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Zestril
Zestril, the brand name for lisinopril, is an oral medication used to treat high blood pressure (hypertension), heart failure, and to improve survival after a heart attack. Lisinopril belongs to the ACE inhibitor (angiotensin-converting enzyme inhibitor) class of medications, which works by relaxing blood vessels, allowing blood to flow more easily. This reduction in blood pressure helps decrease the workload on the heart and reduces the risk of heart attacks, strokes, and kidney problems.
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Frequently Asked Questions
How long does it take for Zestril to start working?
Zestril begins to reduce blood pressure within 1 to 2 hours of taking a dose, but it may take 2 to 4 weeks to see the full blood pressure-lowering effect.
Can Zestril be used with other blood pressure medications?
Yes, Zestril is often used in combination with other blood pressure medications, such as diuretics or calcium channel blockers. However, this combination should be monitored closely to avoid side effects like low blood pressure or high potassium levels.
What should I do if I miss a dose of Zestril?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and resume your normal schedule. Do not double up on doses.
Is Zestril safe during pregnancy?
No, Zestril is not safe during pregnancy and can cause harm to the fetus. Women who become pregnant while taking Zestril should stop the medication immediately and consult their healthcare provider.
Can Zestril cause a cough?
Yes, a dry cough is a common side effect of ACE inhibitors like Zestril. If the cough becomes bothersome, consult your healthcare provider about switching to an alternative medication, such as an ARB.
Comprehensive Drug Guide
How Does Zestril Work?
Zestril works by inhibiting the activity of the enzyme angiotensin-converting enzyme (ACE), which is responsible for converting angiotensin I to angiotensin II, a substance that narrows blood vessels. By blocking this enzyme, Zestril helps to relax blood vessels, lower blood pressure, and reduce the strain on the heart. It also helps the kidneys by decreasing the pressure in the glomeruli, which can protect against kidney damage in patients with hypertension or diabetes.
Common Dosages
- 2.5 mg tablets
- 5 mg tablets
- 10 mg tablets
- 20 mg tablets
- 40 mg tablets
Typical Dosing
- For hypertension: The usual starting dose is 10 mg once daily, with a maintenance dose of 20 mg to 40 mg daily depending on the patient’s response.
- For heart failure: The initial dose is 5 mg once daily, with adjustments based on clinical response. The usual maintenance dose ranges from 5 mg to 20 mg daily.
- After a heart attack: An initial dose of 5 mg is administered within 24 hours of the event, followed by 10 mg daily.
Typical Dosing
FDA Approved Indications
- Hypertension (high blood pressure)
- Heart failure (as an adjunct therapy to diuretics and other heart failure medications)
- Improving survival after a heart attack (acute myocardial infarction)
- Chronic kidney disease (off-label use) in patients with hypertension and diabetes to reduce the risk of kidney damage
Who Shouldn't Take Zestril?
- A history of angioedema related to previous ACE inhibitor use
- Hereditary or idiopathic angioedema
- Bilateral renal artery stenosis or other forms of severe kidney impairment
- Pregnancy: ACE inhibitors can cause injury and death to a developing fetus and should be discontinued as soon as pregnancy is detected.
Advice From The Pharmacist
- Take Zestril once daily, with or without food. Try to take it at the same time each day for consistency.
- Monitor blood pressure regularly to ensure the medication is working effectively. Report any unusual drops in blood pressure or dizziness to your doctor.
- Stay hydrated, but avoid excessive salt intake, as it can reduce the effectiveness of the medication.
- Contact your doctor immediately if you experience swelling of the face, lips, or tongue (angioedema), which can be a serious side effect.
- If you are taking diuretics, discuss the possibility of starting on a lower dose of Zestril, as the combination can increase the risk of low blood pressure.
Side Effects of Zestril
Common Side Effects
- Dizziness or lightheadedness (especially when standing up too quickly)
- Cough (a persistent, dry cough is a common side effect of ACE inhibitors)
- Headache
- Fatigue
- Nausea or diarrhea
Uncommon/Severe Side Effects
- Angioedema (swelling of the face, lips, tongue, or throat)
- Severe hypotension (low blood pressure)
- High potassium levels (hyperkalemia), especially in patients with kidney disease or those taking potassium supplements
- Kidney problems, such as reduced kidney function
Risks and Warnings of Zestril
- Angioedema: Zestril can cause angioedema, a potentially life-threatening condition. If any signs of swelling in the face, lips, throat, or tongue occur, discontinue the medication immediately and seek emergency medical help.
- Hyperkalemia: Zestril can increase potassium levels in the blood, which may lead to dangerous heart rhythms. Patients should avoid potassium supplements or salt substitutes containing potassium unless advised by a doctor.
- Pregnancy risk: Zestril can cause serious harm to a developing fetus if taken during pregnancy. It should be discontinued immediately if pregnancy is confirmed.
- Kidney function: ACE inhibitors can reduce kidney function in some patients. Regular monitoring of kidney function is essential, especially in patients with pre-existing kidney disease.
Interactions with Zestril
Common Drug Interactions
- Diuretics: When combined with Zestril, diuretics (especially potassium-sparing diuretics) may increase the risk of hypotension and hyperkalemia.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen and naproxen may reduce the effectiveness of Zestril and increase the risk of kidney problems.
- Potassium supplements: Taking potassium supplements or potassium-containing salt substitutes can increase the risk of hyperkalemia.
- Lithium: Zestril can increase the levels of lithium in the blood, leading to potential toxicity.
Alternatives to Zestril
- Losartan (Cozaar): An angiotensin II receptor blocker (ARB) used as an alternative for patients who cannot tolerate ACE inhibitors.
- Amlodipine (Norvasc): A calcium channel blocker used to manage high blood pressure and angina.
- Hydrochlorothiazide (HCTZ): A diuretic often combined with other antihypertensives to help reduce blood pressure.
- Valsartan (Diovan): Another ARB that provides similar benefits as ACE inhibitors for treating hypertension and heart failure.
