Lisinopril / Hydrochlorothiazide
Pronunciation: (Lie-SIN-oh-prill/high-droe-klor-oh-THIGH-uh-zide)Class: Antihypertensive combination
Trade Names:
Prinzide 10/12.5 mg
- Tablets 10 mg lisinopril and 12.5 mg hydrochlorothiazide
Trade Names:
Prinzide 20/12.5 mg
- Tablets 20 mg lisinopril and 12.5 mg hydrochlorothiazide
Trade Names:
Prinzide 20/25 mg
- Tablets 20 mg lisinopril and 25 mg hydrochlorothiazide
Trade Names:
Zestoretic 10/12.5 mg
- Tablets 10 mg lisinopril and 12.5 mg hydrochlorothiazide
Trade Names:
Zestoretic 20/12.5 mg
- Tablets 20 mg lisinopril and 12.5 mg hydrochlorothiazide
Trade Names:
Zestoretic 20/25 mg
- Tablets 20 mg lisinopril and 25 mg hydrochlorothiazide
Pharmacology
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Competitively inhibits angiotensin I-converting enzyme, prevention of angiotensin I conversion to angiotensin II, reversing the potassium loss associated with the diuretic.
HydrochlorothiazideIncreases chloride, sodium, and water excretion by interfering with transport of sodium ions across renal tubular epithelium.
Indications and Usage
Treatment of hypertension.
Contraindications
History of angioedema related to previous treatment with an angiotensin-converting enzyme (ACE) inhibitor; hereditary or idiopathic angioedema; anuria; hypersensitivity to sulfonamide-derived drugs, hypersensitivity to any component of the product.
Dosage and Administration
AdultsPO Using daily doses of lisinopril/hydrochlorothiazide combination therapy in lisinopril doses of 10 to 80 mg and hydrochlorothiazide doses of 6.25 to 50 mg, the antihypertensive response rates generally increase with increasing doses of either component. Do not use dosage higher than lisinopril 80 mg and hydrochlorothiazide 50 mg.
General Advice
Administer prescribed dose once daily in the morning, with or without food. Administer with food if GI upset occurs.
Storage/Stability
Store tablets at controlled room temperature (59° to 86°F). Keep container tightly closed. Protect from excessive light and moisture.
Drug Interactions
Hydrochlorothiazide Alcohol, barbiturates, narcoticsIncreased risk of orthostatic hypotension.
Antidiabetic agents (oral agents and insulin)Dosage adjustment of antidiabetic agent may be necessary.
Antihypertensive agentAdditive or potentiation of effects.
Cholestyramine, colestipol resinsImpaired absorption of hydrochlorothiazide.
Corticosteroids, ACTHIncreased electrolyte depletion, increasing the risk of hypokalemia.
LithiumRenal Cl of lithium may be reduced, increasing the risk of lithium toxicity.
Nondepolarizing skeletal muscle relaxants (eg, tubocurarine)Increased effect of the muscle relaxant.
Nonsteroidal anti-inflammatory agentsThe diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics may be reduced.
Pressor amines (eg, norepinephrine)Decreased responsiveness to the pressor amine.
Lisinopril Diuretic therapyExcessive reduction in BP after starting lisinopril therapy.
Nonsteroidal anti-inflammatory agentsWorsening of renal function in patients with compromised renal function; antihypertensive effects of lisinopril may be diminished.
Agents increasing serum potassium (eg, potassium-sparing diuretics [eg, spironolactone], potassium supplements, potassium-containing salt substitutes)May lead to increases in serum potassium.
LithiumBecause of possible increased sodium elimination, the risk of lithium toxicity is increased.
Laboratory Test Interactions
HydrochlorothiazideMay decrease serum protein-bound iodine levels without signs of thyroid disturbances. May cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels, and serum uric acid levels.
LisinoprilFalse elevation of liver enzymes, serum bilirubin, uric acid, or blood glucose may occur.
