Zestril

Zestril (Lisinopril) is an FDA-approved medication used to treat high blood pressure in adults and children over 6, heart failure in adults, and to reduce the risk of death after a heart attack in adults. It comes in tablet form with strengths ranging from 2.5 to 40 mg. Dosages may vary based on the specific condition being treated & individual patient factors. Zestril is taken once daily, with or without food. Common side effects include dizziness, cough, and headache, while serious risks include high potassium levels and kidney issues. Always consult your primary caregiver for personalized dosage and treatment plans.

Zestril (Lisinopril) is a prescription medication in the class of angiotensin-converting enzyme (ACE) inhibitors. It is FDA-approved for three primary uses: treating high blood pressure (hypertension) in adults and children aged six and older, managing heart failure in adults as an adjunct therapy, and reducing the risk of death in adults who have experienced a heart attack. Zestril works by inhibiting ACE, an enzyme that converts angiotensin I to angiotensin II, narrowing blood vessels and increasing blood pressure. By blocking this enzyme, Zestril helps relax blood vessels, lower blood pressure, and ease the heart’s workload.

Zestril is available in tablet form in strengths of 2.5, 5, 10, 20, 30, & 40 mg. The starting dosage for high blood pressure is typically 10 mg once daily, with a maintenance dosage ranging from 20 to 40 mg daily. For heart failure, the usual beginning dose is 5 mg, and for post-heart attack care, an initial dose of 5 mg is given within 24 hours, followed by another 5 mg dose after 1 day, and then 10 mg once daily.

Patients should take Zestril at the same time each day, with or without food. Common side effects include cough, headache, and dizziness. Serious side effects can consist of high potassium levels, kidney problems, and angioedema. Patients must discuss their entire medical history with their doctor to ensure Zestril is safe for them. Special precautions are needed for patients with kidney disease, diabetes, or those undergoing dialysis. Pregnant women should avoid Zestril due to the risk of harm to the developing fetus. Always follow your doctor’s guidance on dosage and monitor for any adverse effects.

Zestril is a brand-name prescription medication approved by the FDA for the following purposes:

• Treat Heart Failure
• Treat High Blood Pressure (Hypertension)
• Reduce the Risk of Death After a Heart Attack

What Are the Forms & Strengths of Zestril?

Zestril comes in the form of tablets and is available in the six following strengths:

• 2.5 mg
• 5 mg
• 10 mg
• 20 mg
• 30 mg
• 40 mg

What Are the Recommended Dosage of Zestril?

Dosage for High Blood Pressure (Hypertension)

• When Used Alone:
  • Starting Dosage: 10 mg once daily.
  • Maintenance Dosage: Typically ranges from 20 mg to 40 mg once daily.
  • Maximum Dosage: 80 mg once daily.
• When Used with Other Blood Pressure Medications:
  • Starting Dosage with Diuretics: 5 mg once daily.
    • Examples of diuretics: Hydrochlorothiazide, Furosemide (Lasix).
  • Adjustments: If starting a diuretic after Zestril, your doctor may lower the Zestril dose. The dosage may also be adjusted based on the response to treatment with other blood pressure medications.

Dosage for Adjunct Treatment of Heart Failure

• Starting Dosage: 5 mg once daily.
• Maximum Dosage: 40 mg once daily.
• Adjustments: Dosage may vary based on factors such as kidney disease, low sodium levels, or dehydration.

Dosage for Heart Attack

• Initial Dosage: 5 mg within 24 hours of the heart attack.
  • Another 5 mg dose within the next 24 hours.
  • 10 mg dose 48 hours after the second dose.
• Maintenance Dosage: 10 mg once daily for at least six weeks.
• Adjustments: Dosage may be modified based on kidney disease or low blood pressure.

Dosage Adjustments for Kidney Problems

• General Adjustments: Starting dosage may be half of the usual starting dose.
  • Example: If the usual starting dose is 10 mg, it will be reduced to 5 mg.
• Dialysis Patients: Starting dosage is 2.5 mg once daily, regardless of the condition being treated.

