About Zestoretic
This drug is an ACE (Angiotensin Converting Enzyme)
Inhibitor plus a thiazide diuretic. ACE inhibitors work to
block an enzyme system, which causes artery walls to relax,
reducing blood pressure. Hydrochlorothiazide works on kidney
enzymes to produce more urine which reduces excess water and
salt in the body, also reducing blood pressure.
Zestoretic treatment may be tried for patients whose blood
pressure isn't controlled by either lisinopril or hydrochlorothiazide
alone. It's important to follow your doctor's instructions
carefully, and take this medication every day at the same
time. Best results come from maintaining steady blood levels.
Zestoretic is prescribed to treat high blood pressure, or
hypertension, and is only available by prescription. Use as
directed.
Zestoretic Side Effects
Notify a doctor if any side effects are severe.
Hydrochlorothiazide
Common Side Effects: constipation, dehydration, diarrhea,
dizziness, fatigue, gas, frequent urination, headache, high
potassium levels, irregular heartbeat, intestinal pain, itching
, leg pain, loss of appetite, low sodium levels, nausea, rash,
shortness of breath, stomachache, upset stomach, weakness.
Less frequent Side Effects: Allergic reaction, altered
sense of taste, dry mouth, hair loss, numbness, vomiting.
Report the following side effects to you doctor immediately,
as they may be signs of an intolerance for the medication
or severe liver damage: Allergic reaction, unusual bleeding,
breathing difficulties, bruising, confusion, joint or muscle
pain, decreased circulation, depression, irregular heartbeat,
numbness or tingling, rash, shortness of breath, sore throat,
weakness, yellowing of skin or eyes.
Cautions: This medication may not be suitable for
everyone, and certain individuals may require dosage adjustments
or more careful medical supervision. To ensure the maximum
safety and effectiveness of treatment, discuss any current
instances or medical history of the following.
- Allergies: Any allergic reaction to hydrochlorothiazide, ameloride, or hydrochlorothiazide means that you should not use the drug again. Bronchial asthma, allergies to sulfa drugs, or other allergies mean that you are at risk for allergic reaction to this drug. Inform your doctor of any allergies. Seek medical care and discontinue treatment if you have an allergic reaction.
- Collagen Vascular Disease: Caution, notify your doctor if you have collagen vascular disease (lupus erythematosus) before taking hydrochlorothiazide.
- Dehydration: Hydrochlorothiazide may increase risk
of dehydration, which could lower blood pressure to unsafe
levels. Avoid dehydration, especially during exercise and
hot weather.
- Diabetes: Caution, notify your doctor if you have diabetes before taking hydrochlorothiazide.
- Glaucoma: Notify your doctor if you have glaucoma before taking hydrochlorothiazide.
- Gout: Tell your doctor if you have gout before taking hydrochlorothiazide.
- Kidney Problems: Notify your doctor of any kidney problems. People with kidney disease should not take hydrochlorothiazide.
- Liver Disease: Caution, notify your doctor if you have liver problems before taking hydrochlorothiazide.
- Low Sodium Diet: Follow your doctor's instructions regarding sodium intake.
- Medical Tests: This medication may alter results on a number of medical tests. Inform the lab technician that you are using hydrochlorothiazide before your test.
- Other Medications: Any other prescription or over the counter medications that you take or may plan to take should be discussed with your prescribing physician and pharmacist. It's particularly important to mention treatments for high blood pressure.
- Potassium: Bananas, orange juice, prunes and raisins are examples of foods high in potassium. Discuss potassium intake with your doctor. Do not take potassium supplements while taking this medication.
- Pregnancy: Safety of hydrochlorothiazide is not established in pregnant women. Notify your doctor if you are pregnant or plan to become pregnant. hydrochlorothiazide shows up in breast milk.
- Surgery: If you will have any type of surgery or dental work, tell your surgeon or doctor that you are taking hydrochlorothiazide.
Lisinopril
Expected Side Effects: Constipation, cough, dizziness,
fainting, lightheadedness, nausea, scalding sensation in mouth.
Adverse Side Effects: The following side effects should
be reported to your doctor immediately, or medical advice
sought if your doctor is not available. If they are serious,
you will need to contact emergency personnel and seek treatment
at once.
