Medication (generic)
Ramipril
Starting dose
2.5 mg once daily
Typical titration / target
Double every 2-4 weeks to 10 mg daily
Monitoring / notes
Check creatinine and potassium 7-14 days after start and dose changes.
Prescribing
ACE inhibitor start
Starting doses, titration targets, and monitoring essentials for ACE inhibitors.
Last reviewed 2026-01-05|cardio | renal | medication
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Dosing quick reference
Medication (generic)
Lisinopril
Starting dose
10 mg once daily
Typical titration / target
Titrate to 20-40 mg daily
Monitoring / notes
Avoid in pregnancy; watch for cough and angioedema.
Medication (generic)
Perindopril
Starting dose
4 mg once daily
Typical titration / target
Titrate to 8 mg daily
Monitoring / notes
Hold during dehydration or acute illness (sick day rules).
| Medication (generic) | Starting dose | Typical titration / target | Monitoring / notes |
|---|---|---|---|
| Ramipril | 2.5 mg once daily | Double every 2-4 weeks to 10 mg daily | Check creatinine and potassium 7-14 days after start and dose changes. |
| Lisinopril | 10 mg once daily | Titrate to 20-40 mg daily | Avoid in pregnancy; watch for cough and angioedema. |
| Perindopril | 4 mg once daily | Titrate to 8 mg daily | Hold during dehydration or acute illness (sick day rules). |
Contraindications
- Avoid if there is prior ACE inhibitor-associated angioedema.
- Avoid in known pregnancy.
- Defer initiation during significant hypotension, volume depletion, or unresolved acute illness.
Renal and hepatic considerations
- Review baseline renal function and potassium before initiation.
- Expect up to a 30% rise in creatinine; larger rises need reassessment.
- Use extra caution with advanced CKD, acute kidney injury risk, or concurrent nephrotoxic exposure.
Pregnancy and lactation cautions
- ACE inhibitors are contraindicated in pregnancy; stop promptly and switch to a pregnancy-compatible option if pregnancy occurs.
- Discuss contraception and preconception planning before initiation when relevant.
- During lactation, confirm agent-specific compatibility and infant monitoring requirements.
Monitoring checkpoints
- Recheck creatinine and potassium 7-14 days after initiation and after dose changes.
- Reinforce home BP monitoring and follow-up within 4-6 weeks.
- Review adverse effects (cough, dizziness, angioedema warning signs) at each contact.
Stop or escalate criteria
- Stop immediately and escalate urgently for angioedema symptoms.
- Stop and reassess if creatinine rises more than expected, clinically significant hyperkalemia develops, or symptomatic hypotension occurs.
- Escalate to specialist support when BP remains uncontrolled after sequential optimization.