Pediatric Dosage (For High Blood Pressure in Children Aged 6 Years and Older)

• Starting Dosage: 0.07 mg/kg of the body weight, given once daily.
  • Example: For a 50-pound child (approximately 23 kg), the dose would be about 1.6 mg daily.
• Maximum Starting Dosage: 5 mg once daily.
• Maintenance Dosage: Up to 40 mg once daily, based on the doctor’s recommendations and individual factors such as kidney disease.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

• Long-term Use: Zestril is typically used as a long-term treatment. If your doctor determines that Zestril is safe and effective for you, you will likely be prescribed it for ongoing use.
• Form: Zestril comes as a tablet that you swallow.
• Instructions: Take Zestril precisely as prescribed by your doctor or healthcare provider.
• Timing: You can take Zestril at any time, but it’s essential to take it at the same time every day to maintain consistent levels in your body.
• Reminder: Use a medication reminder to help ensure you don’t miss a dose. Options include setting an alarm on your phone, using a reminder app, or a kitchen timer.
• Food: Zestril can be taken with or without food.
• Crushing/Splitting: Zestril tablets can be crushed and made into a liquid suspension or split in half before taking.
• Difficulty Swallowing: If you have trouble swallowing the tablets, consult your doctor or pharmacist. They can provide alternative methods for taking the medication.

[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.]

Zestril is part of a class of medications known as angiotensin-converting enzyme (ACE) inhibitors. These drugs function by blocking the action of ACE, an enzyme responsible for converting the hormone angiotensin I into angiotensin II. Angiotensin II narrows blood vessels, which increases blood pressure and also causes the body to retain more water, thereby increasing both blood pressure and the workload on the heart. By inhibiting ACE, Zestril prevents the formation of angiotensin II, allowing blood vessels to remain widened and enabling the body to expel water normally. This results in an increase of blood flow to the heart.

Mild Side Effects: Most mild side effects of Zestril may go away within a few days to a couple of weeks. However, if they persist or become more severe, consult your doctor or pharmacist. Common mild side effects include:

• Anemia: Low red blood cell level
• Cough
• Headache
• Dizziness

Serious Side Effects: These are not common but can occur. If you experience any of the following serious side effects, contact your doctor immediately. If symptoms feel life-threatening or you believe you are noticing a medical emergency, call your local emergency number or 911.

• Sudden problems with kidney function. Signs may include:
  • dark urine
  • confusion
  • leg swelling
  • chest pressure or chest pain
  • itching or rash
  • loss of consciousness
  • low urine output
  • nausea
  • shortness of breath
  • seizure
• High potassium levels. Signs may include:
  • fatigue (lack of energy)
  • muscle pain, cramps, or weakness
  • trouble breathing
  • nausea
  • irregular heartbeat
  • chest pain
• Liver failure. Signs may include:
  • swelling of your legs or abdomen (belly)
  • unexplained weight loss
  • nausea
  • jaundice
  • diarrhea
  • fatigue (lack of energy)
  • loss of appetite
  • bruising or bleeding more quickly than usual
• Angioedema. Signs may include:
  • nausea or vomiting
  • swelling of your face, arms, legs, voice box, lips, intestines, tongue, or vocal cords
  • abdominal (belly) pain
  • trouble breathing
• Leukopenia and neutropenia. Signs may include:
  • fever
  • infection
  • sore throat
• If used during pregnancy, it can harm the developing fetus or miscarriage.
• Allergic reaction.
• Chest pain.
• Low blood pressure.

[Note: This list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Are There Any Warnings for Zestril?

FDA Warning: Risks if Used During Pregnancy

Zestril carries a boxed warning from the Food and Drug Administration (FDA) regarding its use during pregnancy. A boxed warning is the most severe kind of warning issued by the FDA and alerts doctors and patients about the potentially dangerous effects of the drug.

• Risk to Developing Fetus: Using Zestril during pregnancy can cause significant harm to the fetus (growing). Potential risks include low levels of amniotic fluid, which can lead to skeletal deformities and lung problems.
• Risk of Miscarriage: Taking Zestril while pregnant may also increase the risk of miscarriage.

FDA Warning: Risks if Used During Pregnancy

Zestril carries a boxed warning from the Food and Drug Administration (FDA) regarding its use during pregnancy. A boxed warning is the most severe kind of warning issued by the FDA and alerts doctors and patients about the potentially dangerous effects of the drug.