Mild: Abdominal pain or discomfort, allergy (itching,
psoriasis, rash), altered sense of taste, fainting, fast heartbeat
when standing, headache, increased risk of infection, joint
pain, nightmares, ringing in ears, sores on mouth or tongue,
swelling in extremities. Report infection or swelling to your
doctor at once.
Severe: Allergy (swelling of face, tongue, and/or
throat, possibly life threatening), anemia, bone marrow depression
(bleeding or bruising, fever, sore throat, weakness), fluid
retention around heart, high potassium levels, liver damage,
Lupus or other severe skin problems, pancreatitis. These severe
side effects are classed as rare, or may have only occurred
in isolated case reports, but be alert for them and get all
tests and check-ups as recommended by your physician.
Undesirably High Levels of Potassium: Confusion, difficulty
breathing, irregular heartbeat, nervousness, numbness or tingling
(feet, hands, lips), shortness of breath, weakness or heavy
sensation in legs.
Cautions: This medication may not be suitable for
everyone, and certain individuals may require dosage adjustments
or more careful medical supervision. To ensure the maximum
safety and effectiveness of treatment, discuss any current
instances or medical history of the following.
- Allergies: Any allergic reaction to an ACE inhibitor
means that you should not use the drug again. The development
of swelling of the tongue, face, or throat should be reported
to medical personnel at once, and you should stop taking
the medication immediately. Inform your doctor of any food
or dye allergies, this might influence a decision on which
formulation of the treatment to use.
- Bee Sting Allergy - If you had an allergic reaction
during therapy to reduce sensitivity to bee stings, you
should inform your doctor before beginning treatment.
- Blood or Bone Marrow Disease - Do not use.
- Diabetes - Dosage adjustments may be necessary.
ACE inhibitors are preferred by some doctors for the treatment
of high blood pressure in diabetics who have protein in
the urine.
- Heart Attack: Under a doctor's supervision, may
be given within 24 hours of heart attack, after the heart
has stabilized. The usual dose is 5 mg daily if it seems
effective, increased to 10 mg daily for 6 or more weeks
to prevent recurrence.
- Kidney Problems: Lower doses will be necessary,
usually from 2.5 mg-5 mg. Your doctor will advise you regarding
a safe and effective amount. Combination forms of this drug
with hydrochlorothiazide should not be used, as the thiazide
diuretics are less effective in this case than loop diuretics.
- Liver Disease - Lisinopril has minimal impact on
the liver, but your condition should be discussed with your
doctor.
- Low Sodium Diet - May increase risk of high blood
levels of potassium. Speak with your doctor about the best
course of treatment.
- Lupus - Speak to your doctor, this treatment may
or may not be suitable for you.
- Medical Tests - This medication may alter results
on a number of medical tests. Inform the lab technician
that you are using an ACE inhibitor before your test.
- Other Medications - Any other prescription or over
the counter medications that you take or may plan to take
should be discussed with your prescribing physician and
pharmacist. It's particularly important to mention treatments
for high blood pressure, including diuretics, nitrates,
drugs that supress the immune system, gout medication, anti-inflammatories
(NSAIDs), or potassium supplements.
- Potassium - If your blood levels of potassium are
very high, you should not use an ACE inhibitor.
- Pregnancy - ACE inhibitors are not generally advised
during pregnancy, and should not be taken at all during
the last two trimesters (6 months). Speak to your doctor
about safety precautions if you intend to breastfeed.
- Renal Artery Stenosis - Speak with your doctor
about this condition before deciding on a treatment.
- Scleroderma - Speak to your doctor, this treatment
may or may not be suitable for you.
- Surgery - If you will have any type of surgery
or dental work performed under general anesthesia, it is
important for your safety that your surgeon and anesthesiologist
be aware that you use this treatment.
Zestoretic Interactions
This medication may not mix well with all prescription and over the counter treatments, be sure to discuss with your doctor and pharmacist any other treatments you may plan to take, especially any of the following.
- ACE (Angiotensin-Converting Enzyme) Inhibitors - Medications
like Accupril (quinapril),
Aceon (perindopril), Altace
(ramipril), Capoten
(captopril), Lotensin
(benazepril), Mavik (trandolapril), Monopril
(fosinopril), Prinivil or Zestril (lisinopril),
Univasc (moexipril), and Vasotec
(enalapril) may cause high blood potassium when combined
with hydrochlorothiazide.
