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ACE Inhibitor / HFrEF

Lisinopril (HFrEF / Post-MI)

Brand names: Zestril, Carace

Used in: Hypertension

Lisinopril is a long-acting ACE inhibitor used for hypertension, chronic heart failure and the early management of haemodynamically stable patients after myocardial infarction.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION Lisinopril monotherapy is an effective treatment of hypertension in once-daily doses of 10 mg to 80 mg, while hydrochlorothiazide monotherapy is effective in doses of 12.5 mg to 50 mg per day. In clinical trials of lisinopril/hydrochlorothiazide combination therapy using lisinopril doses of 10 mg to 80 mg and hydrochlorothiazide doses of 6.25 mg to 50 mg, the antihypertensive response rates generally increased with increasing dose of either component. The side effects (see WARNINGS ) of lisinopril are generally rare and apparently independent of dose; those of hydrochlorothiazide are a mixture of dose-dependent phenomena (primarily hypokalemia) and dose-independent …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-06-29. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It inhibits angiotensin-converting enzyme, reducing formation of angiotensin II and aldosterone, which lowers vasoconstriction and sodium/water retention.

Prescribing in practice

  • Check renal function and potassium before starting and after each dose increase, and watch for first-dose hypotension—particularly in patients already taking a diuretic or who are volume-depleted.
  • Dry cough and, rarely, angioedema can occur; hyperkalaemia is a recognised risk, especially with other agents that raise potassium.
  • Avoid in pregnancy and in bilateral renal artery stenosis; use caution in significant renal impairment and with concurrent potassium-sparing agents.

Monitoring

Monitor renal function, serum potassium and blood pressure before starting, after dose changes and periodically thereafter; review more closely in heart failure, renal impairment or during intercurrent illness.

Counselling the patient

  • Report a persistent dry cough, or any swelling of the face, lips, tongue or throat—seek urgent medical help for swelling.
  • Avoid potassium-based salt substitutes, and take care when standing up quickly as the first doses may cause dizziness.

Evidence & guidelines

Guideline-recommended for hypertension, heart failure and post-MI care (NICE NG136, NG106, NG185).

Reference: SOLVD Trial; GISSI-3 Trial; ESC HF Guidelines 2021; NICE NG106; SPC Zestril; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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