• Risk to Developing Fetus: Using Zestril during pregnancy can cause significant harm to the fetus (growing). Potential risks include low levels of amniotic fluid, which can lead to skeletal deformities and lung problems.
• Risk of Miscarriage: Taking Zestril while pregnant may also increase the risk of miscarriage.

Before starting Zestril, discussing your medical history with your doctor is essential. Zestril may not be suitable for you if you have certain conditions or factors affecting your health. Here are some essential precautions to consider:

• Dialysis: If you are undergoing dialysis, taking Zestril may cause a severe allergic-like reaction. Inform your doctor about your dialysis treatment to determine if you need a different drug or dialysis type.
• Heart Disease: Patients with heart disease may have an increased risk of low blood pressure as a side effect of Zestril. Your doctor may need to monitor your blood pressure more frequently during treatment.
• Kidney Disease: Zestril can increase the risk of low blood pressure and sudden kidney function problems in patients with kidney disease. Your doctor may need to check your blood pressure and kidney function more often.
• Diabetes: Combining Zestril with diabetes medications can raise the risk of low blood sugar. Inform your doctor if you are taking diabetes medications.
• Low Sodium Levels: Low sodium levels can heighten the risk of low blood pressure from Zestril. Your primary caregiver may monitor your blood pressure more closely and try to raise your sodium levels if necessary.
• Surgery: Anesthesia used during surgery can lower blood pressure. If you are taking Zestril, it may be harder to increase your blood pressure post-surgery. Inform your doctor or surgeon that you are using Zestril.
• History of Angioedema: Do not take Zestril if you have a history of angioedema, as it may increase your possibility of developing this condition again. This includes angioedema that occurred with other ACE inhibitors.
• Pregnancy: Zestril is not safe during pregnancy and has a boxed warning from the FDA. It may harm the developing fetus, leading to low amniotic fluid, skeletal deformities, lung problems, or miscarriage. Stop taking Zestril and inform your doctor immediately if you become pregnant. Discuss alternative treatments if you plan to become pregnant.
• Birth Control: Given the risks during pregnancy, ensure you discuss birth control options with your doctor if you or your partner can become pregnant.
• Breastfeeding: Avoid breastfeeding while taking Zestril, as animal studies suggest the drug may pass into breast milk and potentially affect the breastfed child.

Zestril is contraindicated and should not be used in the following situations:

• Combined Use with Neprilysin Inhibitors: Such as sacubitril
• Combined Use with Aliskiren (Tekturna): In individuals with diabetes
• History of Angioedema: Including those who have had angioedema or allergic reactions involving another ACE inhibitor
• Hereditary Angioedema (HAE): Individuals with a history of any angioedema or hereditary angioedema

• Immediate Action: Take the dose that you missed as soon as you remember.
• Close to Next Dose: If it’s almost time for your next dose, skip the dose that you missed & continue with your regular schedule.
• Avoid Doubling Up: Do not take two doses at once to make up for a missed dose, as this can increase the risk of side effects.
• Reminder Tools: Use a medication reminder, such as setting an alarm on your phone, downloading a reminder app, or using a kitchen timer, to help ensure you don’t miss a dose.

[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.]

• Overdose Risks: Taking more than the recommended dosage may lead to serious side effects, like low blood pressure.
• Immediate Steps: If you think you’ve taken too much Zestril, contact your doctor immediately for advice and potential medical attention.

[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.]

• Temperature: Store Zestril tablets at room temperature between 68°F & 77°F (20°C and 25°C).
• Container: Keep the tablets in a tightly sealed container.
• Storage Location: Avoid storing the medication in damp areas, such as bathrooms, to maintain its effectiveness.

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

Zestril can interact with various medications, supplements, and certain foods. These interactions can either interfere with the drug’s effectiveness or increase the risk of side effects. Here are vital interactions to be aware of:

Zestril and Kidney-Affecting Drugs

• Increased Risks: Combining Zestril with medications that affect kidney function can heighten the risk of low blood pressure, kidney problems, and high potassium levels.
• Examples:
  • NSAIDs: Ibuprofen (Advil), naproxen (Aleve), celecoxib (Celebrex)
  • Blood Pressure Medications: Aliskiren (Tekturna), ARBs such as losartan (Cozaar), valsartan (Diovan), other ACE inhibitors like benazepril (Lotensin), enalapril (Vasotec)
• Monitoring: Your doctor may conduct frequent kidney function tests and monitor your blood pressure and potassium levels.

