1.1. Adults

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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 [1-15]. Combination therapy is FDA-approved for management of hypertension [1,2,16-24]. 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 Dose [1-15]
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 Management [1,2,16-24]
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
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