Lisinopril / HCTZ
Zestoretic is a combination blood pressure medication for adults. It contains lisinopril (an angiotensin-converting enzyme (ACE) inhibitor) and hydrochlorothiazide (a thiazide diuretic). It comes as a tablet that's taken by mouth once per day. Your prescriber will determine your dosage based on how high your blood pressure is and if you're taking other blood pressure medications. Some of the more common side effects it can cause include dizziness, headache, and cough. Zestoretic (lisinopril / hydrochlorothiazide) is available as a generic.
What is Zestoretic (lisinopril / hydrochlorothiazide)?
What is Zestoretic (lisinopril / hydrochlorothiazide) used for?
- High blood pressure in adults
How Zestoretic (lisinopril / hydrochlorothiazide) works
Zestoretic is a combination of two medications that work together to lower blood pressure:
- Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. It relaxes your blood vessels by blocking a protein (ACE) that normally squeezes your blood vessels.
- Hydrochlorothiazide is a thiazide diuretic, which is a water pill. It works in your kidneys to remove extra water and certain electrolytes (like sodium and potassium). This helps lower blood pressure.
Drug facts
Side effects of Zestoretic (lisinopril / hydrochlorothiazide)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dizziness (8%)
- Headache (5%)
- Cough (4%)
- Extreme tiredness (4%)
- Feeling lightheaded when standing after sitting or lying down (3%)
Less Common Side Effects
- Chest pain
- Stomach cramps
- Constipation
- Dry mouth
- Muscle cramps
- Lower sex drive
- Ringing in the ear
Zestoretic (lisinopril / hydrochlorothiazide) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Angioedema (severe swelling): swelling of the face, arms or legs, lips, tongue, or throat
- Dangerously low blood pressure: dizziness, lightheadedness, pale skin, feeling faint
- Serious kidney problems: urinating less often than usual, swelling in your feet, ankles, or hands, unexplained weight gain
- Liver problems: yellowing of the skin or eyes, stomach pain, nausea, vomiting, confusion
- High blood potassium levels: nausea, muscle weakness, abnormal heartbeat
- Severe allergic reaction: swelling of your lips, tongue, throat, or face, trouble breathing, rash
The following Zestoretic (lisinopril / hydrochlorothiazide) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Blurred vision
body aches or pain
chills
confusion
difficulty breathing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
ear congestion
headache
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of voice
runny or stuffy nose
sweating
unusual tiredness or weakness
vomiting
Incidence not known
Persistent non-healing sore
pink growth
reddish patch or irritated area
shiny bump
white, yellow or waxy scar-like area
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Belching
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
decreased interest in sexual intercourse
feeling of constant movement of self or surroundings
inability to have or keep an erection
indigestion
lack or loss of strength
loss in sexual ability, desire, drive, or performance
muscle cramps
rash
sensation of spinning
sleepiness or unusual drowsiness
stomach discomfort, upset, or pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Zestoretic (lisinopril / hydrochlorothiazide)
Pros
- Combines two medications in one pill
- Taken by mouth
- Taken once daily
Cons
- Can make you urinate more often
- Might not be appropriate for someone with a sulfa allergy
- Shouldn't take during pregnancy or breastfeeding
Pharmacist tips for Zestoretic (lisinopril / hydrochlorothiazide)
- Take Zestoretic (lisinopril / hydrochlorothiazide) with or without food at any time of day. If it hurts your stomach, taking it with food might help.
- It's recommended you measure and record your blood pressure at home and bring a record to your medical appointments. This will help your prescriber see how well the medication is working for you and guide any dose changes.
- You might feel dizzy when you start taking Zestoretic (lisinopril / hydrochlorothiazide), or when your prescriber raises the dose. This side effect is temporary and should get better after your body gets used to the new blood pressure. But let your healthcare team know if the dizziness is severe and making it difficult for you to go about your day.
- Dry cough is a well-known side effect of ACE-inhibitors, like lisinopril. It's possible for you to get a cough from taking Zestoretic (lisinopril / hydrochlorothiazide). This side effect can appear at any time during treatment. If you get a cough from Zestoretic (lisinopril / hydrochlorothiazide) and it's bothersome, talk to your prescriber. They might switch you to a different blood pressure medication.
