ZESTRIL 20MG

Active substance: LISINOPRIL DIHYDRATE

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P032418

Taking other medicines
Tell your doctor if you are taking, or have
recently taken, any other medicines. This
includes medicines that you buy without a
prescription. This is because Zestril can affect
the way some medicines work and some
medicines can have an effect on Zestril.
PACKAGE LEAFLET:
INFORMATION FOR THE USER

Zestril 2.5 mg Tablets
Zestril 5 mg Tablets
Zestril 10 mg Tablets
Zestril 20 mg Tablets
lisinopril
Read all of this leaflet carefully before
you start taking this medicine.
- Keep this leaflet. You may need to read
it again.
- If you have any further questions, ask your
doctor or pharmacist.
- This medicine has been prescribed for you.
Do not pass it on to others. It may harm
them, even if their symptoms are the same
as yours.
- If any of the side effects get serious, or
if you notice any side effects not listed
in this leaflet, please tell your doctor or
pharmacist.
In this leaflet:
1. What Zestril is and what it is used for
2. Before you take Zestril
3. How to take Zestril
4. Possible side effects
5. How to store Zestril
6. Further information
1. What Zestril is and what it is used for
Zestril contains a medicine called lisinopril.
This belongs to a group of medicines called
ACE inhibitors.
Zestril can be used for the following conditions:
• To treat high blood pressure (hypertension).
• To treat heart failure.
• If you have recently had a heart attack
(myocardial infarction).
• To treat kidney problems caused by Type II
diabetes in people with high blood pressure.
Zestril works by making your blood vessels
widen. This helps to lower your blood pressure.
It also makes it easier for your heart to pump
blood to all parts of your body.
2. Before you take Zestril
Do not take Zestril if:
• You are allergic (hypersensitive) to lisinopril
or any of the other ingredients of Zestril
(listed in Section 6: Further information).
• You have ever had an allergic reaction
to another ACE inhibitor medicine. The
allergic reaction may have caused swelling
of the hands, feet, ankles, face, lips, tongue
or throat. It may also have made it difficult
to swallow or breathe (angioedema).
• A member of your family has had severe
allergic reactions (angioedema) to an
ACE inhibitor or you have had severe
allergic reactions (angioedema) without a
known cause.
• If you are more than 3 months pregnant.
(It is also better to avoid Zestril in early
pregnancy - see Pregnancy section).
Do not take Zestril if any of the above applies
to you. If you are not sure, talk to your doctor
or pharmacist before taking Zestril.
If you develop a dry cough which is persistent
for a long time after starting treatment with
Zestril, talk to your doctor.
Take special care with Zestril
Check with your doctor or pharmacist before
taking Zestril if:
• You have a narrowing (stenosis) of the aorta
(an artery in your heart) or a narrowing of
the heart valves (mitral valves).
• You have a narrowing (stenosis) of the
kidney artery.
• You have an increase in the thickness of
the heart muscle (known as hypertrophic
cardiomyopathy).
• You have problems with your blood vessels
(collagen vascular disease).
• You have low blood pressure. You may
notice this as feeling dizzy or light-headed,
especially when standing up.
• You have kidney problems or you are
having kidney dialysis.
• You have liver problems.
• You have diabetes.
• You have recently had diarrhoea or
vomiting (being sick).
• Your doctor has told you to control the
amount of salt in your diet.
• You have high levels of cholesterol
and you are having a treatment called
‘LDL apheresis’.
• You must tell your doctor if you think you
are (or might become) pregnant. Zestril
is not recommended in early pregnancy,
and must not be taken if you are more
than 3 months pregnant, as it may cause
serious harm to your baby if used at that
stage (see Pregnancy section).
• You are of black origin as Zestril may be
less effective. You may also more readily
get the side effect ‘angioedema’ (a severe
allergic reaction).
If you are not sure if any of the above apply
to you, talk to your doctor or pharmacist
before taking Zestril.
Treatment for allergies such as insect stings
Tell your doctor if you are having or are going
to have treatment to lower the effects of an
allergy such as insect stings (desensitisation
treatment). If you take Zestril while you are
having this treatment, it may cause a severe
allergic reaction.
Operations
If you are going to have an operation (including
dental surgery) tell the doctor or dentist that
you are taking Zestril. This is because you can
get low blood pressure (hypotension) if you
are given certain local or general anaesthetics
while you are taking Zestril.

