Zestoretic 10/12.5 Mg Tablets
WARNING: Do not take if you are pregnant. Use during pregnancy may cause birth defects or loss of the unborn baby. If you get pregnant or plan on getting pregnant while taking this drug, call your doctor right away. @ COMMON USES: It is used to treat high blood pressure.
Drug Class
Antihypertensive
Pharmacologic Class
Angiotensin-converting enzyme (ACE) inhibitor; Thiazide diuretic
Pregnancy Category
Category D
FDA Approved
Aug 1989
DEA Schedule
Not Controlled
Overview
What is this medicine?
Zestoretic is a combination medicine that contains two drugs: lisinopril and hydrochlorothiazide. Lisinopril helps relax your blood vessels, and hydrochlorothiazide helps your body get rid of extra salt and water. Together, they work to lower your blood pressure.
How to Use This Medicine
Taking Your Medication
To get the most benefit from your medication, follow these guidelines:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
You can take your medication with or without food.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
Note: This medication may increase the frequency of urination. To minimize sleep disturbances, try to avoid taking it too close to bedtime.
Drink plenty of non-caffeinated fluids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To ensure the safety and effectiveness of your medication:
Store it at room temperature, away from light and moisture.
Keep it in a dry place, such as a closet or drawer, and avoid storing it in the bathroom.
Keep all medications out of the reach of children and pets.
Dispose of unused or expired medication properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist.
Check with your pharmacist for guidance on the best way to dispose of your medication, and consider participating in a local drug take-back program.
What to Do If You Miss a Dose
If you miss a dose of your medication:
Take it as soon as you remember.
However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses to make up for a missed dose.
To get the most benefit from your medication, follow these guidelines:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
You can take your medication with or without food.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
Note: This medication may increase the frequency of urination. To minimize sleep disturbances, try to avoid taking it too close to bedtime.
Drink plenty of non-caffeinated fluids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To ensure the safety and effectiveness of your medication:
Store it at room temperature, away from light and moisture.
Keep it in a dry place, such as a closet or drawer, and avoid storing it in the bathroom.
Keep all medications out of the reach of children and pets.
Dispose of unused or expired medication properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist.
Check with your pharmacist for guidance on the best way to dispose of your medication, and consider participating in a local drug take-back program.
What to Do If You Miss a Dose
If you miss a dose of your medication:
Take it as soon as you remember.
However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.
Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Take your medication exactly as prescribed, usually once daily.
- Do not stop taking this medication without talking to your doctor, even if you feel well.
- Limit your intake of high-sodium foods.
- Maintain a healthy diet rich in fruits, vegetables, and whole grains.
- Engage in regular physical activity as advised by your doctor.
- Limit alcohol consumption.
- Avoid potassium supplements or salt substitutes containing potassium unless directed by your doctor.
- Stand up slowly from a sitting or lying position to avoid dizziness.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
10 mg Lisinopril / 12.5 mg Hydrochlorothiazide orally once daily
Dose Range:
10 - 20 mg
Condition-Specific Dosing:
hypertension:
Initial dose is typically 10 mg Lisinopril / 12.5 mg Hydrochlorothiazide once daily. Dosage may be increased after 2-3 weeks to a maximum of 20 mg Lisinopril / 25 mg Hydrochlorothiazide once daily if blood pressure is not controlled. Patients should be titrated on individual components first if possible.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
CrCl > 30 mL/min: No initial dose adjustment needed, but monitor renal function closely.
Moderate:
CrCl 30-80 mL/min: Use with caution. Consider starting with individual components and titrating. Hydrochlorothiazide is generally not recommended if CrCl < 30 mL/min.
Severe:
CrCl < 30 mL/min: Contraindicated due to hydrochlorothiazide component. Lisinopril alone requires significant dose reduction.
Dialysis:
Not recommended for initiation in dialysis patients. Lisinopril is dialyzable, hydrochlorothiazide is not. Use with extreme caution and monitor closely if continued.
Hepatic Impairment:
Mild:
No specific dose adjustment, but use with caution. Thiazides may precipitate hepatic coma in severe impairment.
Moderate:
Use with caution. Monitor fluid and electrolyte balance closely.
