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Lisinopril and Hydrochlorothiazide


Pronunciation

 (lyse IN oh pril & hye droe klor oh THYE a zide)


U.S. Brand Names

 Prinzide®; Zestoretic®


Synonyms

 Hydrochlorothiazide and Lisinopril


Generic Available

 Yes


Canadian Brand Names

 Prinzide®; Zestoretic®


Use

 Treatment of hypertension


Pregnancy Risk Factor

 C/D (2nd and 3rd trimesters)


Pregnancy Implications

 See individual agents.


Lactation

Hydrochlorothiazide: Compatible

Lisinopril: Excretion in breast milk unknown


Contraindications

Based on lisinopril component: Hypersensitivity to lisinopril or any component of the formulation; angioedema related to previous treatment with an ACE inhibitor; hereditary or idiopathic angioedema; bilateral renal artery stenosis; pregnancy (2nd and 3rd trimesters)

Based on hydrochlorothiazide component: Hypersensitivity to hydrochlorothiazide, thiazides, sulfonamide-derived drugs, or any component of the formulation; anuria; renal decompensation; pregnancy (2nd and 3rd trimesters)


Warnings/Precautions

Based on lisinopril component: Anaphylactic reactions can occur. Angioedema can occur at any time during treatment (especially following first dose). Angioedema may involve the head and neck (potentially affecting the airway) or the intestine (presenting with abdominal pain). Careful blood pressure monitoring with first dose (hypotension can occur especially in volume depleted patients). Dosage adjustment needed in renal impairment. Use with caution in hypovolemia; collagen vascular diseases; valvular stenosis (particularly aortic stenosis); hyperkalemia; or before, during, or immediately after anesthesia. Avoid rapid dosage escalation, which may lead to renal insufficiency. Neutropenia/agranulocytosis with myeloid hyperplasia can rarely occur. If patient has renal impairment then a baseline WBC with differential and serum creatinine should be evaluated and monitored closely during the first 3 months of therapy. Hypersensitivity reactions may be seen during hemodialysis with high-flux dialysis membranes (eg, AN69). Deterioration in renal function can occur with initiation. Use with caution in unilateral renal artery stenosis and pre-existing renal insufficiency.

Based on hydrochlorothiazide component: Avoid in severe renal disease (ineffective). Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.


Adverse Reactions

 See individual agents.


Drug Interactions

 See individual agents.


Pharmacodynamics/Kinetics

 See individual agents.


Dosage

 Adults: Oral: Dosage is individualized; see each component for appropriate dosing suggestions; doses >80 mg/day lisinopril or >50 mg/day hydrochlorothiazide are not recommended.


Patient Education

 See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.


Cardiovascular Considerations

 Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for lisinopril and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. ACE inhibitors and thiazides are also standard therapy for left ventricular systolic dysfunction. See Special Cardiovascular Considerations for individual agents.


Dental Health: Effects on Dental Treatment

 No significant effects or complications reported


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 May cause dizziness or fatigue; may rarely cause sedation, insomnia, or depression


Mental Health: Effects on Psychiatric Treatment

 May cause neutropenia; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels


Dosage Forms

 Tablet:

Lisinopril 10 mg and hydrochlorothiazide 12.5 mg

Lisinopril 20 mg and hydrochlorothiazide 12.5 mg

Lisinopril 20 mg and hydrochlorothiazide 25 mg


References

Chase MP, Fiarman GS, Scholz FJ, et al, "Angioedema of the Small Bowel Due to an Angiotensin-Converting Enzyme Inhibitor," J Clin Gastroenterol , 2000, 31(3):254-7.

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report," JAMA , 2003, 289(19):2560-71.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure," Am J Cardiol , 1999, 83(2A):1A-38A.

Hunt SA, Baker DW, Chin MH, et al, "ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure)," J Am Coll Cardiol , 2001, 38(7):2101-13.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care," Am J Hypertens , 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension," Am J Hypertens , 1998, 11(6 Pt 2):73S-8S, 95S-100S.

Smoger SH and Sayed MA, "Simultaneous Mucosal and Small Bowel Angioedema Due to Captopril," South Med J , 1998, 91(11):1060-3.


International Brand Names

 Prinzide® (CA); Zestoretic® (CA)


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