Is 20 mg of lisinopril a high dose?

In this article:

• Typical starting dose
• Typical maintenance dose
• Maxiumum dose
• Is 20 mg of lisinopril a high dose?
• Lisinopril dosage chart
• Is 20 mg of lisinopril safe?
• Possible side effects and warnings
• Signs your lisinopril dose is too high

In this article

• Typical starting dose
• Typical maintenance dose
• Maxiumum dose
• Is 20 mg of lisinopril a high dose?
• Lisinopril dosage chart
• Is 20 mg of lisinopril safe?
• Possible side effects and warnings
• Signs your lisinopril dose is too high

Lisinopril is a prescription medication used to control high blood pressure in people 6 years and older. This drug is an angiotensin-converting enzyme (ACE) inhibitor, a class of drugs recommended by the American Heart Association (AHA) and American College of Cardiology (ACC) as a first-line drug choice for hypertension (high blood pressure). Lisinopril is also approved by the Food and Drug Administration (FDA) to treat heart failure and to improve survival after a heart attack. Healthcare providers may recommend a certain dose of lisinopril based on your condition and various other factors. We’ll explain what’s considered a high dose of lisinopril and its safety and side effect profile.

What’s the typical dosage of lisinopril

The dosage of lisinopril can vary depending on the patient’s age, what they’re prescribed the drug for, whether they have certain medical conditions, other medications they’re taking, and how they respond to the medication. Lisinopril is available in the following doses:

• Oral tablets: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
• Oral solution (liquid): 1 mg/mL

For adults, the typical dosage is between 10 to 40 mg daily. In children 6 years and older, the dosage depends on the child’s weight. 

Typical starting dose of lisinopril

The typical starting dosage of lisinopril can range from 2.5 mg to 10 mg, depending on what it’s being prescribed for:

• For adults with high blood pressure, the 2025 AHA/ACC guidelines recommend starting at 10 mg per day. 
• Adults with heart failure are recommended to start at 2.5 mg of lisinopril daily, according to the 2022 AHA/ACC/Heart Failure Society of America (HFSA) guidelines. 
• Within 24 hours of a heart attack, lisinopril may be recommended starting at 2.5 to 5 mg daily. 
• In patients with kidney disease, the initial dose of lisinopril is typically lower, depending on their creatinine clearance rate. 
• For children 6 years and older, the starting dose is 0.07 mg/kg (maximum 5 mg per dose) once daily. The maximum dose is 0.6 mg/kg/day, or up to 40 mg daily.  

Blen Tesfu, MD, a physician and medical adviser at Welzo, explains, “The majority of patients with elevated blood pressure are prescribed lisinopril at an initial dosage of 5–10 mg, once daily. This lower starting point is used to allow for the body’s adaptation to the new drug, as well as for the provider to evaluate the patient’s tolerance of the new medication.” Then, depending on the patient’s response to the medication, lisinopril “may be gradually increased in small increments over time,” she says. The dose should only be adjusted by the healthcare provider. 

Typical maintenance dose of lisinopril

The typical maintenance dose of lisinopril is 10–40 mg daily, depending on how you respond to the medication and whether you experience any side effects. 

For high blood pressure, the usual dosage is 10–40 mg daily. If your blood pressure isn’t controlled with lisinopril alone, your healthcare provider may add on a low-dose diuretic (water pill) such as hydrochlorothiazide. In this case, your healthcare provider may reduce your dose of lisinopril to 5 mg daily. 

After a heart attack, your healthcare provider may recommend 5 mg lisinopril within 24 hours, then 5 mg after 24 hours and increase it to 10 mg after 48 hours, then 10 mg once daily for at least six weeks. People with low systolic blood pressure may be started on a lower dose of 2.5 mg.

Max lisinopril dosage

“If you have high blood pressure that needs to be controlled because it is caused by other diseases like heart failure, or if your doctor feels that your blood pressure needs to be controlled more aggressively, then a higher dose of lisinopril may be necessary,” says Maria Knobel, MBBS, physician and medical director of Medical Cert UK. 

Lisinopril can be taken up to 40 mg daily for adults and children over 6 years old. Though doses of up to 80 mg daily have been used in people with high blood pressure, there was no further benefit compared to taking 40 mg of lisinopril daily. 

Is 20 mg of lisinopril a high dose?

No, 20 mg of lisinopril isn’t considered a high dose. Though 20 mg is more than the recommended starting dose for the drug, it’s not the maximum recommended dosage, either. This dosage is within the usual 10 to 40 mg dosage that could be recommended. “A 20 mg daily dosage of lisinopril would be classified as moderate in terms of dosage rather than high, as it falls well within the commonly accepted dosages of medication to treat hypertension,” Dr. Tesfu says.

