Lisinopril/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Zestoretic

• ACEI/Diuretic Combos; 
• ACEI/HCTZ Combos

ACE inhibitor and thiazide diuretic combination
Used for hypertension once daily
Lisinopril counteracts the potassium loss from hydrochlorothiazide; more effective than ACE monotherapy in Black patients.

Indicated for the treatment of hypertension in patients who do not respond to monotherapy.

Hypersensitivity to ACE inhibitors, thiazides, or sulfonamides

ACE-inhibitor induced angioedema, hereditary or idiopathic angioedema

Coadministration of ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Anuria or renal stenosis

Coadministration with aliskiren in patients with diabetes mellitus

Lisinopril

• Dizziness (5-12%)
• Cough (4-9%)
• Headache (4-6%)
• Hyperkalemia (2-5%)
• Diarrhea (3-4%)
• Hypotension (1-4%)
• Chest pain (3%)
• Fatigue (3%)
• Nausea/vomiting (2%)
• Rash (1-2%)
• Psoriasis (frequency unknown)

Hydrochlorothiazide

• Hypotension
• Anorexia
• Epigastric distress
• Hypokalemia
• Phototoxicity
• Non-melanoma skin cancer

Begin combination therapy only after failed monotherapy

Severe renal impairment, hepatic impairment

Risk of hypotension, especially with CHF

Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors

If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately

Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors

Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue if hepatic transaminase or jaundice occurs

Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation; cough may resolve within 1-4 weeks after discontinuation 0f therapy

Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents

Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia

Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure

Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume depleted patients, correct volume depletion prior to initiation; monitor closely when initiating and increasing dosing

Pregnancy category: D

Lactation: Discontinue drug or do not nurse