Severe:
Use with caution. Thiazides may precipitate hepatic coma. Not recommended for routine use.
Pharmacology
Mechanism of Action
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, leading to vasodilation, reduced aldosterone secretion (which decreases sodium and water reabsorption), and reduced bradykinin degradation (which contributes to vasodilation). Hydrochlorothiazide is a thiazide diuretic. It inhibits sodium reabsorption in the distal convoluted tubule, leading to increased excretion of sodium, chloride, and water, and to a lesser extent, potassium and magnesium. This reduces plasma volume and peripheral vascular resistance.
Pharmacokinetics
Absorption:
Bioavailability:
Lisinopril: Approximately 25-30%; Hydrochlorothiazide: Approximately 60-80%
Tmax:
Lisinopril: 6-8 hours; Hydrochlorothiazide: 1-2.5 hours
FoodEffect:
Lisinopril: Absorption is not affected by food; Hydrochlorothiazide: Absorption is not significantly affected by food.
Distribution:
Vd:
Lisinopril: Approximately 120 L; Hydrochlorothiazide: Approximately 3.6-7.8 L/kg
ProteinBinding:
Lisinopril: Negligible (<1%); Hydrochlorothiazide: Approximately 40-68%
CnssPenetration:
Limited
Elimination:
HalfLife:
Lisinopril: Functional half-life ~12 hours (due to slow dissociation from ACE); Hydrochlorothiazide: 5.6-14.8 hours
Clearance:
Lisinopril: Renal clearance is proportional to GFR; Hydrochlorothiazide: Renal clearance is approximately 300 mL/min
ExcretionRoute:
Lisinopril: Renal (unchanged); Hydrochlorothiazide: Renal (unchanged)
Unchanged:
Lisinopril: 100%; Hydrochlorothiazide: >95%
Pharmacodynamics
OnsetOfAction:
Lisinopril: 1 hour; Hydrochlorothiazide: 2 hours
PeakEffect:
Lisinopril: 6-8 hours; Hydrochlorothiazide: 4-6 hours
DurationOfAction:
Lisinopril: 24 hours; Hydrochlorothiazide: 6-12 hours
Safety & Warnings
BLACK BOX WARNING
When pregnancy is detected, discontinue Zestoretic as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar, including:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Passing urine more often
+ Flushing
+ Fast breathing
+ Breath that smells like fruit
Signs of kidney problems, such as:
+ Unable to pass urine
+ Change in how much urine is passed
+ Blood in the urine
+ Significant weight gain
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or passing out
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or change in the amount of urine produced
+ Dry mouth
+ Dry eyes
+ Severe upset stomach or vomiting
Chest pain
Persistent cough
Severe stomach pain
Eye problems, such as changes in vision or eye pain, which can lead to permanent vision loss if left untreated
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Changes in skin, such as new or changing moles, lumps, or growths, which can be a sign of skin cancer
Signs of infection, such as fever, chills, or sore throat, which can be a sign of low white blood cell count
Other Possible Side Effects
Most people experience few or no side effects while taking this medication. However, if you notice any of the following side effects, contact your doctor or seek medical attention if they bother you or do not go away:
Feeling dizzy, tired, or weak
Headache
Cough
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood sugar, including:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Passing urine more often
+ Flushing
+ Fast breathing
+ Breath that smells like fruit
Signs of kidney problems, such as:
+ Unable to pass urine
+ Change in how much urine is passed
+ Blood in the urine
+ Significant weight gain
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or passing out
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or change in the amount of urine produced
+ Dry mouth
+ Dry eyes
+ Severe upset stomach or vomiting
Chest pain
Persistent cough
Severe stomach pain
Eye problems, such as changes in vision or eye pain, which can lead to permanent vision loss if left untreated
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Changes in skin, such as new or changing moles, lumps, or growths, which can be a sign of skin cancer
Signs of infection, such as fever, chills, or sore throat, which can be a sign of low white blood cell count
Other Possible Side Effects
Most people experience few or no side effects while taking this medication. However, if you notice any of the following side effects, contact your doctor or seek medical attention if they bother you or do not go away:
Feeling dizzy, tired, or weak
Headache
Cough
Reporting Side Effects
If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Swelling of the face, lips, tongue, or throat (angioedema) - seek emergency medical attention immediately.
