Question 1

What is the equivalent dose of losartan to lisinopril?

Accepted Answer

A common conversion is **lisinopril 20 mg/day ≈ losartan 50 mg/day** for blood pressure. The equivalency is approximate — individual responses vary, and ARBs and ACE-Is are not pharmacologically identical. After a switch for ACE-I cough, BP is typically rechecked and titrated within 1–2 weeks.

Question 2

Is enalapril 10 mg the same as lisinopril 10 mg?

Accepted Answer

For total daily dose, roughly yes — lisinopril 20 mg/day ≈ enalapril 20 mg/day total. But enalapril is dosed BID (10 mg twice daily) while lisinopril is once daily. The PK profiles differ; substituting mg-for-mg without changing the schedule produces peak / trough variability the once-daily formulation avoids.

Question 3

Should I switch my patient from an ACE-I to an ARB if they get a cough?

Accepted Answer

Yes — ACE-I cough resolves with discontinuation, and ARBs do not produce the same cough because they do not raise bradykinin. A standard equivalent ARB dose is appropriate. Monitor potassium and creatinine after the switch as you would for any RAAS change.

Question 4

Can I combine an ACE-I and an ARB?

Accepted Answer

Generally no. ONTARGET (NEJM 2008) showed no mortality benefit from the combination but a substantial increase in hyperkalemia, hypotension, and AKI. Combination therapy has been removed from major HF and HTN guidelines except in very narrow circumstances under specialist management.

Question 5

What is the heart-failure target dose for lisinopril?

Accepted Answer

The ATLAS trial used 32.5–35 mg/day (rounded to 40 mg in practice) as the high-dose target — substantially higher than typical antihypertensive doses. Under-dosing in HFrEF is one of the most common reasons patients fail to achieve trial-level mortality benefit.

Question 6

Should I switch a HFrEF patient on lisinopril to ARNI?

Accepted Answer

If they tolerate ACE-I or ARB and have HFrEF (LVEF ≤40%), yes — current AHA/ACC/HFSA HF guidelines recommend ARNI (sacubitril/valsartan) over ACE-I/ARB monotherapy for HFrEF when tolerated. Wait at least 36 hours after the last ACE-I dose before starting sacubitril/valsartan to avoid angioedema.

Lisinopril	20mg/day	daily	HF target 40 mg
Enalapril	20mg/day	BID	HF target 40 mg
Ramipril	10mg/day	daily–BID	HF target 10 mg
Captopril	100mg/day	TID	HF target 150 mg
Benazepril	20mg/day	daily
Perindopril	8mg/day	daily	HF target 8 mg

Losartan	50mg/day	daily–BID	HF target 150 mg
Valsartan	160mg/day	daily–BID	HF target 320 mg
Telmisartan	80mg/day	daily
Candesartan	16mg/day	daily	HF target 32 mg
Irbesartan	300mg/day	daily
Olmesartan	40mg/day	daily

ACE-I / ARB Equivalent Doses

References

Related