Zestoretic

Zestoretic is a prescription medication used to treat high blood pressure. It is a single product containing 2 medications: lisinopril and hydrochlorothiazide. Lisinopril belongs to a group of drugs called angiotensin-converting enzyme (ACE) inhibitors. Lisinopril works by blocking the ACE enzyme, which helps blood vessels to relax and lowers blood pressure. Hydrochlorothiazide belongs to a group of drugs called thiazide diuretics, which work by stopping reabsorption of salt into your body. This prevents fluid from building up in the body.

This medication comes in tablet form and is typically given once daily with or without food.

Common side effects of Zestoretic include dizziness, headache, and cough. 

Zestoretic can cause tiredness (fatigue) and dizziness. Do not drive or operate heavy machinery until you know how Zestoretic affects you. 

Zestoretic is a prescription medication used to treat high blood pressure.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

• Alvogen, Inc.

Serious side effects have been reported with Zestoretic. See the "Zestoretic Precautions" section. 

Common side effects of Zestoretic include the following:

• dizziness
• headache
• cough
• tiredness/fatigue
• low blood pressure upon standing (orthostatic hypotension)
• diarrhea
• nausea
• infection that affects the nose, throat, and airways (upper respiratory infection)
• muscle cramps
• abnormal physical weakness or lack of energy (asthenia)
• abnormal sensation of tingling or pricking (paresthesia)
• low blood pressure (hypotension)
• vomiting
• indigestion 
• rash
• cannot get or keep an erection (impotence)

This is not a complete list of Zestoretic side effects. Ask your doctor or pharmacist for more information. 

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. 

Tell your doctor about all the medicines you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you are taking:

• certain medications that also lower blood pressure such as angiotensin-­converting enzyme (ACE) inhibitors like enalapril (Vasotec, Vaseretic) and angiotensin receptor II blockers (ARBs) like valsartan (Diovan)
• Diuretics like furosemide (Lasix), hydrochlorothiazide (Microzide, HCTZ), spironolactone (Aldactone), and triamterene (trade name Dyrenium)
• aliskiren (Tekturna)
• potassium supplements or potassium-containing salt substitutes
• alcohol, a class of drugs called barbiturates, or a type of pain medications called narcotics
• diabetic medications
• cholestyramine (Questran) and colestipol (Colestid)
• medicines that provide relief for inflamed areas of the body (corticosteroids) such as methylprednisolone (Medrol) and dexamethasone (Decadron)
• substances that raise blood pressure (pressor amines) such as norepinephrine (Levophed)
• medicines that relax skeletal muscles such as cyclobenzaprine (Flexeril) and carisoprodol (Soma)
• lithium (Lithobid)
• nonsteroidal anti-inflammatory drugs (NSAIDS) such as naproxen (Aleve) and ibuprofen (Advil)
• injectable gold (sodium aurothiomalate)

This is not a complete list of Zestoretic drug interactions. Ask your doctor or pharmacist for more information. 

Serious side effects have been reported with Zestoretic or its ingredients including the following:

• Narrowing of a heart valve and heart muscle thickening (aortic stenosis/hypertrophic cardiomyopathy)
• Allergic reactions. Tell your healthcare provider right away if you have some or all of the following symptoms:
  • swelling of the face, limbs, lips, tongue, throat
  • difficulty breathing
  • stomach (abdominal) pain (intestinal angioedema) with or without nausea or vomiting
• Low blood pressure. Tell your healthcare provider if you continue to experience light headedness. 
• Liver damage.
• Lowered white blood cell count (leukopenia/neutropenia/agranulocytosis) increasing the risk of infections
• A condition in which close objects appear clearly, but far ones don't (myopia) or a buildup of pressure in the eye that can cause blindness (glaucoma). Tell your healthcare provider right away if you experience  visual changes or eye pain.
• Harm to an unborn baby (fetal toxicity). Do not take Zestoretic if you are pregnant or will become pregnant.
• Imbalances in the levels of salts and fluids in your body (electrolyte and fluid imbalance). Tell your healthcare provider right away if you have some or all of the following symptoms:
  • dry mouth
  • thirst
  • weakness
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • low blood pressure
  • low output of urine
  • fast heart rate
  • nausea
  • vomiting

Zestoretic can cause tiredness (fatigue) and dizziness. Do not drive or operate heavy machinery until you know how Zestoretic affects you.

Do not take Zestoretic if you:

• are allergic to Zestoretic, lisinopril, to any other ACE inhibitor, to hydrochlorothiazide, or to other sulfonamide-derived drugs
• kidneys are unable to produce urine (anuric)
• have a history of a type of swelling that affects deeper layers in your skin, often around your eyes and lips (angioedema)
• are a diabetic patient who is taking aliskiren (Tekturna)

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Zestoretic, salt substitutes containing potassium should be avoided. 

Before taking Zestoretic, tell your doctor about all of your medical conditions. Especially tell your doctor if:

• are allergic to Zestoretic, lisinopril, to any other ACE inhibitor, to hydrochlorothiazide, or to other sulfonamide-derived drugs
• kidneys are unable to produce urine (anuric) or have kidney disease
• have a history of a type of swelling that affects deeper layers in your skin, often around your eyes and lips (angioedema)
• are a diabetic, especially if you are taking aliskiren (Tekturna)
• you are about to have major surgery
• you are breastfeeding or plan to breastfeed
• you are pregnant or plan to become pregnant

Tell you doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. 

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Zestoretic falls into category D. When pregnancy is detected, discontinue Zestoretic as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the unborn baby.

Tell your doctor is you are breastfeeding or plan to breastfeed. 

It is not known if lisinopril, a component of Zestoretic, is excreted in human breast milk. Hydrochlorothiazide, the other component of Zestoretic, has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from Zestoretic, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. 

• Take Zestoretic exactly as prescribed. 
• Zestoretic comes in a tablet form and is taken by mouth once daily with or without food. 
• If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Zestoretic at the same time. 

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• your blood pressure
• previous medications used and the doses tried
• how you respond to this medication
• your other medical conditions
• other medications you are taking

The recommended dosing of Zestoretic for treating high blood pressure is based on its two components: lisinopril and hydrochlorothiazide. Lisinopril's recommended dose range is 10 mg to 80 mg once daily. Hydrochlorothiazide's recommended dose range is 12.5 mg to 50 mg once daily.

If you take too much Zestoretic, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. 

• Store at room temperature, 68-77°F (20-25°C).
• Protect from excessive light and humidity.
• Keep this and all medications out of the reach of children. 

WARNING: FETAL TOXICITY

• When pregnancy is detected, discontinue Zestoretic as soon as possible.
• Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. See Warnings: Fetal Toxicity.