- Take Zestoretic (lisinopril / hydrochlorothiazide) exactly as prescribed. Don't change your dose or stop taking the medication suddenly without talking to your prescriber first. Doing so can cause your blood pressure to rise quickly. You might need to lower your dose slowly over time before you can completely stop taking it.
- It's best to avoid drinking alcohol when you're taking Zestoretic (lisinopril / hydrochlorothiazide). Doing so can cause Zestoretic (lisinopril / hydrochlorothiazide) to not work as well) in treating your condition. This is because drinking alcohol regularly over a longer period of time can raise your blood pressure.
- Make sure to maintain a balanced diet, including a low-salt diet, while taking Zestoretic (lisinopril / hydrochlorothiazide) to help lower your blood pressure. Depending on your risk factors and other medical problems, it's possible you might be able to stop taking Zestoretic (lisinopril / hydrochlorothiazide) if your blood pressure gets within goal.
- Both lisinopril and hydrochlorothiazide can interact with many other medications, such as lithium (Lithobid) and non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen (Advil, Motrin)). Make sure to tell your care team about all the medications you're taking before and during treatment with Zestoretic (lisinopril / hydrochlorothiazide).
- If you're pregnant, thinking of getting pregnant, or breastfeeding and are taking Zestoretic (lisinopril / hydrochlorothiazide), contact your prescriber right away. Your prescriber will likely recommend a different medication that's safer during pregnancy.
Common questions about Zestoretic (lisinopril / hydrochlorothiazide)
Lisinopril is a single-ingredient angiotensin-converting enzyme (ACE) inhibitor medication. But Zestoretic is a combination medication that contains lisinopril and hydrochlorothiazide. Your healthcare professional might switch you from lisinopril to Zestoretic (lisinopril / hydrochlorothiazide) if you need to be on more than one blood pressure medication at the same time.
Lisinopril in Zestoretic can start to lower your blood pressure after an hour. And hydrochlorothiazide in Zestoretic can cause you to urinate more after a few hours. But it can take about 2 to 3 weeks to see the full blood pressure-lowering effect from Zestoretic (lisinopril / hydrochlorothiazide). Keep in mind that it can take some time before your prescriber finds a dose that works best for you, and they might need to adjust your dose depending on your blood pressure reading. Keep track of your blood pressure numbers and bring them to your appointments to help your healthcare team better understand how well Zestoretic (lisinopril / hydrochlorothiazide) is working for you.
It takes a little over 3 days for most of Zestoretic (lisinopril / hydrochlorothiazide) to leave your body after a dose. This time frame is estimated based on the half-life of lisinopril and hydrochlorothiazide. The half-life can be longer in people with kidney problems because both these medications are removed by the kidneys. Keep in mind that in order for Zestoretic (lisinopril / hydrochlorothiazide) to work well to control your blood pressure, you need to take this medication daily. Talk with your healthcare team if you have any specific concerns related to how long Zestoretic (lisinopril / hydrochlorothiazide) stays in your body.
Take Zestoretic (lisinopril / hydrochlorothiazide) as prescribed by your healthcare team. They might recommend that you take Zestoretic (lisinopril / hydrochlorothiazide) in the morning or early afternoon because hydrochlorothiazide (a water pill) can make you urinate more often. To minimize getting up at night to use the bathroom, try not to take it too close to bedtime. But if Zestoretic (lisinopril / hydrochlorothiazide) doesn't make you urinate more, then it might not matter much when you take it (unless your prescriber says so). What's more important is taking Zestoretic (lisinopril / hydrochlorothiazide) consistently around the same time each day. If you've any questions about when's the best time to take Zestoretic (lisinopril / hydrochlorothiazide), talk with your prescriber.
Ask your heart specialist if you can take aspirin with Zestoretic (lisinopril / hydrochlorothiazide) Aspirin is an nonsteroidal anti-inflammatory drugs (NSAID) and low-dose aspirin is sometimes prescribed to prevent certain heart-related problems. While aspirin isn't known to interact with Zestoretic (lisinopril / hydrochlorothiazide), it might not be the best choice for everyone because it can raise the risk of bleeding.
Don't cut Zestoretic (lisinopril / hydrochlorothiazide) tablets in half unless your healthcare team says it's safe to do so. Zestoretic (lisinopril / hydrochlorothiazide) is a combination medication and the tablets don't have a score line (line in the middle of the tablet to cut). It's generally not recommended to cut a combination medication, like Zestoretic (lisinopril / hydrochlorothiazide), because the two halves of the cut pill might not contain the same amount of lisinopril and hydrochlorothiazide. Also, it's difficult to cut a non-scored tablet evenly (even if you're using a pill splitter), which can cause you to take the wrong dose.
