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Zestoretic
Zestoretic is a combination medication containing lisinopril, an ACE inhibitor (angiotensin-converting enzyme inhibitor), and hydrochlorothiazide (HCTZ), a thiazide diuretic. It is primarily prescribed to treat high blood pressure (hypertension). Lisinopril works by relaxing blood vessels and reducing the production of angiotensin II, a substance that causes blood vessels to constrict, while hydrochlorothiazide helps reduce fluid retention by increasing the excretion of sodium and water through the kidneys. This dual action effectively lowers blood pressure and reduces the risk of strokes, heart attacks, and kidney problems.
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Frequently Asked Questions
How long does it take for Zestoretic to start lowering blood pressure?
Zestoretic typically begins to lower blood pressure within 1-2 hours after taking the dose, with full effects seen after 1-2 weeks of regular use.
Can I take Zestoretic if I am pregnant?
No, Zestoretic should not be taken during pregnancy, as ACE inhibitors can cause harm or death to the developing fetus. Consult your healthcare provider for alternative medications if you are pregnant or planning to become pregnant.
What should I do if I miss a dose of Zestoretic?
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to make up for a missed dose.
Can I take Zestoretic with other blood pressure medications?
Yes, Zestoretic may be combined with other antihypertensive medications under the guidance of your healthcare provider. However, be cautious of excessive lowering of blood pressure.
Does Zestoretic cause frequent urination?
Yes, due to the diuretic (HCTZ) component, you may experience increased urination, particularly in the first few weeks of treatment. This is normal and part of the drug’s mechanism to reduce blood pressure.
Comprehensive Drug Guide
How Does Zestoretic Work?
- Lisinopril works by inhibiting the enzyme angiotensin-converting enzyme (ACE), which prevents the formation of angiotensin II, a substance that causes blood vessels to constrict and raises blood pressure.
- Hydrochlorothiazide (HCTZ) is a diuretic that increases urine production by promoting the excretion of sodium and water from the kidneys. This reduces blood volume and helps lower blood pressure.
What is Zestoretic Used For?
Common Dosages
- 10 mg lisinopril / 12.5 mg HCTZ
- 20 mg lisinopril / 12.5 mg HCTZ
- 20 mg lisinopril / 25 mg HCTZ
The typical starting dose is based on the patient's response to blood pressure control and their prior use of either medication alone.
Typical Dosing
- The usual starting dose of Zestoretic is 10 mg lisinopril / 12.5 mg HCTZ once daily. The dose may be increased based on response to treatment, with the maximum recommended dose being 20 mg lisinopril / 25 mg HCTZ once daily.
- The medication is typically taken once daily, preferably in the morning to prevent frequent urination during the night.
Typical Dosing
FDA Approved Indications
- Hypertension (high blood pressure) in patients who require combination therapy for adequate blood pressure control.
Who Shouldn't Take Zestoretic?
- Hypersensitivity to lisinopril, hydrochlorothiazide, or other sulfonamide-derived drugs.
- A history of angioedema related to previous ACE inhibitor use.
- Severe kidney disease or an inability to produce urine (anuria).
- Pregnancy, as ACE inhibitors can cause harm or death to the developing fetus.
- Allergy to sulfa drugs (since hydrochlorothiazide is a sulfonamide derivative).
Advice From The Pharmacist
- Take Zestoretic once daily, preferably in the morning with or without food. Taking it in the morning helps avoid excessive nighttime urination.
- Monitor your blood pressure regularly to ensure the medication is effectively controlling your hypertension.
- Stay well-hydrated, but avoid excessive salt or potassium intake, as Zestoretic can affect electrolyte levels.
- Avoid alcohol, as it may enhance the blood pressure-lowering effect of the medication, leading to dizziness or fainting.
- Do not use potassium supplements or salt substitutes containing potassium without consulting your doctor, as ACE inhibitors can increase potassium levels in the blood.
Side Effects of Zestoretic
Common Side Effects
- Dizziness or lightheadedness, especially when standing up
- Cough (related to lisinopril)
- Headache
- Increased urination
- Fatigue
Uncommon/Severe Side Effects
- Angioedema (swelling of the face, lips, throat, or tongue)
- Severe hypotension (low blood pressure)
- Hyperkalemia (high potassium levels)
- Kidney dysfunction or worsening kidney function
- Electrolyte imbalances (low sodium, low potassium)
Risks and Warnings of Zestoretic
- Angioedema: ACE inhibitors like lisinopril can cause angioedema, a potentially life-threatening condition involving swelling of the face, throat, or tongue. If this occurs, discontinue use and seek immediate medical attention.
- Hyperkalemia: Zestoretic may increase potassium levels, especially in patients with kidney disease or those taking potassium supplements or potassium-sparing diuretics. Regular monitoring of blood potassium levels is important.
- Hypotension: Zestoretic may cause low blood pressure, particularly in patients who are dehydrated or have low blood volume. Dizziness and fainting may occur, especially after the first dose or when the dose is increased.
- Electrolyte Imbalance: Hydrochlorothiazide can lead to electrolyte imbalances such as low potassium (hypokalemia), low sodium (hyponatremia), or dehydration. Regular blood tests may be required to monitor these levels.
Interactions with Zestoretic
Common Drug Interactions
- Potassium supplements or salt substitutes: May increase the risk of hyperkalemia when taken with Zestoretic.
- NSAIDs (e.g., ibuprofen, naproxen): These can reduce the blood pressure-lowering effects of Zestoretic and may worsen kidney function.
- Diuretics: Additional diuretics may increase the risk of electrolyte imbalances.
- Lithium: Taking Zestoretic with lithium may increase the risk of lithium toxicity.
- Other blood pressure medications: Combining Zestoretic with other antihypertensives may cause excessive lowering of blood pressure.
Alternatives to Zestoretic
- Losartan/Hydrochlorothiazide (Hyzaar): Another combination of an angiotensin receptor blocker (ARB) and a diuretic used to treat hypertension.
- Benazepril/Hydrochlorothiazide (Lotensin HCT): A combination of an ACE inhibitor and a diuretic, similar to Zestoretic, for the treatment of high blood pressure.
- Amlodipine/Benazepril (Lotrel): A combination of a calcium channel blocker and an ACE inhibitor for managing hypertension.
