ZESTRIL 20MG TABLETS

Active substance: LISINOPRIL DIHYDRATE

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PACKAGE LEAFLET: INFORMATION FOR THE USER

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.
Your medicine is called Zestril 10mg or 20mg Tablets but will be
referred to as Zestril throughout the remainder of this leaflet.
Your medicine is also available in the following strengths: 2.5mg
and 5mg.
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.

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.
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.
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.

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.
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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 lightheaded, 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.
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.
5. How to store Zestril
• Keep out of the sight and reach of children.
• Do not use after the expiry date (EXP) which is stated on the blister
strip and the carton.
• 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, magnesium stearate and
red iron oxide (E172).
Zestril contains either 10mg or 20mg of lisinpril (as dihydrate).
What Zestril looks like and contents of the pack
Zestril 10 mg Tablets: round, pink, uncoated, biconvex tablet with “♥ 10”
on one side and plain on the other side.
Zestril 20 mg Tablets: round, brownish-red, uncoated, biconvex tablet
with “♥ 20” on one side and plain on the other side.
Zestril tablets are available in blister packs of 28 or 98 tablets.
Manufactured by AstraZeneca UK Ltd. Macclesfield, England.
Procured from within the EU. Product Licence holder: Quadrant
Pharmaceuticals Ltd. Lynstock House, Lynstock Way, Lostock, Bolton
BL6 4SA. Repackaged by Maxearn Ltd. Bolton BL6 4SA.
PL 20774/1346
PL 20774/1347

Zestril 10mg Tablets
Zestril 20mg Tablets

POM

Zestril is a registered trademark of AstraZeneca UK Ltd.
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Leaflet prepared: 24 June 2013

PP1/1346/47/V3

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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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