- Difficulty breathing or swallowing - seek emergency medical attention immediately.
- Severe dizziness or fainting.
- Persistent dry cough.
- Signs of electrolyte imbalance: unusual tiredness, muscle weakness, cramps, nausea, vomiting, irregular heartbeat.
- Signs of kidney problems: little or no urination, swelling in your feet or ankles, feeling tired or short of breath.
- Yellowing of the skin or eyes (jaundice).
- Unexplained fever, sore throat, or other signs of infection.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
A known sulfa allergy.
A history of angioedema, a severe and potentially life-threatening reaction characterized by symptoms such as swelling of the hands, face, lips, eyes, tongue, or throat, difficulty breathing, swallowing problems, or unusual hoarseness.
Kidney disease or any kidney problems.
Inability to urinate.
Current or recent use of specific medications, including:
+ Dofetilide.
+ Lithium.
+ Aliskiren-containing drugs, especially if you have diabetes or kidney problems.
+ Sacubitril-containing drugs within the last 36 hours.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. Your doctor and pharmacist need this information to assess potential interactions and ensure it is safe for you to take this medication. Never start, stop, or adjust the dose of any medication without consulting your doctor first.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
A known sulfa allergy.
A history of angioedema, a severe and potentially life-threatening reaction characterized by symptoms such as swelling of the hands, face, lips, eyes, tongue, or throat, difficulty breathing, swallowing problems, or unusual hoarseness.
Kidney disease or any kidney problems.
Inability to urinate.
Current or recent use of specific medications, including:
+ Dofetilide.
+ Lithium.
+ Aliskiren-containing drugs, especially if you have diabetes or kidney problems.
+ Sacubitril-containing drugs within the last 36 hours.
This list is not exhaustive, and it is crucial to disclose all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you have. Your doctor and pharmacist need this information to assess potential interactions and ensure it is safe for you to take this medication. Never start, stop, or adjust the dose of any medication without consulting your doctor first.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Interactions with Other Substances
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter (OTC) medications that may cause drowsiness, consult your doctor.
Monitoring and Laboratory Tests
If you have diabetes, closely monitor your blood sugar levels. Your doctor will also require you to undergo regular blood work, blood pressure checks, and other laboratory tests. Inform all your healthcare providers and laboratory personnel that you are taking this medication, as it may affect certain lab tests.
Potassium and Salt Intake
If you are taking a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium product, discuss this with your doctor. Additionally, if you are on a low-salt or salt-free diet, consult your doctor before continuing.
Over-the-Counter Medications and Natural Products
Before using OTC products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or certain natural products, consult your doctor.
Interactions with Other Medications
If you are taking cholestyramine or colestipol, consult your pharmacist about the proper administration of these medications with this drug. Be aware of the potential for gout attacks.
Lupus and Other Conditions
If you have lupus, this medication may exacerbate your condition. Inform your doctor immediately if you experience any new or worsening symptoms. In hot weather or during physical activity, drink plenty of fluids to prevent dehydration. If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as this may lead to low blood pressure.
High Cholesterol and Triglycerides
This medication may cause increased cholesterol and triglyceride levels. If you have high cholesterol or triglycerides, discuss this with your doctor.
Angioedema and Other Serious Reactions
A severe and potentially life-threatening reaction called angioedema has been associated with this medication. The risk of angioedema may be higher in Black patients.
Special Precautions
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects. If you are breastfeeding, consult your doctor to discuss potential risks to your baby.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Interactions with Other Substances
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter (OTC) medications that may cause drowsiness, consult your doctor.
Monitoring and Laboratory Tests
If you have diabetes, closely monitor your blood sugar levels. Your doctor will also require you to undergo regular blood work, blood pressure checks, and other laboratory tests. Inform all your healthcare providers and laboratory personnel that you are taking this medication, as it may affect certain lab tests.
Potassium and Salt Intake
If you are taking a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium product, discuss this with your doctor. Additionally, if you are on a low-salt or salt-free diet, consult your doctor before continuing.
