Lisinopril / Hydrochlorothiazide

Zestoretic

Zestoretic combines two active ingredients, lisinopril, and hydrochlorothiazide, to effectively manage high blood pressure. Lisinopril, an ACE inhibitor, relaxes blood vessels for smoother blood flow, while hydrochlorothiazide, a diuretic, helps eliminate excess salt and water through urine. This dual action not only aids in preventing strokes, heart attacks, and kidney problems but also improves treatment efficacy when single medications fail to control blood pressure. It is available in various strengths, ensuring flexible dosing tailored to individual needs, and is typically taken once daily. Proper adherence, alongside lifestyle adjustments, plays a crucial role in its effectiveness.

Product Overview

Zestoretic is a prescription medication specifically designed to treat hypertension, a prevalent condition that can lead to severe cardiovascular issues if unmanaged. This medication synergistically combines lisinopril and hydrochlorothiazide. Lisinopril works by inhibiting the angiotensin-converting enzyme (ACE), which leads to relaxed blood vessels and improved blood flow. On the other hand, hydrochlorothiazide acts as a diuretic that prompts the kidneys to remove unnecessary salt and water from the body through urine, effectively reducing blood volume and pressure.

Zestoretic is generally prescribed when monotherapy does not sufficiently control blood pressure. The formulation is available in oral tablet forms with varying dosages, such as 10 mg/12.5 mg, 20 mg/12.5 mg, and 20 mg/25 mg, to cater to different therapeutic needs. The typical starting dose can range based on previous treatments, with options to adjust based on efficacy and patient response, up to a maximum of hydrochlorothiazide 50 mg and lisinopril 80 mg daily.

Patients are advised to take Zestoretic once a day, ideally in the morning, to avoid nocturnal urination due to its diuretic effect. It can be taken with or without food. Consistency in the timing of the dose helps maintain steady medication levels in the body, enhancing overall effectiveness. Regular follow-ups and blood pressure monitoring are crucial, as adjustments to dosage or treatment may be required based on the patient’s response. For optimal results, Zestoretic should be part of a broader treatment plan that includes dietary changes, regular exercise, and possibly other medications. Patients should be aware of potential side effects ranging from mild, such as dizziness and headaches, to severe, such as electrolyte imbalances and allergic reactions. Awareness and prompt reporting of side effects can significantly aid in managing and adjusting treatment to ensure safety and efficacy.

What Are the Uses of Zestoretic?

• Treatment of High blood pressure in adults

What Are the Forms & Strengths of Zestoretic?

It comes in the form of oral tablets and has the following strengths and quantity:

• 10mg/12.5mg (Quantity 90 tablets)
• 20mg/12.5mg Quantity 30 tablets)
• 20mg/25mg Quantity 30 tablets)

What Are the Recommended Dosage of Zestoretic?

Dosage of Zestoretic for Hypertension

Usual Adult Dosage for High Blood Pressure:

• Initial Dosage: Start with a combination of 12.5 mg of hydrochlorothiazide and 10 to 20 mg of lisinopril, taken orally once daily. The exact starting dose depends on the dose of any previous blood pressure medication you were taking.
• Maximum Dosage: The highest recommended dosage is 50 mg of hydrochlorothiazide and 80 mg of lisinopril per day.

Additional Guidance:

• Your doctor may choose to increase the dosage every 2 to 3 weeks based on how your blood pressure responds.
• If your blood pressure is well-managed with 25 mg of hydrochlorothiazide alone but you are experiencing significant potassium loss, your doctor might adjust your treatment to 12.5 mg of hydrochlorothiazide with 10 mg of lisinopril daily. This adjustment helps maintain blood pressure control while potentially reducing the risk of electrolyte imbalances.

[Note: Always follow your doctor’s instructions carefully, and have regular check-ups to monitor your blood pressure and potassium levels. Adjustments to your medication should only be made under medical supervision.]

How to Use Zestoretic?