In particular, tell your doctor or pharmacist if
you are taking any of the following medicines:
• Other medicines to help lower your blood
pressure.
• Water tablets (diuretic medicines).
• Medicines to break up blood clots (usually
given in hospital).
• Beta-blocker medicines, such as atenolol
and propranolol.
• Nitrate medicines (for heart problems).
• Non-steroidal anti‑inflammatory drugs
(NSAIDs) used to treat pain and arthritis.
• Aspirin (Acetylsalicylic acid), if you are
taking more than 3 grams each day.
• Medicines for depression and for mental
problems, including lithium.
• Potassium tablets or salt substitutes that
have potassium in them.
• Insulin or medicines that you take by mouth
for diabetes.
• Medicines used to treat asthma.
• Medicines to treat nose or sinus congestion
or other cold remedies (including those you
can buy in the pharmacy).
• Medicines to suppress the body’s immune
response (immunosuppressants).
• Allopurinol (for gout).
• Procainamide (for heart beat problems).
• Medicines that contain gold, such as sodium
aurothiomalate, which may be given to you
as an injection.
Pregnancy and breast‑feeding
Pregnancy:
You must tell your doctor if you think you are
(or might become) pregnant. Your doctor will
normally advise you to stop taking Zestril
before you become pregnant or as soon as
you know you are pregnant and will advise
you to take another medicine instead of
Zestril. Zestril is not recommended in early
pregnancy, and must not be taken when
more than 3 months pregnant, as it may
cause serious harm to your baby if used
after the third month of pregnancy.
Breast-feeding:
Tell your doctor if you are breast-feeding
or about to start breast-feeding. Zestril is
not recommended for mothers who are
breast-feeding, and your doctor may choose
another treatment for you if you wish to
breast-feed, especially if your baby is
newborn, or was born prematurely.
Driving and using machines
• Some people feel dizzy or tired when
taking this medicine. If this happens to you,
do not drive or use any tools or machines.
• You must wait to see how your medicine
affects you before trying these activities.
3. How to take Zestril
Always take Zestril exactly as your doctor has
told you. You should check with your doctor
or pharmacist if you are not sure.
Once you have started taking Zestril your
doctor may take blood tests. Your doctor may
then adjust your dose so you take the right
amount of medicine for you.
Taking your medicine
• Swallow the tablet with a drink of water.
• Try to take your tablets at the same time
each day. It does not matter if you take
Zestril before or after food.
• Keep taking Zestril for as long as your
doctor tells you to, it is a long term
treatment. It is important to keep taking
Zestril every day.
Taking your first dose
• Take special care when you have your
first dose of Zestril or if your dose is
increased. It may cause a greater fall in
blood pressure than later doses.
• This may make you feel dizzy or
light-headed. If this happens, it may help
to lie down. If you are concerned, please
talk to your doctor as soon as possible.
Adults
Your dose depends on your medical condition
and whether you are taking any other
medicines. Your doctor will tell you how many
tablets to take each day. Check with your
doctor or pharmacist if you are unsure.
For high blood pressure
• The usual starting dose is 10 mg once
a day.
• The usual long‑term dose is 20 mg once
a day.
For heart failure
• The usual starting dose is 2.5 mg once
a day.
• The long‑term dose is 5 to 35 mg once
a day.
After a heart attack
• The usual starting dose is 5 mg within
24 hours of your attack and 5 mg
one day later.
• The usual long-term dose is 10 mg once
a day.
For kidney problems caused by diabetes
• The usual dose is either 10 mg or
20 mg once a day.
If you are elderly, have kidney problems or
are taking diuretic medicines your doctor may
give you a lower dose than the usual dose.
Children and adolescents (6 to 16 years old)
with high blood pressure
• Zestril is not recommended for children
under 6 years or in any children with
severe kidney problems.
• The doctor will work out the correct dose
for your child. The dose depends on the
child’s body weight.
• For children who weigh between 20 kg
and 50 kg, the usual starting dose is
2.5 mg once a day.
• For children who weigh more than 50 kg,
the usual starting dose is 5 mg once a day.