- Alcohol - May lower blood pressure even further and increase
drowsiness. Speak with your doctor about recommended use.
- Anafranil (clomipramine) - This medication may build up
to toxic levels, and cause wild mood swings.
- Angiotensin II antagonists - Taking angiotensin II antagonists
such as Cozaar (losartan)
or Diovan (valsartan)
while taking hydrochlorothiazide may increase the risk of
high blood levels of potassium.
- Antacids - May decrease absorption. Do not use within
two hours of taking your medication.
- Arginine - May cause dangerous potassium levels when combined
with hydrochlorothiazide.
- Aspirin, salicylic acid, or other salicylates - ACE inhibitor
treatment may be less effective.
- Barbiturates - Sedatives like Butalbital, Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal,
Phenobarbitol, Seconal, or other barbiturates may not be
suitable treatments for use with this medication.
- Blood pressure medications - The effects of other blood
pressure medications may be increased when combined with
hydrochlorothiazide. Notify your doctor of all medications
you are taking.
- Cholestyramine (Questran) - Notify your doctor if you
are taking cholestyramine before taking hydrochlorothiazide.
- Colestipol (Colestid) - Notify your doctor before combining
this medication with hydrochlorothiazide.
- Cotrimoxazole - May increase blood levels of potassium
and the risk of disturbances in heart rhythm.
- Cox II inhibitors like Celebrex
(celecoxib) and Vioxx (rofecoxib)
may make ACE inhibitors less effective.
- Diuretics Do not mix other diuretics with Zestoretic treatment.
- Diabetes medications - Notify your doctor if you take
diabetes medications such as Micronase, DiaBeta, or insulin.
- Diabinese (chlorpropamide) - Combining hydrochlorothiazide
with Diabinese may cause blood sodium levels to become too
low.
- Diuretics - Do not combine with other diuretics without
your doctor's approval.
- Erythropoietin - This medication may be less effective
when taken with an ACE inhibitor.
- Glucophage (metformin) - Combining with hydrochlorothiazide
may increase blood levels of Glucophage and cause hypoglycemia.
Combining with ACE inhibitor may cause high potassium levels
or lactic acidosis when diabetic patients combine these
treatments.
- Herbal supplements - Talk with your doctor before taking
any herbal supplements with hydrochlorothiazide.
- High blood pressure medications - Consult your doctor
before combining hydrochlorothiazide with other high blood
pressure medications.
- Imuran (azathioprine) - Risk of severe anemia.
- Interferons (alpha, & beta) - Do not combine, high
risk of blood disorders when these medications are used
together.
- Iron, supplemental - Do not take within 2 hours of an
ACE inhibitor, this mineral may decrease symptoms of cough
that can develop with long-term use. Do not use supplemental
iron without the supervision of a doctor, high levels may
be dangerous.
- Lanoxin (digoxin) -
The effectiveness of Lanoxin may be decreased when taken
with hydrochlorothiazide.
- Lithium - Toxic levels of this
drug may build up, the combination is not generally advised.
- Low salt milk - Increases risk of high blood levels of
potassium.
- Muscle relaxants - Notify your doctor if you are taking
muscle relaxants before combining with hydrochlorothiazide.
- Mycobutin (rifabutin) - ACE inhibitors may be less effective.
- Narcan (naloxone) - May decrease effectiveness of treatment.
- Narcotic pain medication like Codeine, Demerol
(meperidine), Buprenex (buprenorphine), Darvon (propoxyphene),
Dilaudid (hydromorphone), MS Contin or Kadian (morphine),
nalbuphine, OxyContin
(oxycodone), Percocet
(oxycodone and acetaminophen), Stadol (butorphanol),
Talwin compound (pentazocine), or Vicodin
(hydrocodone and acetaminophen), Vicoprofen
(hydrocodone and ibuprofen) should be used only if your
doctor approves on a case-by-case basis.
- Non-Steroidal Anti-Inflammatories, or NSAIDs, such as
Butazolidine (phenylbutazone), Clinoril
(sulindac), Ibuprofen (Motrin), Indocin (indomethacin),
Feldene (piroxicam), Naprosyn
(naproxen), Toradol
(ketorolac), and others may decrease the effectiveness
of treatment.
- Norepinephrine (Levophed) - Notify your doctor if you
take Norepinphrine.
