Zestoretic is a prescription medication combining two antihypertensive agents, lisinopril and hydrochlorothiazide, into a single tablet for the management of hypertension. This fixed-dose combination therapy is designed for patients whose blood pressure is not adequately controlled on monotherapy. It leverages the complementary mechanisms of an ACE inhibitor and a thiazide diuretic to provide synergistic blood pressure reduction, simplifying treatment regimens and potentially improving adherence. Zestoretic is indicated when such combination therapy is deemed appropriate, offering a clinically validated approach to achieving target blood pressure goals.

Features

• Contains lisinopril (an ACE inhibitor) and hydrochlorothiazide (a thiazide diuretic) in a single tablet
• Available in multiple strength combinations (e.g., lisinopril 10 mg/hydrochlorothiazide 12.5 mg, lisinopril 20 mg/hydrochlorothiazide 12.5 mg, lisinopril 20 mg/hydrochlorothiazide 25 mg)
• Oral tablet formulation for once-daily administration
• Manufactured under strict pharmaceutical quality control standards
• Requires a prescription and regular medical supervision

Benefits

• Provides dual-mechanism blood pressure control through complementary pharmacological actions
• May improve medication adherence by reducing pill burden compared to separate agents
• Can be more effective in achieving blood pressure targets than monotherapy in appropriate patients
• Offers dosing convenience with once-daily administration
• May reduce cardiovascular risk through effective hypertension management
• Provides predictable pharmacokinetics with established safety profile

Common use

Zestoretic is primarily indicated for the treatment of hypertension in patients for whom combination therapy is appropriate. This typically includes patients whose blood pressure is not adequately controlled with either lisinopril or hydrochlorothiazide alone. The combination may be suitable as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals, particularly those with stage 2 hypertension or above target despite lifestyle modifications. Clinical decision-making should consider individual patient characteristics, including race, age, volume status, renal function, and the presence of compelling indications for specific antihypertensive classes.

Dosage and direction

The dosage of Zestoretic should be individualized based on the patient’s previous antihypertensive therapy and blood pressure response. The usual recommended starting dose is one tablet of Zestoretic 10/12.5 (lisinopril 10 mg/hydrochlorothiazide 12.5 mg) once daily. For patients currently receiving lisinopril monotherapy, the recommended starting dose is based on the current lisinopril dose. For patients receiving diuretic therapy, the diuretic should be discontinued 2-3 days before starting Zestoretic to reduce the risk of hypotension. Dosage may be titrated at intervals of 2-4 weeks based on blood pressure response. The maximum recommended daily dose is lisinopril 80 mg/hydrochlorothiazide 50 mg. Tablets should be taken orally, with or without food, at approximately the same time each day.

Precautions

Patients should be monitored for hypotension, especially after the initial dose or dosage increases. Renal function should be assessed before and during treatment, particularly in patients with renal artery stenosis, heart failure, or volume depletion. Serum electrolytes, particularly potassium, sodium, and magnesium, should be monitored regularly due to the risk of hypokalemia, hyponatremia, and hypomagnesemia. Use with caution in patients with impaired hepatic function or progressive liver disease, as minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Photosensitivity reactions may occur; patients should be advised to use sun protection. Regular blood pressure monitoring is essential to assess therapeutic response. Patients with collagen vascular disease or receiving immunosuppressive therapy may be at increased risk for hematologic reactions.

Contraindications

Zestoretic is contraindicated in patients with known hypersensitivity to lisinopril, hydrochlorothiazide, or any other sulfonamide-derived drugs. It is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment. Do not use in patients with hereditary or idiopathic angioedema. Contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs. Not recommended during pregnancy, especially during the second and third trimesters, due to potential fetal harm. Should not be used in combination with aliskiren in patients with diabetes.

Possible side effect

Common side effects may include dizziness (6.5%), headache (5.2%), cough (3.9%), fatigue (3.0%), and orthostatic effects (1.4%). Gastrointestinal effects such as nausea (2.1%) and diarrhea (2.3%) may occur. Metabolic effects may include hypokalemia (2.5%), hyperuricemia, and hyperglycemia. Less frequent but potentially serious adverse reactions include angioedema (0.1%), which may involve the face, extremities, lips, tongue, glottis, and/or larynx. Renal impairment, including acute renal failure, may occur, particularly in volume-depleted patients. Hematologic effects such as neutropenia/agranulocytosis and thrombocytopenia have been reported. Photosensitivity reactions and pancreatitis have been reported rarely.

Drug interaction

Zestoretic may interact with several medication classes. Diuretics, other antihypertensive agents, and alcohol may potentiate hypotension. NSAIDs may reduce the antihypertensive effect and increase the risk of renal impairment. Lithium excretion may be reduced, increasing the risk of lithium toxicity. Potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may increase the risk of hyperkalemia. Oral hypoglycemic agents may require dosage adjustment. Gold injections may cause nitritoid reactions. The antihypertensive effect may be reduced by sympathomimetics. Cholestyramine and colestipol may reduce absorption of hydrochlorothiazide.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is almost time for the next dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. Consistent daily administration is important for maintaining blood pressure control. Patients should be advised to maintain a regular dosing schedule and consider using reminder systems if missed doses occur frequently.

Overdose

Symptoms of overdose may include severe hypotension, electrolyte disturbances, dehydration, renal failure, and lethargy that may progress to coma. Bradycardia, tachycardia, and other arrhythmias may occur. Specific supportive measures should include correction of dehydration, electrolyte imbalances, and hypotension. Gastric lavage may be considered if ingestion was recent. Lisinopril may be removed from the body by hemodialysis. Hydrochlorothiazide is not effectively removed by dialysis. Treatment should be symptomatic and supportive, with close monitoring of vital signs, serum electrolytes, and renal function.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F). Keep container tightly closed. Protect from moisture and light. Keep out of reach of children. Do not use after the expiration date printed on the packaging. Tablets should be kept in their original container with the lid tightly closed. Do not transfer to other containers, as this may affect stability. Do not flush medications down the toilet or pour them into a drain unless instructed to do so.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Zestoretic is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual patient responses may vary. Patients should not initiate, discontinue, or change dosage without consulting their healthcare provider. The complete prescribing information should be consulted before initiating therapy. Healthcare professionals should weigh potential benefits against possible risks before prescribing.

Reviews

Clinical studies have demonstrated that Zestoretic provides effective blood pressure control in hypertensive patients. In comparative trials, the combination therapy showed superior efficacy compared to monotherapy components alone. Patient satisfaction surveys indicate improved adherence with fixed-dose combination therapy. However, individual experiences may vary, and some patients may experience side effects that affect tolerability. Long-term observational studies support the maintenance of antihypertensive efficacy with appropriate monitoring. Healthcare providers generally regard Zestoretic as a valuable option in the antihypertensive armamentarium when combination therapy is indicated.