If you accidentally miss a dose of Zestoretic (lisinopril / hydrochlorothiazide), take it as soon as you remember. But if it's close to your next dose, then skip that dose and take your next dose at your regularly scheduled time. Don't take two doses of Zestoretic (lisinopril / hydrochlorothiazide) at the same time to make up any missed doses, because this could lead to more side effects.
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Risks and warnings for Zestoretic (lisinopril / hydrochlorothiazide)
Zestoretic (lisinopril / hydrochlorothiazide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for use during pregnancy
Lisinopril in Zestoretic can cause severe and sometimes life-threatening harm to unborn babies, so it shouldn't be used during pregnancy. If you find out that you're pregnant while taking Zestoretic (lisinopril / hydrochlorothiazide), stop and let your prescriber know right away. If you're pregnant before starting Zestoretic (lisinopril / hydrochlorothiazide) or thinking of becoming pregnant during treatment, discuss with your healthcare professional (HCP) about safer options to treat your blood pressure.
Angioedema (swelling)
- Risk factors: Black people | Having angioedema in the past
People who take medications that contain an ACE inhibitor, like lisinopril in Zestoretic, can experience a rare, but serious side effect called angioedema. This involves swelling in different parts of the body, including the face, throat, and tongue. Swelling of the tongue or throat area can be potentially life-threatening, since it can make it difficult to breathe. Angioedema can happen at any time during treatment. This risk is higher in Black people than in non-Black people. Get medical attention immediately if you experience swelling in any of the areas mentioned above, stomach pain, or difficulty breathing. You'll have to stop taking Zestoretic (lisinopril / hydrochlorothiazide) if this happens.
Low blood pressure
- Risk factors: Not enough fluid in your body | Having diarrhea or vomiting for a long time | Low salt levels in your body | Taking higher doses of diuretic medications
Sometimes, taking Zestoretic (lisinopril / hydrochlorothiazide) can cause your blood pressure to drop too much. This can cause you to feel dizzy, tired, or lightheaded. This side effect is more common when you first start Zestoretic (lisinopril / hydrochlorothiazide) or when the dose is raised. Make sure to stay well-hydrated. If your blood pressure drops too much and you feel dizzy, make sure to sit down slowly while holding onto something and let your care team know. If you fall and hit your head, get medical help right away. If you feel dizzy, lightheaded, faint, tired, or confused while taking Zestoretic (lisinopril / hydrochlorothiazide), contact your prescriber right away.
Kidney damage
- Risk factors: Severe heart failure | Kidney problems | Not enough fluid in your body | Taking other medications that can cause kidney damage | History of narrow heart valves (aortic stenosis)
Sometimes, Zestoretic (lisinopril / hydrochlorothiazide) can affect your kidneys and cause them to not work as well. The risk is higher for people who have certain types of kidney problems, such as renal artery stenosis or very severe heart failure. Your prescriber might order lab tests every so often to make sure your kidneys are healthy and working properly. If you develop kidney problems, or if your kidney problems worsen while taking Zestoretic (lisinopril / hydrochlorothiazide), your prescriber might recommend that you stop taking this medication. Let your prescriber know if you're urinating less often than usual, as this could be a sign that your kidneys aren't working as well.
Changes in electrolyte, blood sugar, and cholesterol levels
Zestoretic (lisinopril / hydrochlorothiazide) can affect the level of certain electrolytes in your body, including sodium, potassium, and magnesium. Your prescriber might order blood work regularly while you're taking this medication to make sure your electrolyte levels are in a safe range. Let your care team know if you experience a fast heart beat, weakness, low energy, muscle pain or cramps, less urination than usual, nausea, or vomiting. These can be signs of electrolyte changes in your body.
In addition, Zestoretic (lisinopril / hydrochlorothiazide) can change your blood sugar. It can also raise your cholesterol levels. Your prescriber might also check your blood sugar and cholesterol levels regularly while you're taking this medication.