• Before You Start:
  • Patient Information Leaflet: Always read the Patient Information Leaflet provided by your pharmacist when you start taking Zestoretic and each time you get a refill. If you have any questions, consult your doctor or pharmacist.
• Taking the Medication:
  • Method of Administration: Take Zestoretic orally, with or without food, as your doctor prescribes. It is generally recommended to take your dose in the morning.
  • Frequency of Urination: Since Zestoretic can increase urination, try to take it at least 4 hours before bedtime to avoid having to get up during the night.
• If Taking Other Medications:
  • Cholesterol-Lowering Drugs: If you are also on bile acid-binding resins like cholestyramine or colestipol, take Zestoretic at least 4 to 6 hours after or 4 hours before taking these medications.
• Dosage:
  • Individual Adjustment: Your dose will depend on your medical condition and how you respond to treatment.
• Consistent Use:
  • Daily Routine: To maximize the benefits, take Zestoretic at the same time every day. Continue taking it even if you feel fine, as high blood pressure often has no symptoms.
  • Regular Intake: It’s important to take this medication regularly as prescribed to maintain steady blood pressure levels.
• Monitoring:
  • Response to Treatment: Inform your doctor if your condition does not improve or if your blood pressure readings increase or remain high.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Zestoretic Work?

Zestoretic works by combining two different types of medications that help to lower blood pressure in distinct ways. The first component, lisinopril, is an ACE inhibitor. It helps relax your blood vessels by blocking a protein called ACE that usually causes blood vessels to tighten. The second component, hydrochlorothiazide, is a type of medication known as a thiazide diuretic or a “water pill.” It aids in lowering blood pressure by causing the kidneys to get rid of excess water and certain electrolytes, such as sodium and potassium. By removing this extra fluid, your blood pressure goes down, making it easier for your heart to pump blood.

Important Safety Information for Using Zestoretic

What Are the Side Effects of Zestoretic?

Common Side Effects of Zestoretic: Zestoretic may cause some side effects that usually last only a short time—from a few days to a few weeks. If these side effects persist or become bothersome, it is important to speak with your doctor or pharmacist. It’s essential to monitor how you feel while taking Zestoretic and report any prolonged or severe symptoms to your healthcare provider. Common side effects of Zestoretic may include:

• Headache 
• Cough
• Tired feeling
• Dizziness

Serious Side Effects of Zestoretic: Zestoretic can sometimes cause serious side effects. Although the following list does not include all possible serious side effects, it highlights some of the major ones. If you experience any of these, contact your doctor right away. In cases where the side effects seem life-threatening or if you think you’re having a medical emergency, call 911 or your local emergency number immediately. Possible serious side effects of Zestoretic may Include:

• Feeling Like You Might Faint: Experiencing a light-headed feeling as if you are about to pass out.
• Eye Issues: Pain in the eyes or problems with your vision.
• Urination Problems: Having little or no urine output can be a sign of kidney issues.
• Weakness and Fatigue: Feeling unusually weak, tired, or restless.
• Infection Symptoms: Fever, chills, a sore throat, mouth sores, and difficulty swallowing.
• Jaundice: Yellowing of the skin or eyes, which can indicate liver problems.
• High Potassium Levels: Symptoms may include nausea, a tingly feeling, chest pain, irregular heartbeats, and loss of muscle movement.
• Low Potassium Levels: Symptoms might include leg cramps, constipation, irregular heartbeats, a fluttering sensation in your chest, increased thirst or urination, numbness, tingling, muscle weakness, or a limp feeling.
• Low Sodium Levels: You might experience headaches, confusion, slurred speech, severe weakness, vomiting, loss of coordination, or feeling unsteady.

[Note: It’s essential to monitor how you feel while taking Zestoretic and report any prolonged or severe symptoms to your healthcare provider.]

Are There Any Warnings for Zestoretic?

• Pregnancy: Do not take Zestoretic if you are pregnant. If you find out you are pregnant while taking this medication, stop using it immediately and inform your doctor.
• Angioedema and Allergies: Avoid using Zestoretic if you have a history of angioedema (severe swelling), are unable to urinate, or have allergies to sulfa drugs or ACE inhibitors.
• Interactions with Other Medications: Do not take Zestoretic within 36 hours before or after using medications containing sacubitril, such as Entresto. If you have diabetes, you should also avoid taking Zestoretic with medications containing Aliskiren, which is used to treat high blood pressure.