Over-the-Counter Medications and Natural Products
Before using OTC products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or certain natural products, consult your doctor.
Interactions with Other Medications
If you are taking cholestyramine or colestipol, consult your pharmacist about the proper administration of these medications with this drug. Be aware of the potential for gout attacks.
Lupus and Other Conditions
If you have lupus, this medication may exacerbate your condition. Inform your doctor immediately if you experience any new or worsening symptoms. In hot weather or during physical activity, drink plenty of fluids to prevent dehydration. If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as this may lead to low blood pressure.
High Cholesterol and Triglycerides
This medication may cause increased cholesterol and triglyceride levels. If you have high cholesterol or triglycerides, discuss this with your doctor.
Angioedema and Other Serious Reactions
A severe and potentially life-threatening reaction called angioedema has been associated with this medication. The risk of angioedema may be higher in Black patients.
Special Precautions
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects. If you are breastfeeding, consult your doctor to discuss potential risks to your baby.
Overdose Information
Overdose Symptoms:
- Severe hypotension (low blood pressure)
- Dizziness, lightheadedness, fainting
- Electrolyte disturbances (e.g., hyperkalemia, hypokalemia, hyponatremia)
- Dehydration
- Acute renal failure
- Tachycardia or bradycardia
What to Do:
If you suspect an overdose, seek emergency medical attention immediately or call Poison Control at 1-800-222-1222. Treatment is supportive and symptomatic, including intravenous fluids for hypotension and correction of electrolyte imbalances.
Drug Interactions
Contraindicated Interactions
- Aliskiren (in patients with diabetes or renal impairment (GFR < 60 mL/min/1.73 m2))
- Sacubitril/valsartan (Entresto) - concomitant use or within 36 hours of switching due to increased risk of angioedema
Major Interactions
- Potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride) and potassium supplements (increased risk of hyperkalemia)
- Lithium (increased lithium levels and toxicity)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors (reduced antihypertensive effect, increased risk of renal impairment, especially in dehydrated or elderly patients)
- Gold (injectable) (nitritoid reactions including facial flushing, nausea, vomiting, hypotension upon concomitant use with ACE inhibitors)
- Other antihypertensives (additive hypotensive effects)
Moderate Interactions
- Antidiabetic agents (insulin, oral hypoglycemics) (may enhance hypoglycemic effect, monitor blood glucose)
- Cholestyramine and colestipol resins (may impair absorption of hydrochlorothiazide)
- Corticosteroids, ACTH (intensified electrolyte depletion, particularly hypokalemia)
- Digoxin (hypokalemia/hypomagnesemia induced by HCTZ can predispose to digitalis toxicity)
- Muscle relaxants, non-depolarizing (enhanced effect of muscle relaxants)
- Allopurinol (increased risk of hypersensitivity reactions to allopurinol)
- Cyclosporine (increased risk of hyperkalemia and renal dysfunction)
- Trimethoprim (increased risk of hyperkalemia)
Minor Interactions
- Alcohol (may potentiate orthostatic hypotension)
- Barbiturates, narcotics (may potentiate orthostatic hypotension)
- Pressor amines (e.g., norepinephrine) (possible decreased response to pressor amines)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide therapy.
Timing: Prior to initiation
Serum Electrolytes (Potassium, Sodium, Magnesium, Calcium)
Rationale: Lisinopril can cause hyperkalemia; HCTZ can cause hypokalemia, hyponatremia, hypomagnesemia, hypercalcemia.
Timing: Prior to initiation
Renal Function (BUN, Serum Creatinine, eGFR)
Rationale: To assess baseline renal function and risk of acute kidney injury, especially with ACE inhibitors and diuretics.
Timing: Prior to initiation
Liver Function Tests (LFTs)
Rationale: To assess baseline hepatic function, as thiazides can precipitate hepatic coma in severe impairment.
Timing: Prior to initiation
Uric Acid
Rationale: HCTZ can increase serum uric acid levels.
