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Zestoretic

(lisinopril - hydrochlorothiazide)

How does this medication work? What will it do for me?

This is a combination product containing 2 medications: lisinopril and hydrochlorothiazide. It is used to treat high blood pressure.

Lisinopril belongs to a class of medications called ACE inhibitors and helps to lower blood pressure by relaxing blood vessels and reducing the workload of the heart. Hydrochlorothiazide belongs to a class of medications called diuretics or "water pills" that help control blood pressure by getting rid of excess salt and water.

It may take up to 2 to 4 weeks to see the full benefits of the medication.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

Once the dose of each medication (lisinopril and hydrochlorothiazide) that best controls your blood pressure has been determined, the combination tablets can be started.

The recommended dose ranges are:

  • lisinopril 10 mg - hydrochlorothiazide 12.5 mg, 1 tablet once daily
  • lisinopril 20 mg - hydrochlorothiazide 12.5 mg, 1 or 2 tablets once daily
  • lisinopril 20 mg - hydrochlorothiazide 25 mg, 1 or 2 tablets once daily

This medication can be taken with or without food. Swallow the tablet with water. Try to take your tablet at the same time each day, preferably in the morning.

Lower doses may be used for people who take other medications that lower blood pressure or for people who have kidney disease.

Do not stop taking your tablets unless your doctor recommends it.

Many things can affect the dose of medication that a person needs, such as their body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If more than 6 hours have passed since your last dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

10/12.5 mg
Each peach, round, biconvex tablet, with "Zt" over "10" intagliated on one side and blank on the other side, contains lisinopril 10 mg and hydrochlorothiazide 12.5 mg. Nonmedicinal ingredients: calcium hydrogen phosphate dihydrate, cornstarch, magnesium stearate, mannitol, pregelatinized starch, red iron oxide, and yellow iron oxide.

20/12.5 mg
Each white, round, biconvex tablet, with "Zestoretic" intagliated on one side and blank on the other side, contains lisinopril 20 mg and hydrochlorothiazide 12.5 mg. Nonmedicinal ingredients: calcium hydrogen phosphate dihydrate, cornstarch, magnesium stearate, mannitol, and pregelatinized starch.

20/25 mg
Each peach, round, biconvex tablet, with "Zestoretic" intagliated on one side and blank on the other side, contains lisinopril 20 mg and hydrochlorothiazide 25 mg. Nonmedicinal ingredients: calcium hydrogen phosphate dihydrate, cornstarch, magnesium stearate, mannitol, pregelatinized starch, red iron oxide, and yellow iron oxide.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to lisinopril, hydrochlorothiazide, or any ingredients of this medication
  • are allergic to sulfa (sulfonamide) medications
  • are pregnant or intend to become pregnant
  • are breast-feeding
  • have difficulty producing urine or are unable to urinate
  • have a history of angioedema after taking any ACE inhibitors (e.g., captopril, enalapril, fosinopril, lisinopril, ramipril)
  • have hereditary angioedema (a serious allergic reaction which causes swelling of the hands, feet, ankles, face, lips, tongue, or throat) or have angioedema with no known cause
  • have diabetes or kidney disease and are taking aliskiren

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • cough
  • dizziness or lightheadedness
  • erectile dysfunction (difficulty getting or keeping an erection)
  • headache
  • indigestion
  • nausea
  • numbness or tingling in the fingers or toes
  • sensitivity to the sun
  • skin rash
  • tiredness
  • upper respiratory infection
  • vomiting
  • weakness (loss of strength)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • dizziness, lightheadedness, or fainting (signs of low blood pressure)
  • rapid, irregular heartbeat
  • joint pain (e.g., toe pain may be a sign of gout)
  • muscle cramps
  • signs of anemia (low red blood cells; e.g., dizziness,  pale skin, unusual tiredness or weakness, shortness of breath)
  • signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood,  bleeding gums, cuts that don’t stop bleeding)
  • signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
  • signs of kidney problems (e.g., decreased urination, nausea, vomiting, swelling of legs, hands, fatigue)
  • signs of liver problems such as abdominal pain, nausea or vomiting, itching of skin, yellow eyes or skin
  • signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
  • skin rash (with or without itching), fever, or joint pain
  • swelling of hands, ankles or feet
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
  • signs of too much or too little potassium in the body
    • dry mouth
    • increased thirst
    • irregular heartbeat
    • mood or mental changes
    • muscle cramps or pain
    • numbness or tingling in hands, feet, or lips
    • weak pulse
    • weakness or heaviness of legs
  • skin rash, with or without itching, fever, or joint pain
  • stomach pain (severe) with nausea and vomiting
  • tingling or burning sensation

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • chest pain
  • symptoms of a serious allergic reaction, including angioedema (e.g., hives; swelling of the face, mouth, hands, or feet; and difficulty breathing)
  • severe skin rash, including skin blistering and peeling (possibly with headache, fever, coughing, or aching before the rash begins)
  • symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

HEALTH CANADA ADVISORY

February 4, 2014

Health Canada has issued new restrictions concerning the use of lisinopril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Allergic reaction: Some people who are allergic to sulfonamide medications also experience allergic reactions to hydrochlorothiazide. Before you take this medication, inform your doctor about any previous adverse reactions you have had to medications, especially to sulfonamide antibiotics or diabetes medications. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.