[Note: Always consult with your doctor before making any changes to your medication regimen, especially if you have underlying health conditions or are taking other medications.]

What Are the Zestoretic Precautions?

• Do Not Share: This medication is prescribed specifically for you. Do not share it with anyone else.
• Lifestyle Adjustments: To enhance the effectiveness of Zestoretic, consider making lifestyle changes such as increasing physical activity, quitting smoking, and adopting a low-cholesterol and low-fat diet. Discuss these potential changes with your doctor.
• Regular Testing: While taking Zestoretic, it’s important to undergo routine lab and medical tests to monitor your kidney function and potassium levels and conduct skin exams. Make sure to keep all scheduled medical and lab appointments.
• Monitoring Health at Home: Regularly monitor your blood pressure and heart rate at home. Knowing how to check these vitals and reporting the readings to your doctor can help manage your condition more effectively.
• Allergies: Inform your doctor or pharmacist if you have allergies to lisinopril, hydrochlorothiazide, other ACE inhibitors (like captopril or benazepril), or any other substances. This medication may contain inactive ingredients that can cause allergic reactions or other problems.
• Medical History: Share your medical history with your healthcare provider, especially if you have had:
  • Procedures to filter your blood (such as dialysis, LDL apheresis)
  • Swelling reactions (angioedema)
  • Conditions like kidney disease, gout, liver disease,  lupus, or skin cancer
  • Treatments for wasp/bee sting allergy
• Dizziness: Zestoretic may cause dizziness. Avoid alcohol and marijuana, as these can increase dizziness. Do not drive or operate machinery until you know you can do so safely.
• Dehydration Risks: Inform your doctor if you experience severe sweating, diarrhea, or vomiting, as these can lead to dehydration and dizziness. Drink plenty of fluids unless advised otherwise by your doctor.
• Diabetes: This medication may impact your blood sugar levels. Regularly check your blood sugar as directed and discuss the results with your doctor. Your diabetes management plan may need adjustments.
• Sun Sensitivity: Zestoretic can increase your sensitivity to the sun and your risk for skin cancer over long-term use. Limit sun exposure, avoid tanning booths and sunlamps, and wear protective clothing and sunscreen when outdoors. Notify your doctor if you experience any skin changes like sunburn, blisters, or redness.
• Potassium Levels: This medication can affect potassium levels. Consult your healthcare provider before using potassium supplements or salt substitutes that contain potassium.
• Surgical Considerations: Before undergoing any surgery, inform your healthcare team about all medications you are taking, including prescription, over-the-counter, and herbal products.
• Older Adults: If you are an older adult, be aware that you may be more sensitive to the side effects of this drug, particularly dizziness and changes in urine output.
• Breastfeeding: It is unknown if lisinopril passes into breast milk, whereas hydrochlorothiazide does pass into breast milk but is unlikely to harm a nursing infant. Discuss with your doctor before breastfeeding.

What Are the Contraindications of Zestoretic?

Before starting Zestoretic, which contains lisinopril and hydrochlorothiazide, you must tell your healthcare provider if you have any of the following conditions or circumstances, as it may not be safe for you:

• Diabetes and Aliskiren Use: Do not use Zestoretic if you are taking aliskiren (Tekturna) and have diabetes. This combination can cause serious complications.
• Neprilysin Inhibitors: Avoid taking Zestoretic within 36 hours before or after using neprilysin inhibitors, such as Entresto (sacubitril/valsartan), due to potential severe interactions.
• Urinary Issues: Do not use Zestoretic if you are unable to produce urine, as it can worsen your condition.
• Sulfa Drug Allergy: If you are allergic to sulfa medications, avoid taking Zestoretic. It contains hydrochlorothiazide, a sulfa drug that could cause allergic reactions.
• ACE Inhibitor Allergy: Do not take Zestoretic if you have had allergic reactions to ACE inhibitors in the past.
• History of Angioedema: If you have a history of severe swelling (angioedema), mainly related to previous use of ACE inhibitors, Zestoretic is not recommended for you.

What If You Missed a Dose of Zestoretic?

If you forget to take a dose of Zestoretic, take it as soon as you remember. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at once to compensate for the missed one, as this could increase the risk of side effects.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

What Happens If You Take Too Much of Zestoretic?