If you take more Zestril than you should
If you take more Zestril than prescribed by
your doctor, talk to a doctor or go to a hospital
immediately. The following effects are most
likely to happen: Dizziness, palpitations.
If you forget to take Zestril
• If you forget to take a dose, take it as soon
as you remember. However, if it is nearly
time for the next dose, skip the missed dose.
• Do not take a double dose to make up for
a forgotten dose.
If you stop taking Zestril
Do not stop taking your tablets, even if you are
feeling well, unless your doctor tells you to.
If you have any further questions on the use of
this medicine, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, Zestril can cause side
effects, although not everybody gets them.
If you experience any of the following reactions,
stop taking Zestril and see your doctor
immediately:
• Severe allergic reactions (rare, affects
1 to 10 users in 10,000). The signs may
include sudden onset of:
- Swelling of your face, lips, tongue or
throat. This may make it difficult to
swallow.
- Severe or sudden swelling of your hands,
feet and ankles.
- Difficulty breathing.
- Severe itching of the skin (with
raised lumps).
• Severe skin disorders, like a sudden,
unexpected rash or burning, red or peeling
skin (very rare, affects less than 1 user
in 10,000).
• An infection with symptoms such as fever
and serious deterioration of your general
condition, or fever with local infection
symptoms such as sore throat/pharynx/
mouth or urinary problems (very rare,
affects less than 1 user in 10,000).
Other possible side effects:
Common (affects 1 to 10 users in 100)
• Headache.
• Feeling dizzy or light‑headed, especially if
you stand up quickly.
• Diarrhoea.
• A dry cough that does not go away.
• Being sick (vomiting).
• Kidney problems (shown in a blood test).
Uncommon (affects 1 to 10 users in 1,000)
• Mood changes.
• Change of colour in your fingers or
toes (pale blue followed by redness) or
numbness or tingling in your fingers or toes.
• Changes in the way things taste.
• Feeling sleepy.
• Spinning feeling (vertigo).
• Having difficulty sleeping.
• Stroke.
• Fast heart beat.
• Runny nose.
• Feeling sick (nausea).
• Stomach pain or indigestion.
• Skin rash or itching.
• Being unable to get an erection (impotence).
• Feeling tired or feeling weak (loss of
strength).
• A very big drop in blood pressure may
happen in people with the following
conditions: coronary heart disease;
narrowing of the aorta (a heart artery),
kidney artery or heart valves; an increase
in the thickness of the heart muscle.
If this happens to you, you may feel dizzy
or light-headed, especially if you stand
up quickly.
• Changes in blood tests that show how well
your liver and kidneys are working.
• Heart attack.
Rare (affects 1 to 10 users in 10,000)
• Feeling confused.
• A lumpy rash (hives).
• Dry mouth.
• Hair loss.
• Psoriasis (a skin problem).
• Changes in the way things smell.
• Development of breasts in men.
• Changes to some of the cells or other
parts of your blood. Your doctor may take
blood samples from time to time to check
whether Zestril has had any effect on your
blood. The signs may include feeling tired,
pale skin, a sore throat, high temperature
(fever), joint and muscle pains, swelling
of the joints or glands, or sensitivity to
sunlight.
• Low levels of sodium in your blood (the
symptoms may be tiredness, headache,
nausea, vomiting).
• Sudden renal failure.
Very rare (affect less than 1 user in 10,000)
• Sinusitis (a feeling of pain and fullness
behind your cheeks and eyes).
• Wheezing.
• Low levels of sugar in your blood
(hypoglycaemia). The signs may include
feeling hungry or weak, sweating and a
fast heart beat.
• Inflammation of the lungs. The signs include
cough, feeling short of breath and high
temperature (fever).
• Yellowing of the skin or the whites of the
eyes (jaundice).
• Inflammation of the liver. This can cause
loss of appetite, yellowing of the skin and
eyes, and dark coloured urine.
• Inflammation of the pancreas. This causes
moderate to severe pain in the stomach.
• Severe skin disorders. The symptoms
include redness, blistering and peeling.
• Sweating.
• Passing less water (urine) than normal or
passing no water.
• Liver failure.
• Lumps.
• Inflamed gut.