Allergy desensitization treatment: Tell your doctor if you are undergoing or will undergo desensitization treatment for an allergy. Desensitization treatment reduces the effects of the allergy (e.g., the reaction to bee or wasp stings), but it can sometimes cause a more severe allergic reaction if you are taking ACE inhibitors during the desensitization treatment.

Angioedema: Angioedema is a serious allergic reaction that causes swelling of the hands, feet, ankles, face, lips, tongue, or throat. If you experience any of these when you take lisinopril - hydrochlorothiazide, stop taking the medication at once and get immediate medical attention.

You should avoid taking any other medications in the ACE inhibitors class of medications. People who have had angioedema caused by other substances may be at increased risk of angioedema when they take an ACE inhibitor.

Cholesterol: Increases in cholesterol and triglyceride levels may occur when taking hydrochlorothiazide. If you have high cholesterol, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Cough: People taking lisinopril may develop a dry, persistent cough that usually disappears only after stopping or lowering the lisinopril dose of this medication. Inform your doctor of any cough that does not seem to be related to a usual cause.

Diabetes: This medication may make it more difficult for people who have diabetes to control their blood sugar. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.  An adjustment to doses of antidiabetic medications may be required.

Drowsiness/reduced alertness: Lisinopril - hydrochlorothiazide can cause dizziness or tiredness and you should not perform tasks such as driving or using machines that require special attention until you know how the medication will affect you.

Fluid and electrolyte balance: Increases in blood levels of potassium may occur for some people who take this medication. The levels of electrolytes such as calcium, potassium, sodium, magnesium, and chloride can be affected by treatment with hydrochlorothiazide. Your doctor will periodically check to see if these are in balance by requesting blood tests. Warning signs of fluid and electrolyte imbalance include:

  • confusion
  • drowsiness
  • dryness of mouth
  • lethargy
  • low blood pressure
  • muscle pains or cramps
  • muscular fatigue
  • nausea
  • racing heartbeat
  • restlessness
  • seizures
  • thirst
  • vomiting
  • weakness

Gout: High levels of uric acid may occur in the blood or gout (a type of arthritis that causes sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area) may be brought on in certain people receiving hydrochlorothiazide.

Heart or blood vessel disease: If you have a narrowing of the aorta (aortic stenosis) or the kidney artery (renal artery stenosis), or increased thickness of the heart muscle (hypertrophic cardiomyopathy), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Changes in kidney function have been seen in certain people (e.g., people with narrowed blood vessels in their kidneys, or those with severe congestive heart failure). Lisinopril - hydrochlorothiazide may cause abnormally low amounts or no urine to be passed. The use of diuretics (water pills) or nonsteroidal anti-inflammatory drugs (NSAIDs) may further increase risk of kidney trouble for people already at risk for this problem. Your doctor will periodically check your kidney function by arranging blood tests.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. This medication can also worsen liver function. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication. If you notice any signs of liver problems (e.g., abdominal pain, itching of skin, or yellow eyes or skin, loss of appetite, vomiting), contact your doctor immediately.

Low blood pressure: Occasionally, blood pressure drops too low after taking lisinopril - hydrochlorothiazide. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for people who take water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not drinking enough liquids. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Low white blood cell count: Your doctor may periodically request blood tests to monitor your level of white blood cells, as some people taking this medication have experienced low white blood cell counts.

Surgery or anesthesia: Tell your doctor or dentist that you are taking lisinopril - hydrochlorothiazide before you are given a local or general anaesthetic. When combined with some anesthetics, this medication may cause a short-term drop in blood pressure.

Pregnancy: Pregnant women should not take this medication. If you become pregnant, stop taking this medication and contact your doctor immediately.

Breast-feeding: It is not known if lisinopril passes into breast milk, but hydrochlorothiazide does. Women should not breast-feed while taking lisinopril - hydrochlorothiazide.

Children: The safety and effectiveness of this medication have not been established for children. Its use by this age group is not recommended.

What other drugs could interact with this medication?

There may be an interaction between lisinopril - hydrochlorothiazide and any of the following:

  • aliskiren
  • allopurinol
  • amifostine
  • alpha-adrenergic blocking agents (e.g., clonidine, doxazosin, prazosin, terazosin)
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • angiotensin receptor blockers (ARBs; losartan, valsartan, candesartan)
  • antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
  • anticholinergics (e.g., benztropine, ipratropium, oxybutynin)
  • barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
  • beta-blockers (e.g., atenolol, carvedilol, propranolol)
  • beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
  • brimonidine
  • calcitriol
  • calcium carbonate, calcium citrate
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • carbamazepine
  • cholestyramine
  • colestipol
  • inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
  • oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
  • cyclosporine
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • diazoxide
  • digoxin
  • other diuretics (water pills; e.g., furosemide, triamterene)
  • dofetilide
  • ginger
  • ginseng
  • heparin
  • hydralazine
  • licorice
  • lithium
  • low molecular weight heparins (LMWHs; e.g., dalteparin, enoxaparin, tinzaparin)
  • medications that increase blood levels of potassium (e.g., potassium chloride, salt substitutes containing potassium)
  • methylphenidate
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • multivitamins/minerals with ADE
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine)
  • nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen)
  • oxcarbazepine
  • phenytoin
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • porfimer
  • rituximab
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • sodium phosphates
  • tolvaptan
  • topiramate
  • tramadol
  • trimethoprim
  • vitamin D
  • warfarin
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2017. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Zestoretic

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