In case of an overdose, if someone experiences severe symptoms like fainting or difficulty breathing, call 911 immediately. For less urgent symptoms such as severe dizziness or fainting, contact a poison control center for guidance. Residents in the U.S. can reach poison control at 1-800-222-1222.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

How to Store a Zestoretic?

• Store Zestoretic at room temperature, away from direct light and moisture. 
• Avoid storing it in the bathroom, where it can get damp. 
• Keep all medications out of the reach of children and pets. 
• Do not dispose of medications in the toilet or down a drain unless instructed to do so. 
• To safely discard Zestoretic when it is expired or no longer needed, consult your pharmacist or your local waste disposal company for proper disposal methods.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

What Medications Interact with Zestoretic?

Interactions between drugs can affect how your medications work or increase the risk of serious side effects. This guide does not list all possible interactions. Keep a record of all the medications you use, including prescription drugs, over-the-counter products, and herbal supplements, and share this information with your doctor and pharmacist. Always get your doctor’s approval before starting, stopping, or changing the dosage of any medications.

Some medications that may interact with Zestoretic include:

• Aliskiren
• Dofetilide
• Immunosuppressants like everolimus and sirolimus
• Lithium
• Drugs that increase potassium levels, such as angiotensin receptor blockers (ARBs) like losartan or valsartan, and birth control pills containing drospirenone
• Sacubitril

Other products may contain ingredients that could raise your blood pressure or worsen heart failure. Discuss with your pharmacist the products you are using to understand how to safely use them, particularly cough and cold products, diet aids, or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.

Zestoretic may also affect the results of specific lab tests, such as those measuring parathyroid function, leading to false results. Ensure that lab personnel and all your doctors know you are taking this medication.

[Note: This isn’t a complete list, and there could be other drugs that interact with Zestoretic. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

What Are the Zestoretic Alternatives?

Here are some alternatives to Zestoretic that may include:

• Exforge (amlodipine/valsartan)
• Zestoretic (combination lisinopril/hydrochlorothiazide)
• Avalide (HCTZ/irbesartan)
• Atacand (candesartan)
• Aldactone (spironolactone)
• Cardura (doxazosin)
• Coreg (carvedilol)
• Felodipine XR
• Coreg CR (extended-release carvedilol)
• Lopressor (metoprolol)
• Benicar (olmesartan)
• Micardis (telmisartan)
• Lotrel (combination amlodipine/benazepril)
• Inderal LA (extended-release propranolol)
• Lasix (furosemide)
• Lotensin (benazepril)
• Accupril (quinapril)
• Ziac (bisoprolol/HCTZ)
• Twynsta (amlodipine/telmisartan)
• Benicar HCT (HCTZ/olmesartan)
• Capozide (HCTZ/captopril)
• Vaseretic (HCTZ/enalapril)
• Hydrochlorothiazide (HCTZ)
• Atacand HCT (HCTZ/candesartan)
• Altace (ramipril)
• Tribenor (amlodipine/HCTZ/olmesartan)
• Isradipine
• Catapres (clonidine)
• Diovan (valsartan)
• Toprol XL (metoprolol extended release)
• Exforge HCT (amlodipine/HCTZ/valsartan)
• Zestril (lisinopril)
• Captopril
• Tenormin (atenolol)
• Diovan HCT (HCTZ/valsartan)
• Tekturna HCT (HCTZ/aliskiren)
• Tekturna (aliskiren)
• Accuretic (HCTZ/quinapril)
• Methyldopa
• Trandate (labetalol)
• Vasotec (enalapril)
• Bystolic (nebivolol)
• Perindopril
• Azor (amlodipine/olmesartan)
• Micardis HCT (HCTZ/telmisartan)
• Nifedical XL (extended-release nifedipine)
• Cardizem CD (diltiazem extended release)
• Hydralazine
• Cozaar (losartan)
• Fosinopril
• Benicar HCT (HCTZ/olmesartan)
• Catapres TTS (clonidine patch)
• Lotensin HCT (HCTZ/benazepril)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

Zestoretic Cost & Coupons

Zestoretic can be expensive, especially without insurance coverage, often costing more than expected per month out-of-pocket. To help manage these costs, consider purchasing Zestoretic from Canadian pharmacies, which usually offer the medication at significantly lower prices. For those looking to buy Zestoretic online from Canada, Polar Bear Meds is a reputable option that offers these drugs in the USA at reduced rates. Additionally, first-time customers can benefit from a Zestoretic coupon code, WELCOMEPB10, which provides a 10% discount on their initial purchase. This approach ensures affordable access to Zestoretic for those managing hypertension in America.

