1.1. Adults

Angiotensin-converting enzyme (ACE) inhibitors are FDA-approved for use in adults for diabetic nephropathy (captopril only), heart failure, hypertension, and improved survival/reduction of complications post-myocardial infarction. Combination therapy is FDA-approved for the management of hypertension. ACE inhibitors are available as monotherapy as well as combination products with a calcium channel blocker or hydrochlorothiazide. Adult maximum daily doses for ACE inhibitors are summarized in Tables 1 and 2 for mono- and combination therapy, respectively. Dosages exceeding these recommendations will be reviewed.

Table 1: ACE Inhibitors as Monotherapy - Maximum Daily Adult Dose1-15
Drug Name Dosage Form/Strength Treatment Indication Maximum Recommended Dosage
benazepril (Lotensin®, generics) 5 mg, 10 mg, 20 mg, 40 mg tablets hypertension 80 mg/day*
captopril (generics) 12.5 mg, 25 mg, 50 mg, 100 mg tablets diabetic nephropathy/ proteinuria 75 mg/day
    heart failure 450 mg/day
    hypertension 450 mg/day
    post-myocardial infarction 150 mg/day
enalapril (Vasotec®, generics; Epaned®) 2.5 mg, 5 mg, 10 mg, 20 mg tablets; 1 mg/ml oral solution asymptomatic left ventricular dysfunction 20 mg/day
    heart failure 40 mg/day
    hypertension 40 mg/day
fosinopril (generics) 10 mg, 20 mg, 40 mg tablets heart failure 40 mg/day
    hypertension 80 mg/day
lisinopril (Zestril, generics; Qbrelis) 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg tablets; 1 mg/ml oral solution acute myocardial infarction 10 mg/day
    heart failure 40 mg/day
    hypertension 80 mg/day
moexipril (generics) 7.5 mg, 15 mg tablets hypertension 30 mg/day
perindopril (generics) 2 mg, 4 mg, 8 mg tablets hypertension

16 mg/day

elderly, renal function impairment:  8 mg/day
    myocardial infarction prophylaxis 8 mg/day
quinapril (Accupril®, generics) 5 mg, 10 mg, 20 mg, 40 mg tablets heart failure 40 mg/day
    hypertension 80 mg/day
ramipril (Altace®, generics) 1.25 mg, 2.5 mg, 5 mg, 10 mg capsules heart failure (post myocardial infarction) 10 mg/day
    hypertension 20 mg/day
    myocardial infarction/ stroke prophylaxis in patients 55 years of age or older 10 mg/day
trandolapril (generics) 1 mg, 2 mg, 4 mg tablets hypertension 8 mg/day
    post myocardial infarction (heart failure, left ventricular dysfunction) 4 mg/day

Legend:

  • *Doses as high as 80 mg have provided increased response; however, experience with these higher dosages is limited.
Table 2: Adult Maximum Dosage Recommendations for ACE Inhibitor Combination Therapy in Hypertension Management1,2,16-25
Drug Name Dosage Form/Strength Maximum Recommended Dosage
amlodipine/benazepril (Lotrel®, generics)
  • 2.5 mg/10 mg (generic only)
  • 5 mg/10 mg
  • 5 mg/20 mg
  • 5 mg/40 mg (generic only)
  • 10 mg/20 mg
  • 10 mg/40 mg capsules
 10 mg/40 mg/day
benazepril/hydrochlorothiazide (Lotensin HCT®, generics)
  • 5 mg/6.25 mg (generic only)
  • 10 mg/12.5 mg
  • 20 mg/12.5 mg
  • 20 mg/25 mg tablets
 20 mg/25 mg/day
enalapril/hydrochlorothiazide (Vaseretic®, generics)
  • 5 mg/12.5 mg (generic only)
  • 10 mg/25 mg tablets
 20 mg/50 mg/day
fosinopril/hydrochlorothiazide (generics)
  • 10 mg/12.5 mg
  • 20 mg/12.5 mg tablets
 80 mg/50 mg/day
lisinopril/hydrochlorothiazide (Zestoretic®, generics)
  • 10 mg/12.5 mg
  • 20 mg/12.5 mg
  • 20 mg/25 mg tablets
 80 mg/50 mg/day
moexipril/hydrochlorothiazide (generics)
  • 7.5 mg/12.5 mg
  • 15 mg/12.5 mg
  • 15 mg/25 mg tablets
 30 mg/50 mg/day
perindopril/amlodipine (Prestalia®)
  • 3.5 mg/2.5 mg
  • 7 mg/5 mg
  • 14 mg/10 mg tablets
 14 mg/10 mg/day
quinapril/hydrochlorothiazide (Accuretic®, generics)
  • 10 mg/12.5 mg
  • 20 mg/12.5 mg
  • 20 mg/25 mg tablets
 40 mg/25 mg/day
trandolapril/verapamil (generics)
  • 1 mg/240 mg
  • 2 mg/180 mg
  • 2 mg/240 mg
  • 4 mg/240 mg extended-release tablets
 4 mg/240 mg/day