- Phenothiazines - Medications like Compazine (prochlorperazine),
Mellaril (thioridazine), Phenergan (promethazine), Prolixin
(fluphenazine), Serentil (mesoridazine), Sparine (promazine),
Stelazine (trifluoperazine), Temaril (trimeprazine), Tindal
(acetophenazine), Thorazine (chlorpromazine), Trilafon (perphenazine),
and Vesprin (triflupromazine). These tranquilizers and antipsychotics
increase the risk of low blood pressure when standing in
combination with ACE inhibitors.
- Potassium supplements - Do not take potassium supplements
while taking hydrochlorothiazide. Follow your doctor's guidelines
regarding potassium rich foods such as bananas, orange juice,
prunes, and raisins. Individuals using ACE inhibitors are
at risk for elevated levels of blood potassium.
- Prednisone - Notify your doctor if you are taking prednisone
or other corticosteroids.
- Prograf (tacrolimus) - May cause high potassium levels
when combined with hydrochlorothiazide.
- Rifadin (rifampin) - ACE inhibitors may be less effective.
- Salt substitutes - Increases risk of high blood levels
of potassium.
- Sandimmune (cyclosporine) - May cause delayed kidney failure
in combination with ACE inhibitors. May cause excessive
potassium levels when combined with hydrochlorothiazide.
- Spironolactone - Combining hydrochlorothiazide with spironolactone
such as Aldactone or Aldactazide may result in high potassium
levels.
- Quinaglute (quinidine) - Risk of heartbeat abnormalities
when combined with hydrochlorothiazide.
- Tikosyn (dofetilide)
- Combining with hydrochlorothiazide may cause severe heartbeat
irregularities.
- Triamterene - Combining hydrochlorothiazide with triamterene
such as Dyrenium or Dyazide may cause dangerously high potassium
levels.
- Zyloprim (allopurinol) - Increased risk of serious skin
reactions.
Zestoretic Dosages
Zestoretic comes in the following lisinopril-hydrochlorothiazide
(HCTZ) ratios:
- 10mg-12.5mg Peach, round, debossed with 141 on one side, ZESTORETIC on the other
- 20mg-12.5mg White, round, debossed with 142 on one side, ZESTORETIC on the other
- 20mg-25mg Peach, round, debossed with 145 on one side, ZESTORETIC on the other
Typical starting dose is 10mg-12.5mg daily, or 5 if a diuretic
combination will be used. Usual ongoing adult dose is 20-40
mg of lisinopril once daily, taken in one dose. For individuals
who still have blood pressure fluctuations, a twice daily
dose may be used. The maximum daily dose of lisinopril is
80 mg.
Zestoretic Directions
For best results, take your medication at the same time every
day.
If you miss a dose, take it as soon as you remember. If it's
nearly time for your next dose, skip the missed dose and resume
your regular schedule. Do not take double doses, or change
your dose without permission from your doctor. Sudden changes
in blood pressure are undesirable, and may put elderly patients
at greater risk of stroke or heart attack.
Tablets may be taken with or without food, and they may be
crushed to aid consumption. If an extended release form should
come on the market, however, consult the instructions on the
packaging. Extended release medications should generally be
taken as is, and may be less effective or cause overdose if
crushed.
Store Zestoretic away from direct light and heat. Store in a dry location; avoid storing it in the bathroom, near sinks, or other areas where it may become damp. Do not use after the expiration date.
Keep Zestoretic away from children; both when storing it, and when discarding any unused medication.
Zestoretic and Pregnancy
During the first trimester, lisinopril should only be
used if absolutely necessary. Use during the last two trimesters
of pregnancy could potentially inflict severe bone deformations,
low birth weight, or death on the unborn child. Hydrochlorothiazide
may cause side effects including jaundice, blood problems,
and low potassium in the newborn baby.
If you are breast-feeding, seek your doctor's advice. Not
absolutely contraindicated, but infant should be monitored
closely.
Zestoretic and Children
The safety and effectiveness of these medications in individuals under the age of 18 has not been adequately studied.
Zestoretic and Seniors
ACE inhibitors and diuretics should be started in the smallest
possible doses. Sudden changes in blood pressure, including
rapid decreases, can increase the risk of heart attack or
stroke.
Zestoretic is a trademark of AstraZeneca
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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