
At patients with kidney insufficiency, the dosing depends upon the creatinine clearance of 10-30 ml/minute is 5 mg/daily, and at patients with creatinine clearance under 10 ml/minute is 2.5 mg/daily. Individually is adapted the maintenance dosage of the effect.