ACE Inhibitor Comparison Table

ACE Inhibitors have been a workhorse in managing blood pressure for years. While lisinopril is the most commonly used agent that I see in practice, I thought it would be helpful to put together an ACE Inhibitor Comparison table to share with the audience and highlight some important differences. If you’d like more information on ACE inhibitors and lisinopril in general, check out this podcast episode.

HTN DosingIndicationsHalf-LifeEliminationMiscellaneous
Lisinopril20-40mg/dayHTN, HF, Post-STEMI; Off-label: Migraine ppx, NSTEMI ACS, Proteinuric CKD, nephropathy, Posttransplant erythrocytosis12 hoursRenalAvailable in combination with HCTZ
Enalapril5-40mg/dayHTN, HF, Post-STEMI; Off-label: Migraine ppx, NSTEMI ACS, Proteinuric CKD, nephropathy, Posttransplant erythrocytosis2-11 hoursPrimarily Renal and significant fecalQD-BID dosing

Available in combination with HCTZ
Ramipril2.5-20mg/dayHTN, CV risk reduction, HF; Off-label: STEMI and NSTEMI ACS, proteinuric CKD, nephropathy13-17 hoursPrimarily Renal and significant fecalQD or BID dosing
Captopril25-150mg TIDHTN, HF, Post-MI ACS, diabetic nephropathy; Off-label: primary aldosteronism2 hoursRenalAE: Altered sense of taste

BID-TID dosing

Available in combination with HCTZ
Benazepril20-40mg/dayHTN10-11 hoursRenalAvailable in combination with amlodipine, HCTZ
Perindopril4-16mg QDHTN, Stable coronary artery disease; Off-label: HFrEF30-120 hoursRenalAvailable in combination with amlodipine
Quinapril20-80mg QDHTN, HFrEF3 hoursRenalAvailable in combination with HCTZ
Fosinopril10-40mg QDHTN, HFrEF; Off-label: HIV associated nephropathy12 hoursRenal and fecalAvailable in combination with HCTZ
Trandolapril2-4mg QDHTN, Post-MI HF/LVD; Off-label: HFrEF6-10 hoursPrimarily fecal and significant renalAvailable in combination with verapamil
Moexipril7.5-30mg/dayHTN1.5-10 hoursPrimarily fecal and minor renalQD-BID dosing

Available in combination with HCTZ
ACE Inhibitor Comparison Table

Half-Life Differences of ACE Inhibitors

The first major difference is half-life and how that relates to the frequency of dosing. A medication like captopril has a very short half-life and needs to be dosed multiple times per day. This is not good when talking about a medication that a patient is likely going to be taking for years. The shorter the half-life the more likely we are to encounter blood pressure fluctuations as well.

Adverse Effects

In general, the ACE inhibitors have very little variation in adverse effects. Cough, hyperkalemia, renal impairment, and angioedema are the most commonly associated adverse effects and the ones you are likely to see on your board exams and in practice. The one unique adverse effect that occurs with captopril and generally not with other ACE Inhibitors is taste alterations.


ACE Inhibitors are primarily eliminated one of two ways. In the ACE Inhibitor Comparison Chart above, you can see these drugs can be eliminated in the urine (renal) or in the feces. What is very nice about ACE inhibitors is that we don’t typically need to worry about metabolic breakdown and interactions through CYP enzymes.

This table was put together by Amy Van Loon, PharmD Candidate.

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Written By Eric Christianson

September 17, 2023

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