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Lisinopril / hydrochlorothiazide

Class
Antihypertensives
Subclass
Angiotensin-converting enzyme inhibitor / thiazide combination
Substance name
Lisinopril / hydroCHLOROthiazide
Brand names
Zestoretic®
Contains
Hydrochlorothiazide
Lisinopril
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment of hypertension
•
Start at: 10-20/12.5 mg PO daily
•
Maintenance: 10-80/12.5-50 mg PO daily
•
Maximum: 80/50 mg per day
Titrate hydrochlorothiazide dose every 2-3 weeks.
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
Safety risks
Boxed warnings
Fetal toxicity
Contraindications
Hypersensitivity to lisinopril/hydrochlorothiazide or any of its components
Anuria
Hereditary or idiopathic angioedema
History of ACEi-induced angioedema
Concomitant use of a neprilysin inhibitor (e.g., sacubitril) or within 36 hours of switching to or from sacubitril/valsartan, a neprilysin inhibitor
Warnings and precautions
Acute angle-closure glaucoma, acute transient myopia
•
Use caution in patients with hypersensitivity to sulfonamide or penicillin.
Agranulocytosis, jaundice, ALF
•
Maintain a high level of suspicion, as lisinopril/hydrochlorothiazide has been associated with an increased risk for these adverse events.
Hypotension
•
Use extreme caution in patients with HF with SBP < 100 mmHg, ischemic heart disease, severe aortic stenosis, HCM, cerebrovascular disease, hyponatremia, renal dialysis, severe volume and/or salt depletion of any etiology, or taking high-dose diuretic therapy.
Increased serum calcium, decreased serum phosphate
•
Use caution in all patients, especially with hyperparathyroidism or prolonged therapy.
Renal failure
•
Use caution in patients with renal artery stenosis, CKD, severe congestive HF, post-myocardial infarction, or volume depletion.
Specific populations
Renal impairment
eGFR > 30 mL/min/1.73 m²
•
Use with caution.
eGFR < 30 mL/min/1.73 m²
•
Avoid use.
Renal replacement therapy
Any modality
•
Avoid use.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Do not use. Evidence of fetal harm in humans. Discontinue lisinopril when pregnancy is detected.
•
Use of RAAS inhibitors during the second and third trimesters can cause reduced fetal renal function leading to anuria and renal failure, oligohydramnios, fetal lung hypoplasia, and skeletal deformations, including skull hypoplasia, hypotension, and death.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Common 1-10%
•
Hypotension, ↑ serum potassium, orthostatic hypotension, asthenia, chest pain, cough, ↓ libido, dizziness, erectile dysfunction, fatigue, headache, indigestion, muscle cramps, palpitations, paresthesia, skin rash, upper respiratory tract infections
Uncommon < 1%
•
Syncope
Rare < 0.1%
•
Acute liver failure, acute pancreatitis
Unknown frequency
•
Acute angle-closure glaucoma, agranulocytosis, anaphylaxis, angioedema, basal cell carcinoma, cardiac arrhythmias, cholestatic jaundice, cutaneous squamous cell carcinoma, cutaneous lupus erythematosus, ↓ WBC count, ↓ blood glucose, ↓ blood neutrophil count, ↓ serum magnesium, ↓ serum phosphate, ↓ serum potassium, ↓ serum sodium, drug withdrawal syndrome, hemolytic anemia, ↑ BUN, ↑ LFTs, ↑ blood glucose, ↑ serum calcium, ↑ serum creatinine, ↑ serum total cholesterol, ↑ serum triglycerides, ↑ serum uric acid, merkel cell carcinoma, myopia, non-melanoma skin cancer, pancytopenia, pemphigus vulgaris, photosensitivity of skin, psoriasis, pulmonary edema, renal failure, angina pectoris, sexual dysfunction, systemic lupus erythematosus, vasculitis, zinc deficiency
Interactions
Drug(s)
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