Adverse Reactions
Adverse reactions have been limited to those that have been previously reported with lisinopril or hydrochlorothiazide. The most frequently occurring adverse reactions reported with the combination include the following:
Cardiovascular
Orthostatic effects; excessive hypotension; syncope; palpitation.
CNS
Dizziness; headache; fatigue; asthenia; paresthesia.
Dermatologic
Rash.
GI
Diarrhea; nausea; vomiting; dyspepsia.
Genitourinary
Impotence.
Respiratory
Cough; upper respiratory infection.
Miscellaneous
Muscle cramps; angioedema.
Precautions
WarningsWhen used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible. |
Pregnancy
Category D (second and third trimesters); Category C (first trimester).
Lactation
Undetermined.
Children
Safety and efficacy not established.
Hypersensitivity
Angioedema, including swelling of the face, extremities, lips, tongue, glottis and/or larynx, has been reported rarely. Angioedema associated with laryngeal edema may be fatal; promptly discontinue drug.
Renal Function
Use with caution.
Hepatic Function
Use with caution. Minor alterations of fluid and electrolyte balance may precipitate hepatic coma.
Anaphylactoid reactions
ACE inhibitors affect the metabolism of eicosanoids and polypeptides, including endogenous bradykinin. Patients may be subject to a variety of adverse reactions, some of them serious.
Aortic stenosis/hypertrophic cardiomyopathy
Use with caution.
Cough
Persistent nonproductive cough has been reported; always resolves after discontinuation of therapy.
Fluid/Electrolyte imbalance
All patients receiving thiazide therapy should be observed for clinical signs of fluid or electrolyte imbalance, mainly hyperkalemia and hypokalemia, hypercalcemia, hyponatremia, and hypomagnesemia.
Glucose tolerance
Dosage adjustment of insulin or oral hypoglycemic agents may be required. Hyperglycemia may occur with thiazide diuretics.
Head/Neck angioedema
Angioedema of the face, extremities, lips, tongue, glottis, and/or larynx has been reported rarely.
Hyperuricemia
Hyperuricemia may occur or frank gout may be precipitated in certain patients receiving thiazide therapy.
Hypotension
Excessive hypotension may occur, especially in severely salt-or volume-depleted patients or those with severe CHF.
Intestinal angioedema
Has been reported; patients may present with abdominal pain (with or without nausea or vomiting).
Lipids
Increases in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy.
Neutropenia/Agranulocytosis
May occur more frequently in patients with renal function impairment, especially if they also have collagen vascular disease.
Overdosage
Symptoms
Dehydration, electrolyte imbalance, hypotension.
Patient Information
- Advise patient to take prescribed dose once daily, without regard to meals but to take with food if GI upset occurs.
- Advise patient to try to take each dose at about the same time each day.
- Inform patient that drug controls, but does not cure, hypertension and to continue taking drug as prescribed even when BP is not elevated.
- Caution patient not to change the dose or stop taking unless advised by health care provider.
- Instruct patient to continue taking other BP medications as prescribed by health care provider.
- Instruct patient in BP and pulse measurement skills.
- Advise patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Also advise patient to take record of BP and pulse to each follow-up visit.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
- Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing.
- Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP, resulting in lightheadedness or fainting.
- Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings.
- Caution patient to avoid unnecessary exposure to UV light (eg, sunlight, tanning booths), to use sunscreen, and to wear protective clothing when exposed to UV light to avoid photosensitivity reaction.
- Emphasize to hypertensive patient importance of other modalities on BP: weight control, regular exercise, smoking cessation, moderate intake of alcohol and salt.
- Instruct patient to stop taking drug and immediately report any of these symptoms to health care provider: fainting; swelling of the face, lips, eyelids, or tongue; difficulty breathing; any indication of infection (eg, sore throat, fever).
- Instruct patient to inform health care provider if a persistent cough develops while taking this medication.
- Caution patient not to take any prescription or OTC medications, potassium-containing salt substitutes, potassium supplements, herbal preparations, or dietary supplements unless advised by health care provider.
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Compare Lisinopril/Hydrochlorothiazide with other medications for the treatment of:
High Blood Pressure, Heart Failure