Timing: Prior to initiation
Blood Glucose
Rationale: HCTZ can cause hyperglycemia.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly (e.g., weekly after initiation/dose change, then monthly/quarterly)
Target: <130/80 mmHg or individualized target
Action Threshold: Persistently elevated BP despite maximum dose, or symptomatic hypotension
Serum Electrolytes (Potassium, Sodium)
Frequency: 1-2 weeks after initiation/dose change, then every 3-6 months or as clinically indicated
Target: Potassium: 3.5-5.0 mEq/L; Sodium: 135-145 mEq/L
Action Threshold: Potassium <3.0 or >5.5 mEq/L; Sodium <130 or >150 mEq/L, or symptomatic electrolyte imbalance
Renal Function (BUN, Serum Creatinine, eGFR)
Frequency: 1-2 weeks after initiation/dose change, then every 3-6 months or as clinically indicated
Target: Stable or within acceptable limits for patient's baseline
Action Threshold: Increase in serum creatinine >30% from baseline, or significant decrease in eGFR
Uric Acid
Frequency: Periodically, especially if patient has history of gout
Target: Within normal limits
Action Threshold: Symptomatic hyperuricemia or gout flares
Blood Glucose
Frequency: Periodically, especially in diabetic patients
Target: Individualized glycemic targets
Action Threshold: Significant hyperglycemia or loss of glycemic control
Symptom Monitoring
- Dizziness or lightheadedness (especially upon standing)
- Persistent dry cough
- Swelling of face, lips, tongue, throat (angioedema)
- Difficulty breathing or swallowing
- Signs of electrolyte imbalance (e.g., muscle weakness, cramps, irregular heartbeat, excessive thirst, confusion)
- Signs of dehydration (e.g., dry mouth, decreased urination)
- Unusual fatigue or weakness
- Yellowing of skin or eyes (jaundice)
- Signs of gout (joint pain, swelling)
Special Patient Groups
Pregnancy
Contraindicated during the second and third trimesters of pregnancy due to the risk of fetal injury and death. Discontinue as soon as pregnancy is detected.
Trimester-Specific Risks:
First Trimester:
Limited data, but potential risk cannot be excluded. ACE inhibitors are generally avoided.
Second Trimester:
High risk of fetal injury (e.g., renal dysfunction, oligohydramnios, skull hypoplasia, lung hypoplasia, skeletal deformations, death).
Third Trimester:
High risk of fetal injury (e.g., renal dysfunction, oligohydramnios, skull hypoplasia, lung hypoplasia, skeletal deformations, death).
Lactation
Both lisinopril and hydrochlorothiazide are excreted in breast milk. Use with caution. Hydrochlorothiazide may suppress lactation. Monitor infant for dehydration and electrolyte imbalance.
Infant Risk:
L3 (Moderately Safe - Limited data suggest possible risk; weigh benefits vs. risks. Monitor infant for adverse effects like dehydration, lethargy, electrolyte imbalance).
Pediatric Use
Safety and effectiveness have not been established in pediatric patients. Not recommended for use in children.
Geriatric Use
Use with caution. Elderly patients may be more sensitive to the hypotensive and electrolyte effects. Start with lower doses and monitor renal function and electrolytes closely. Increased risk of falls due to orthostatic hypotension.
Clinical Information
Clinical Pearls
- Zestoretic is a convenient once-daily combination for patients requiring both an ACE inhibitor and a diuretic for blood pressure control.
- The most common side effect of lisinopril is a persistent dry cough, which usually resolves upon discontinuation.
- Monitor for angioedema, a rare but serious side effect, especially in the first few weeks of therapy.
- Patients should be advised to avoid potassium supplements or salt substitutes unless specifically instructed by their physician due to the lisinopril component.
- Hydrochlorothiazide can increase uric acid levels and may precipitate gout attacks in susceptible individuals.
- Educate patients on symptoms of dehydration and electrolyte imbalance, especially during hot weather or illness causing vomiting/diarrhea.
Alternative Therapies
- Other classes of antihypertensives (e.g., Calcium Channel Blockers, Beta-blockers, Alpha-blockers, direct vasodilators)
- Individual ACE inhibitors (e.g., Lisinopril, Enalapril)
- Individual Thiazide diuretics (e.g., Hydrochlorothiazide, Chlorthalidone)
- Loop diuretics (e.g., Furosemide) for patients with significant renal impairment or heart failure
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it occurred.