Inside, regardless of food intake.With arterial hypertension, patients who do not receive other antihypertensives are prescribed 5 mg once a day. In the absence of effect, the dose is increased every 2-3 days by 5 mg to an average therapeutic dose of 20-40 mg per day (increasing the dose above 40 mg per day does not usually lead to a further decrease in blood pressure). The usual daily maintenance dose is 20 mg. The maximum daily dose is 40 mg.
The overall effect usually develops in 2-4 weeks from the start of treatment, which should be taken into account when increasing the dose. With insufficient clinical effect, it is possible to combine the drug with other antihypertensive drugs.
With renovascular hypertension or other conditions with increased activity renin-angiotensin-aldosterone system it is advisable to prescribe a low initial dose of 2.5-5 mg per day, under enhanced medical supervision (control of blood pressure, kidney function, potassium concentration in blood serum). The maintenance dose, continuing strict medical control, should be determined depending on the dynamics of blood pressure.
With renal insufficiency, due to the fact that lisinopril is released through the kidneys, the initial dose should be determined depending on the creatinine clearance, then, in accordance with the reaction, a maintenance dose should be established in conditions of frequent monitoring of renal function, potassium level, sodium in the blood serum.
With persistent arterial hypertension long-term maintenance therapy of 10-15 mg per day is indicated.
In chronic heart failure, the initial dose is 2.5 mg 1 time per day, followed by an increase of 2.5 mg 3-5 days before the usual maintenance daily dose of 5-20 mg. The dose should not exceed 20 mg per day.
In elderly people, a more pronounced and prolonged hypotensive effect is often observed, which is associated with a decrease in the rate of excretion of lisinopril (it is recommended to start treatment with 2.5 mg per day).
Acute myocardial infarction (as part of combination therapy). In the first day - inside 5 mg, then 5 mg every other day, 10 mg after two days and then 10 mg once a day. The course of treatment - at least 6 weeks.
At the beginning of treatment or within the first 3 days after acute myocardial infarction, a lower dose of 2.5 mg should be given in patients with low systolic blood pressure (120 mm Hg or lower). In the case of lowering blood pressure (systolic blood pressure less than or equal to 100 mm mercury column) daily dose of 5 mg, if necessary, temporarily reduced to 2.5 mg. In the case of a prolonged, marked decrease in blood pressure (systolic blood pressure Below 90 mm mercury column more than 1 hour) treatment with lisinopril should be discontinued.
Diabetic nephropathy. In patients with non-insulin-dependent diabetes mellitus, 10 mg of lisinopril is administered once a day. If necessary, it is possible to increase the dose to 20 mg once a day in order to achieve diastolic blood pressure values below 75 mm mercury column in the sitting position. In patients with insulin-dependent diabetes mellitus, the dosage is the same with the aim of achieving values diastolic blood pressure Below 90 mm mercury column in the sitting position.