5. How to store Zestril
• Keep out of the reach and sight of children.
• Do not use after the expiry date (EXP)
which is stated on the blister strip and
the carton. The expiry date refers to the
last day of that month.
• 2.5 mg tablets: Do not store above 25°C.
• 5 mg, 10 mg and 20 mg tablets: Do not
store above 30°C. 
• Medicines should not be disposed of via
waste water or household waste. Ask your
pharmacist how to dispose of medicines
no longer required. This will help to protect
the environment.
6. Further information
What Zestril contains
The active substance is lisinopril (as dihydrate).
The other ingredients are mannitol, calcium
hydrogen phosphate dihydrate, maize starch,
pregelatinised starch and magnesium stearate.
In addition, the pink and brownish-red tablets
contain red iron oxide (E172).
Zestril is supplied in 4 strengths containing
2.5 mg, 5 mg, 10 mg or 20 mg of lisinopril
(as dihydrate).
What Zestril looks like and contents of
the pack
Zestril 2.5 mg Tablets: round, white, uncoated,
biconvex tablet with “♥ 2.5” on one side and
plain on the other side. Diameter 6 mm.
Zestril 5 mg Tablets: round, pink, uncoated,
biconvex tablet with “♥ 5” on one side and
bisected on the other side. Diameter 6 mm.
The tablet can be divided into equal halves.
Zestril 10 mg Tablets: round, pink, uncoated,
biconvex tablet with “♥ 10” on one side and
plain on the other side. Diameter 8 mm.
Zestril 20 mg Tablets: round, brownish-red,
uncoated, biconvex tablet with “♥ 20”
on one side and plain on the other side.
Diameter 8 mm.
Zestril tablets are available in aluminium foil
blister packs of 14, 20, 28, 30, 42, 50, 56,
60, 84, 98, 100, 400 and 500 tablets. Blister
packs containing multiples of 7 tablets may
also be available with weekday marks.
Zestril tablets are also available in bottle
packs of 20, 30, 50, 100 and 400 tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and
Manufacturer
The Marketing Authorisations for Zestril
are held by AstraZeneca UK Ltd,
600 Capability Green, Luton, LU1 3LU, UK.
Zestril is manufactured by
AstraZeneca UK Limited,
Silk Road Business Park, Macclesfield,
Cheshire SK10 2NA, UK.
This medicine is authorised in the Member
States of the EEA under the following names:
Acemin (AT), Acerbon (DE), Zestril
(BE, ES, IE, FR, IT, EL, LU, NO, NL, PT,
SE, UK).

To listen to or request a
copy of this leaflet in Braille,
large print or audio please
call, free of charge:
0800 198 5000 (UK only)
Please be ready to give the
following information:
Product name
Reference Number
Zestril 2.5 mg Tablets
PL 17901/ 0060
Zestril 5 mg Tablets
PL 17901/ 0061
Zestril 10 mg Tablets
PL 17901/ 0062
Zestril 20 mg Tablets
PL 17901/ 0063
This is a service provided by
the Royal National Institute
of Blind People.
Leaflet last updated: November 2011
© AstraZeneca 2011
Zestril is a trade mark of the AstraZeneca
group of companies.
CV 11 0137

Not known (frequency cannot be estimated
from available data)
• Symptoms of depression.
• Fainting.
Side effects in children appear to be
comparable to those seen in adults.
If any of the side effects get serious, or if
you notice any side effects not listed in this
leaflet, please tell your doctor or pharmacist.

P032418

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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