Frequently Asked Questions

What is the best time to take Zestoretic?

Zestoretic is typically taken as directed by your healthcare provider. Generally, they may advise you to take it in the morning or early afternoon. This timing is recommended because Zestoretic contains hydrochlorothiazide, a diuretic (commonly known as a water pill), which increases the frequency of urination. Taking it earlier in the day helps avoid disruptions to your sleep cycle, such as waking up during the night to go to the bathroom. However, the specific time to take Zestoretic can vary depending on how the medication affects you personally. If you find that Zestoretic does not significantly increase your need to urinate, the exact timing might be less critical. 

Can you cut Zestoretic in half?

It is important not to cut Zestoretic tablets in half unless your healthcare team specifically instructs you to do so. Zestoretic is a combination medication, which means each tablet contains a fixed dose of two different active ingredients: lisinopril and hydrochlorothiazide. Because the tablets are not scored (they do not have a line indicating where to split them), they are not designed to be divided.

Splitting a non-scored, combination tablet like Zestoretic can lead to uneven distribution of the active ingredients. This inconsistency means one half of the tablet may contain more of one medication than the other, which could result in you receiving an incorrect dose. Incorrect dosing can potentially decrease the effectiveness of the medication or increase the risk of side effects. 

How long does it take for Zestoretic to work?

Zestoretic starts to impact your body relatively quickly after you take it. The lisinopril component begins to lower your blood pressure within an hour of ingestion. The hydrochlorothiazide part, which is a diuretic, starts to increase urine output a few hours after you take the dose. However, achieving the full blood pressure-lowering effect of Zestoretic may take approximately 2 to 3 weeks.

It’s important to understand that finding the correct dosage of Zestoretic can take some time. Your healthcare provider may need to adjust your dosage based on how your blood pressure responds to the medication. To assist in this process, it is helpful to keep a record of your blood pressure readings. Regularly monitoring and noting down your blood pressure will provide valuable information to your healthcare team, helping them determine the effectiveness of Zestoretic and make any necessary adjustments to your treatment plan.

How long does Zestoretic stay in your system?

Zestoretic generally takes a little over three days to be mostly eliminated from your system. This estimate is based on the half-lives of the two active ingredients in Zestoretic: lisinopril and hydrochlorothiazide. A medication’s half-life is the time it takes for half of the drug to be processed and removed from the body. For individuals with kidney issues, this process may take longer because both components of Zestoretic are primarily excreted through the kidneys. To ensure that Zestoretic effectively controls your blood pressure, it is essential to adhere to a regular daily dosing schedule.

Can I take aspirin with Zestoretic?

If you’re considering combining aspirin with Zestoretic, it’s important to consult your cardiologist or healthcare provider. Although aspirin is a non-steroidal anti-inflammatory drug (NSAID) and is often prescribed in low doses to prevent heart problems, it’s crucial to ensure it’s safe for your specific situation. Aspirin does not typically interact with Zestoretic, but it can increase the risk of bleeding, which might not be suitable for everyone. 

What is the difference between lisinopril and Zestoretic?

Lisinopril is a medication known as an angiotensin-converting enzyme (ACE) inhibitor and is used alone to treat high blood pressure. In contrast, Zestoretic combines lisinopril with another drug, hydrochlorothiazide, which is a type of medication called a diuretic or “water pill.” The combination in Zestoretic helps enhance the blood pressure-lowering effects by tackling different mechanisms. If your blood pressure isn’t adequately controlled with lisinopril alone, your healthcare provider might suggest switching to Zestoretic to get the benefits of both an ACE inhibitor and a diuretic, potentially leading to better management of your blood pressure.

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