Zestril and Diabetes Medications

• Low Blood Sugar Risk: Taking Zestril with diabetes medications can enhance their blood sugar-lowering effects, increasing the risk of hypoglycemia.
• Examples:
  • Insulin: Insulin aspart (NovoLog), insulin glargine (Lantus), insulin lispro (Humalog)
  • Oral Medications: Glipizide (Glucotrol XL), glimepiride (Amaryl), metformin (Glucophage)

Zestril and Lithium

• Increased Lithium Levels: Zestril can raise blood lithium levels, potentially leading to toxicity.
• Monitoring: Inform your doctor if you take lithium, as they will need to monitor your lithium levels closely.

Zestril and Diuretics

• Low Blood Pressure Risk: Combining Zestril with diuretics can increase the risk of low blood pressure. However, diuretics are often used with Zestril to manage high blood pressure.
• Potassium Levels: Certain diuretics, such as amiloride, triamterene (Dyrenium), and spironolactone (Aldactone), can increase potassium levels when taken with Zestril.
• Monitoring: Your doctor will closely monitor your blood pressure and potassium levels if you take these medications together.

Zestril and mTOR Inhibitors

• Angioedema Risk: Taking Zestril with mTOR inhibitors can increase the risk of angioedema.
• Examples: sirolimus (Rapamune), everolimus (Afinitor), temsirolimus (Torisel)

Zestril and Gold Injections

• Reactions: Using Zestril with gold injections can cause reactions like low blood pressure, nausea, vomiting, and flushing.
• Alternative Treatments: Your doctor may suggest different treatments if you receive gold injections.

Zestril and Neprilysin Inhibitors

• Angioedema Risk: Combining Zestril with neprilysin inhibitors can increase the risk of angioedema.
• Example: Sacubitril/valsartan (Entresto)

What Are the Other Zestril Interactions?

• Zestril and Herbs and Supplements: There are no herbs or supplements known to specifically interact with Zestril. Despite the lack of specific reports, always check with your doctor or pharmacist before taking any new herbs or supplements while on Zestril to avoid potential interactions.
• Zestril and Foods: No foods have been specifically reported to interact with Zestril. If you have any questions or concerns about eating certain foods while taking Zestril, discuss them with your doctor for personalized advice.

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

If Zestril isn’t suitable for you or you’re seeking alternative treatments, various medications can treat high blood pressure, heart failure, & reduce the risk of death after a heart attack. Discuss with your doctor to find the best alternative for your specific condition.

Alternatives for Heart Failure

Below are some examples of other alternative medications that may be used in the treatment of heart failure include:

• Cozaar (losartan)
• Coreg (carvedilol)
• Altace (ramipril)
• Diovan (valsartan)
• Entresto (sacubitril/valsartan)
• Vasotec (enalapril)
• Corlanor (ivabradine)
• BiDil (isosorbide dinitrate/hydralazine)
• Lopressor (metoprolol)
• Aldactone (spironolactone)

Alternatives for High Blood Pressure

Below are some examples of other alternative drugs may be used to treat hypertension include:

• Norvasc (amlodipine)
• Lopressor (metoprolol)
• Aldactone (spironolactone)
• Cardura (doxazosin)
• Cozaar (losartan)
• Diovan (valsartan)
• Lasix (furosemide)
• Lotensin (benazepril)
• Catapres (clonidine)
• Cardizem (diltiazem)
• Vasotec (enalapril)
• Tenormin (atenolol)
• Tekturna (aliskiren)
• chlorthalidone
• hydrochlorothiazide
• hydralazine

Alternatives for Heart Attack

Below are some examples of other alternative medications that may be used in the treatment of heart attack include:

• Crestor (rosuvastatin)
• Coreg (carvedilol)
• Lopressor (metoprolol)
• Vasotec (enalapril)
• Altace (ramipril)
• Lipitor (atorvastatin)
• Diovan (valsartan)
• Cardizem (diltiazem)
• Calan (verapamil)

[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.]

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