Is It Better To Take Lisinopril In The Morning Or At Night?
In our latest question and answer, the pharmacist discusses whether or not lisinopril should be taken in the morning or evening.
I just started taking lisinopril 10mg. Is it better to take it in the morning or at night?
Lisinopril can safely be taken in the morning or at night. For most individuals, you should simply choose a time that is most convenient for you.
Having said that, there are some studies that suggest nighttime dosing is more effective than morning dosing since it better controls blood pressure levels during sleeping hours and in the early morning, where cardiac events are more common.
The Best Time To Take Lisinopril
The prescribing information for Zestril, the brand name for lisinopril, simply recommends to dose "once daily" and does not specify a specific time of day.
However, it does state that if you are taking the 10 mg daily dose, you should check your blood pressure just prior to dosing, to see if the effects of the drug are wearing off at the end of the dosing interval (i.e. before it is time to take your next dose).
If your blood pressure doesn't seem to be as well controlled by the time of your next dose, it is recommended to increase your dose, not change the time you take it. Per the prescribing information:
The antihypertensive effect [of lisinopril] may diminish toward the end of the dosing interval regardless of the administered dose, but most commonly with a dose of 10 mg daily. This can be evaluated by measuring blood pressure just prior to dosing to determine whether satisfactory control is being maintained for 24 hours. If it is not, an increase in dose should be considered.
Consider The Side Effects
One of the most important considerations when picking a time to take your daily dose of lisinopril are the potential side effects.
Some of the most common side effects of lisinopril include:
If you have taken blood pressure medication before, and experienced any of these side effects, taking your lisinopril at bedtime versus in the morning may be a better option. It won't much matter if lisinopril makes you tired if you are simply going to bed!
What Do Studies Say About Dosing Time
The study of how administration time may influence the overall effect of a drug is commonly referred to as 'chronotherapeutics' or 'chronopharmacology'.
Blood pressure medications are very often evaluated in regard to 'chronotherapeutics' since elevated blood pressure levels at certain times of the day (e.g. in the morning) is more associated with cardiac events (e.g. heart attacks) compared to other times of the day.
For some drugs, timing doesn't appear to be important.
For example, one study published in the Journal of Hypertension reported that administration time for Diovan (valsartan), an ARB blood pressure medication, doesn't have any effect on 24-hour blood pressure control.
Other studies, however, such as this study published in 'Hypertension', showed that evening dosing of Altace (ramipril), an ACE-Inhibitor like lisinopril, showed significantly better control of blood pressure during the nocturnal hours when compared to morning dosing.
Lisinopril Dosing Time Studies
Where lisinopril is concerned, there are a few studies that suggest that nighttime dosing may be preferred over morning dosing to better control night-time and early morning blood pressure.
One such study, published in European Review for Medical and Pharmaceutical Sciences, concluded the following:
"Data demonstrate that when the drug [lisinopril] is administered in the evening it reduces more greatly BP in the early morning, it keeps its activity at the end of the administration interval and it does not induce excessive hypotension, during sleep, when BP [blood pressure] is physiologically lower even in essentially hypertensive patients. Let us therefore assume that Lisinopril administration at 10 PM is more favourable, because by respecting the BP circadian rhythm, it protects better hypertensive patients from both vascular chronobiological risk, in the morning hours, when pressure rises, and from the Cruickshank’s effect (J curve) in night hour."
Other studies have reported similar results, that nighttime dosing of certain blood pressure medications (like lisinopril) can better control nighttime and early morning blood pressure levels, which could potentially reduce the risk of cardiovascular events.
It is important to note that the official dosing recommendations that are approved by the FDA don't specify a specific dosing time for lisinopril.
Most studies that report nighttime dosing may be more beneficial are generally preliminary and recommend further studies to gain a better understanding of whether or not the time of day you take your lisinopril dose makes a clinically significant difference.
Answer SummaryLisinopril is recommended to be taken once daily, without regard to a specific time. However, several studies report that nighttime dosing of blood pressure medications may provide better nocturnal and early morning blood pressure control, potentially reducing the risk of cardiovascular events (which are generally more common in the morning).
- Elsevier ClinicalKey: Lisinopril Monograph
- Zestril Prescribing Information
- Chronotherapy with the angiotensin-converting enzyme inhibitor ramipril in essential hypertension: improved blood pressure control with bedtime dosing. PubMed
- Time of administration important? Morning versus evening dosing of valsartan. PubMed
- Timing of Administration: For Commonly-Prescribed Medicines in Australia. PubMed
- Efficacy and Safety of Nighttime Dosing of Antihypertensives: Review of the Literature and Design of a Pragmatic Clinical Trial. PubMed
- Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. PubMed
- Management of antihypertensive treatment with Lisinopril: a chronotherapeutic approach. PubMed