Lisinopril/Hydrochlorothiazide

Lisinopril/Hydrochlorothiazide is a combination medicine used to treat hypertension (high blood pressure). Lowering blood pressure may lower the risk of a stroke or heart attack.

• Lisinopril/Hydrochlorothiazide is available under the following different brand names: Zestoretic

Common side effects of Lisinopril/Hydrochlorothiazide include:

• cough,
• headache,
• dizziness, and
• feeling tired.

Serious side effects of Lisinopril/Hydrochlorothiazide include:

• feeling lightheaded,
• eye pain or vision problems,
• little or no urination,
• weakness,
• drowsiness,
• feeling restless,
• fever,
• chills,
• sore throat,
• mouth sores,
• trouble swallowing,
• yellowing of the skin and eyes (jaundice),
• high potassium--nausea, tingly feeling, chest pain, irregular heartbeats, loss of movement, 
• low potassium--leg cramps, constipation, irregular heartbeats, fluttering in the chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling, and 
• low sodium--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, and feeling unsteady.

Rare side effects of Lisinopril/Hydrochlorothiazide include:

• none 

Adult dosage

Tablet

• 10 mg/12.5 mg
• 20 mg/12.5 mg
• 20 mg/25 mg
• Hypertension
• Adult dosage
• 10-80 mg lisinopril/6.25-50 mg hydrochlorothiazide orally once daily; titrate dose after 2-3 weeks of therapy based on clinical response; not to exceed 80 mg lisinopril or 50 mg hydrochlorothiazide per day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Lisinopril/Hydrochlorothiazide has severe interactions with no other drugs.
•  Lisinopril/Hydrochlorothiazide has serious interactions with the following drugs:
  • aminolevulinic acid oral
  • aminolevulinic acid topical
  • carbamazepine
  • cyclophosphamide
  • cyclosporine
  • dofetilide
  • isocarboxazid
  • lofexidine
  • methyl aminolevulinate
  • squill
  • tretinoin
  • tretinoin topical
• Lisinopril/Hydrochlorothiazide has moderate interactions with at least 161 other drugs.
• Lisinopril/Hydrochlorothiazide has minor interactions with at least 149 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to ACE inhibitors, thiazides, or sulfonamides
• ACE-inhibitor induced angioedema, hereditary or idiopathic angioedema
• Coadministration of ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan
• Anuria or renal stenosis
• Coadministration with aliskiren in patients with diabetes mellitus

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Lisinopril/Hydrochlorothiazide?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Lisinopril/Hydrochlorothiazide?”

Cautions

• Begin combination therapy only after failed monotherapy
• Severe renal impairment, hepatic impairment
• Risk of hypotension, especially with CHF
• Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors
• If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately
• Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors
• Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue if hepatic transaminase or jaundice occurs
• Dry hacking nonproductive cough may occur within a few months of treatment; consider other causes of cough before discontinuation; cough may resolve within 1-4 weeks after discontinuation 0f therapy
• Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium-sparing diuretics and potassium supplements; use cautiously if at all with these agents
• Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia
• Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure
• Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume-depleted patients, correct volume depletion before initiation; monitor closely when initiating and increasing dosing
• Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitors; patients with both renal impairment and collagen disease are at increased risk of developing neutropenia; monitor CBC with a differential in these patients
• Photosensitization may occur; instruct patients to protect skin from the sun and undergo regular skin cancer screening
• Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma that may occur within hours of initiating therapy; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain; additional treatment may be needed if uncontrolled intraocular pressure persists; risk factors include the history of sulfonamide or penicillin allergy
• Use caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia
• Closely observe patients with ischemic heart disease or cerebrovascular disease as falling blood pressure may result in complications, including stroke and myocardial infarction; fluid replacement may restore blood pressure to resume therapy; discontinue if hypotension recurs
• Following bariatric surgery, diuretics should be avoided as dehydration and electrolyte disturbances may occur; diuretics may be resumed as indicated after oral fluid intake goals are reached
• Use Hydrochlorothiazide with caution in patients with diabetes or at risk of diabetes; may see an increase in glucose
• Use caution in patients with collagen vascular disease, especially in patients with concomitant renal impairment
• Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia
• Increased cholesterol and triglyceride levels were reported with thiazides; use caution in patients with moderate to high cholesterol concentrations
• Pathologic changes in parathyroid glands with hypercalcemia and hypophosphatemia reported with prolonged use; discontinue before testing for parathyroid function
• Dual blockade of the renin-angiotensin-aldosterone system (ie, ARB plus an ACE inhibitor or aliskiren) in patients with established atherosclerotic disease or heart failure or with diabetes with end-organ damage is associated with a higher frequency of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure), as compared with the use of a single renin-angiotensin-aldosterone system agent; limit dual blockade to individually defined cases, with close monitoring of renal function
• Neonates with a history of in utero exposure: If oliguria or hypotension occurs, support of blood pressure and renal perfusion; exchange transfusions or dialysis may be required

Pregnancy and Lactation

• Use in LIFE-THREATENING emergencies when no safer drug is available. Positive evidence of human fetal risk.

Lactation

• Discontinue the drug or do not nurse