Classes
DEA Class; Rx
Common Brand Names; Zestoretic
- ACEI/Diuretic Combos;
- ACEI/HCTZ Combos
Description
ACE inhibitor and thiazide diuretic combination
Used for hypertension once daily
Lisinopril counteracts the potassium loss from hydrochlorothiazide; more effective than ACE monotherapy in Black patients.
Indications
Indicated for the treatment of hypertension in patients who do not respond to monotherapy.
Contraindications
Hypersensitivity to ACE inhibitors, thiazides, or sulfonamides
ACE-inhibitor induced angioedema, hereditary or idiopathic angioedema
Coadministration of ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan
Anuria or renal stenosis
Coadministration with aliskiren in patients with diabetes mellitus
Adverse Effects
Lisinopril
- Dizziness (5-12%)
- Cough (4-9%)
- Headache (4-6%)
- Hyperkalemia (2-5%)
- Diarrhea (3-4%)
- Hypotension (1-4%)
- Chest pain (3%)
- Fatigue (3%)
- Nausea/vomiting (2%)
- Rash (1-2%)
- Psoriasis (frequency unknown)
Hydrochlorothiazide
- Hypotension
- Anorexia
- Epigastric distress
- Hypokalemia
- Phototoxicity
- Non-melanoma skin cancer
Warnings
Begin combination therapy only after failed monotherapy
Severe renal impairment, hepatic impairment
Risk of hypotension, especially with CHF
Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors
If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately
Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors
Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue if hepatic transaminase or jaundice occurs
Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation; cough may resolve within 1-4 weeks after discontinuation 0f therapy
Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents
Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia
Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure
Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume depleted patients, correct volume depletion prior to initiation; monitor closely when initiating and increasing dosing
Pregnancy and Lactation
Pregnancy category: D
Lactation: Discontinue drug or do not nurse
Maximum Dosage
80 mg/day PO lisinopril and 50 mg/day PO hydrochlorothiazide.
80 mg/day PO lisinopril and 50 mg/day PO hydrochlorothiazide.
Safety and efficacy have not been established.
Safety and efficacy have not been established.
How supplied
Lisinopril/Hydrochlorothiazide
tablet
- 10mg/12.5mg
- 20mg/12.5mg
- 20mg/25mg