Healthcare providers may increase your dose of lisinopril from the initial dose based on how you tolerate the drug and how well your symptoms are controlled. 

Lisinopril dosage chart
Condition	Starting dose	Maintenance dose	Maximum dose
High blood pressure (adults)	10 mg daily	10–40 mg daily	40 mg daily
Heart failure in adults	2.5 or 5 mg daily	20–40 mg daily
People with kidney disease	2.5 mg or 5 mg daily, depending on creatinine clearance and whether you are on dialysis
High blood pressure (children 6 years and older)	0.07 mg/kg once daily, up to 5 mg daily
Heart attack in adults	2.5–5 mg daily, starting within 24 hours	10 mg daily

Is 20 mg of lisinopril safe?

Yes. Generally, 20 mg of lisinopril is safe when taken as prescribed by a healthcare provider. This dose is within the range of usual doses of lisinopril listed on its drug label. If you experience new or worsening symptoms while taking lisinopril, contact your healthcare provider to investigate so they can adjust your treatment as needed. 

Possible lisinopril side effects and warnings

Lisinopril comes with a risk of side effects and warnings to be aware of. Common side effects of lisinopril include: 

• Headache
• Dizziness
• Low blood pressure (hypotension)
• High potassium levels (hyperkalemia)
• Cough

Though there aren’t many clinical trials that suggest whether doses affect the risks of side effects, one study in subjects with heart failure taking a higher dose of lisinopril (32.5–35 mg daily) experienced more dizziness and kidney function changes compared to subjects taking a lower dose (2.5–5 mg daily) of the drug. “As doses [of lisinopril] become larger, healthcare professionals will check a patient’s kidneys and their potassium levels much more closely. This will assist in ensuring that the medication is both safe and effective for the patient,” Dr. Tesfu shares.

There are some serious side effects and warnings around taking lisinopril to keep in mind. First, people who are pregnant should not take lisinopril. The medication has a black box warning for fetal toxicity, meaning taking lisinopril during pregnancy can cause harm to the developing fetus. 

Other serious side effects of lisinopril include:

• Head and neck swelling (angioedema)
• Anaphylactic reactions
• Impaired kidney function, possibly causing kidney failure
• Low blood pressure (hypotension), which can cause fainting, dizziness, or death
• High blood potassium (hyperkalemia), which can cause heart rhythm changes, muscle weakness, and numbness
• Liver failure

These serious side effects require immediate medical attention. Call emergency medical services and talk to your healthcare provider as soon as possible if you notice any signs or symptoms of these serious side effects. 

ACE inhibitors, including lisinopril, may interact with other medications and substances, such as:

• Diuretics such as furosemide, hydrochlorothiazide, or spironolactone
• Antidiabetic medications, such as insulins, which can lower blood sugar to an unsafe level (hypoglycemia)
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), which can compound with lisinopril’s effects to impair kidney function, especially in certain people at higher risk
• Other ACE inhibitors, angiotensin receptor blockers (ARBs) like valsartan, and aliskiren (People with diabetes should never take lisinopril with aliskiren.) 

Read our article for a complete list of lisinopril’s drug interactions, including how to minimize or manage them. 

Signs your lisinopril dose is too high

Even if you’re not taking the maximum daily dose of 40 mg lisinopril, you still may experience side effects. Talk to your healthcare provider about adjusting your dose if you notice signs, including:

• Dizziness, lightheadedness, or confusion
• Fainting 
• Heart palpitations, rapid heartbeats, muscle weakness, or numbness and tingling
• Decreased urination
• Extreme drowsiness or tiredness

“If any of these symptoms occur, do not ignore them and seek immediate medical help,” Dr. Knobel advises. These can be a sign that your lisinopril dose may need adjustment. Your healthcare provider can work with you to adjust your dose or find an alternative so your medication therapy is both safe and effective. 

Final thoughts

Although it’s not considered a low dose, 20 mg of lisinopril is not considered an unusually high dose of the medication, either. Healthcare providers prescribe lisinopril based on the condition it’s treating, the patient’s medical history, and how the patient responds to the medication. Typical doses for lisinopril range from 10–40 mg daily for most indications.

Like any prescription medication, lisinopril comes with warnings and risks of side effects. It’s important to always communicate with your healthcare professional about any new or worsening symptoms so they can tailor your treatment to reduce side effects while managing your condition.