Zestoretic (lisinopril dihydrate + hydrochlorothiazide..): Uses, Dosage & Side Effects

What it's for (Indications)

Hypertension (including as a first-line therapy for high blood pressure), Heart failure, Prevention of myocardial infarction, and Prevention of stroke.

Dosage Information

Type	Guideline
Standard	Lisinopril monotherapy is effective at once-daily doses of 10 mg to 80 mg, while hydrochlorothiazide monotherapy is effective at 12.5 mg to 50 mg per day. For combination therapy, lisinopril doses typically range from 10 mg to 80 mg and hydrochlorothiazide doses from 6.25 mg to 50 mg. Antihypertensive response rates generally increase with increasing doses of either component. Dose adjustment may be required for patients with liver or kidney impairment. While lisinopril's side effects are generally rare and dose-independent, hydrochlorothiazide's side effects, such as hypokalemia, can be dose-dependent.

Type

Guideline

Standard

Lisinopril monotherapy is effective at once-daily doses of 10 mg to 80 mg, while hydrochlorothiazide monotherapy is effective at 12.5 mg to 50 mg per day. For combination therapy, lisinopril doses typically range from 10 mg to 80 mg and hydrochlorothiazide doses from 6.25 mg to 50 mg. Antihypertensive response rates generally increase with increasing doses of either component. Dose adjustment may be required for patients with liver or kidney impairment. While lisinopril's side effects are generally rare and dose-independent, hydrochlorothiazide's side effects, such as hypokalemia, can be dose-dependent.

Safety & Warnings

Common Side Effects

Common adverse effects include dizziness (7.
5%), headache (5.
2%), dry cough (3.
9%), fatigue (3.
7%), and orthostatic effects (3.
2%), which can manifest as lightheadedness or low blood pressure.
Other reported side effects include chest pain, nausea, diarrhea, and runny nose.
The hydrochlorothiazide component may lead to dose-dependent hypokalemia and, less commonly, dose-independent pancreatitis.
Adverse experiences are generally mild and transient; however, angioedema and excessive hypotension/syncope are severe potential adverse events.

Serious Warnings

Black Box Warning: WARNING: FETAL TOXICITY. When pregnancy is detected, discontinue lisinopril and hydrochlorothiazide as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
Pregnancy: Lisinopril and hydrochlorothiazide are not recommended during pregnancy due to the risk of fetal injury and death.
Discontinue treatment as soon as pregnancy is detected.
Lactation: The safety and effectiveness of this medicine are undetermined in nursing females; consult a doctor.
Driving: May cause dizziness; avoid driving or operating machinery until effects are known.
Organ Impairment: Patients with liver or kidney conditions should use this medicine with caution, and dose adjustment may be required.
Alcohol: Avoid alcohol consumption as it may increase the severity of side effects.
Medical History: Inform your doctor about your complete medical history, especially concerning heart or kidney diseases, diabetes, and angioedema.
Medication Management: Do not discontinue this medicine without informing your doctor.
Inform your doctor about all current medicines, including over-the-counter drugs and supplements, and any upcoming surgery.
Angioedema/Hypotension: Be vigilant for signs of angioedema or excessive hypotension/syncope.
Electrolyte Imbalance: Monitoring for changes in serum potassium and other electrolytes is important, especially due to the hydrochlorothiazide component.
Drug Interactions: Use with caution if co-administering with aliskiren (especially in patients with diabetes or renal impairment).
Do not administer within 36 hours of switching to or from sacubitril/valsartan.

How it Works (Mechanism of Action)

Lisinopril is an angiotensin-converting enzyme inhibitor (ACEI) that is not a prodrug. It functions by inhibiting ACE, a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor angiotensin II. Inhibition of ACE leads to decreased plasma angiotensin II, resulting in reduced vasopressor activity and decreased aldosterone secretion. This decrease in aldosterone may cause a small increase in serum potassium. Removal of angiotensin II's negative feedback on renin secretion leads to increased plasma renin activity.