Vision problems
- Risk factors: Sulfa or penicillin allergies
Though rare, some people experience vision changes within hours or weeks after starting Zestoretic (lisinopril / hydrochlorothiazide) because of the hydrochlorothiazide part of the medication. Tell your prescriber right away about any vision changes or eye pain and stop taking Zestoretic (lisinopril / hydrochlorothiazide) as soon as possible. In some cases, surgery might be required to avoid permanent vision loss.
Lupus
In some rare cases, Zestoretic (lisinopril / hydrochlorothiazide) can cause worsening of or new lupus. Let your prescriber know if you notice a rash across your cheeks and nose or feel very tired.
Zestoretic (lisinopril / hydrochlorothiazide) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 20mg/12.5mg | 90 tablets | $14.61 | $0.16 |
| 20mg/25mg | 90 tablets | $10.00 | $0.11 |
| 10mg/12.5mg | 90 tablets | $13.72 | $0.15 |
Typical dosage for Zestoretic (lisinopril / hydrochlorothiazide)
Your prescriber will pick a starting dose based on things like how high your blood pressure is, which other blood pressure medications you're currently taking or have recently taken, and your risk for side effects.
- Adults: The typical starting dose is 10 mg/12.5 mg (lisinopril/hydrochlorothiazide) by mouth once daily. If needed, your prescriber will raise your dose every 2 to 3 weeks. The maximum recommended dose is 80 mg/50 mg (lisinopril/hydrochlorothiazide) daily.
More on Zestoretic (lisinopril / hydrochlorothiazide) dosage
Interactions between Zestoretic (lisinopril / hydrochlorothiazide) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Aliskiren
- Dofetilide
- Sacubitril
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Acetyldigoxin
- Alteplase, Recombinant
- Amiloride
- Amphetamine
- Amtolmetin Guacil
- Arsenic Trioxide
- Aspirin
- Azathioprine
- Azilsartan
- Azilsartan Medoxomil
- Benzphetamine
- Bromfenac
- Bufexamac
- Candesartan Cilexetil
- Canrenoate
- Celecoxib
- Choline Salicylate
- Clonixin
- Deslanoside
- Desmopressin
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Diclofenac
- Diflunisal
- Digitalis
- Digitoxin
- Digoxin
- Dipyrone
- Droperidol
- Droxicam
- Eplerenone
- Eprosartan
- Etodolac
- Etofenamate
- Etoricoxib
- Everolimus
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Flecainide
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Irbesartan
- Ketanserin
- Ketoprofen
- Ketorolac
- Levomethadyl
- Lisdexamfetamine
- Lithium
- Lornoxicam
- Losartan
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Mercaptopurine
- Methamphetamine
- Methotrexate
- Metildigoxin
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Olmesartan Medoxomil
- Ouabain
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Porfimer
- Potassium
- Potassium Phosphate
- Proglumetacin
- Propyphenazone
- Proquazone
- Proscillaridin
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sirolimus
- Sodium Salicylate
- Sotalol
- Spironolactone
- Sulindac
- Telmisartan
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Triamterene
- Trimethoprim
- Valdecoxib
- Valsartan
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aminolevulinic Acid
- Aspirin
- Azosemide
- Bepridil
- Bromfenac
- Bufexamac
- Bumetanide
- Bupivacaine
- Bupivacaine Liposome
- Capsaicin
- Carbamazepine
- Celecoxib
- Cholestyramine
- Choline Salicylate
- Clonixin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyrone
- Droxicam
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Furosemide
- Ginkgo
- Gold Sodium Thiomalate
- Gossypol
- Ibuprofen
- Indomethacin
- Ketoprofen
- Ketorolac
- Licorice
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Nesiritide
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Octreotide
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piretanide
- Piroxicam
- Proglumetacin
- Propionic Acid
- Propyphenazone
- Proquazone
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tizanidine
- Tolfenamic Acid
- Tolmetin
- Topiramate
- Torsemide
- Valdecoxib
How much does Zestoretic (lisinopril / hydrochlorothiazide) cost?
Zestoretic (lisinopril / hydrochlorothiazide) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Zestoretic (lisinopril / hydrochlorothiazide) will not be safe for you to take.
- Taking at the same time as aliskiren (Tekturna) in people with diabetes (high blood sugar)
- Taking at the same time or within 36 hours of neprilysin inhibitors, such as Entresto (sacubitril / valsartan)
- Not producing urine
- Allergy to sulfa medications
- Allergy to ACE inhibitors
- History of angioedema (severe swelling)
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